Flat Nipples: When to Seek Medical Advice - Breast and Thyroid

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Nipple issues


Hello, both of my nipples are flat, and there is thick, dark, somewhat hard skin on top, with a seam in the middle.
When I wash, I feel like if I rub them a bit harder, a piece of flesh might come off, but it doesn't hurt or itch.
Is this normal? If I need to see a doctor, which specialty should I consult? Thank you.

Liu Xiaojie, 10~19 year old female. Ask Date: 2022/06/28

Dr. Yuan Tianmin reply Breast and Thyroid


I personally think this is more of a skin issue, so it would be best to consult a dermatologist first.

Reply Date: 2022/06/28

More Info


Flat nipples can be a common anatomical variation and may not necessarily indicate a health issue. However, the presence of thickened skin, especially if it has a black color, and the sensation of "losing a piece of flesh" during washing could warrant further evaluation. It’s essential to consider several factors when assessing whether to seek medical advice.

Firstly, flat nipples can occur due to various reasons, including hormonal changes, genetics, or even previous breastfeeding experiences. In many cases, they are entirely normal and do not require treatment. However, if there are accompanying symptoms such as changes in color, texture, or any unusual discharge, it may be a sign of an underlying condition that needs attention.

The thickened, dark skin you described could be a benign condition known as hyperkeratosis, which is characterized by an overproduction of keratin, leading to thickened skin. This can occur in various parts of the body, including the nipples. While hyperkeratosis is generally harmless, it can sometimes be associated with other skin conditions or irritations.

The "seam" you mentioned in the middle of the nipple could be a natural anatomical feature or a sign of a condition such as a fissure or a skin tag. If it is not painful or itchy, it may not be a cause for concern, but it is always best to err on the side of caution.

Given your symptoms, it would be advisable to consult a healthcare professional. The appropriate specialist to see would be a dermatologist, as they can evaluate skin conditions and provide a thorough examination of the nipple area. If there are concerns about breast health or potential underlying issues, a referral to a breast specialist or a general practitioner may also be appropriate.

When you visit the dermatologist, be prepared to discuss your symptoms in detail, including how long you have noticed these changes, any other symptoms you may have experienced, and your medical history. This information will help the doctor make an accurate diagnosis and recommend the best course of action.

In summary, while flat nipples can be normal, the additional symptoms you described suggest that a medical evaluation is warranted. Consulting a dermatologist will help clarify whether your symptoms are benign or if they require further investigation. Remember, it is always better to seek medical advice when you have concerns about changes in your body, as early detection and treatment can lead to better outcomes.

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