White Discoloration at the Nipple-Areola Junction: Causes and Concerns

The area where the nipple connects to the areola appears white (similar to being soaked in water for too long)?

Hello: I am 30 years old, married, and have two children, both delivered by cesarean section.
I breastfed my second child from May 1999 to March 2000.
Even now, if I squeeze my breasts, a small amount of milk still comes out.
However, I recently noticed that the area where my left nipple connects to the areola has turned white, resembling skin that has been soaked in water for too long.
Additionally, I feel a fullness in my breast, and when I touch it, there is a large hard lump.
What could be the issue?

Mi Mi, 30~39 year old female. Ask Date: 2002/01/22

Dr. Zhan Deqin reply Obstetrics and Gynecology

1.
If there is a change in breast color along with a hard lump, it is advisable to consult a breast surgeon or consider undergoing a breast ultrasound examination.

2.
If there is still breast milk present, a blood test to check prolactin levels should be performed to determine if they are elevated, which will help decide whether further investigation is needed.

Reply Date: 2002/01/22

More Info

The white discoloration at the nipple-areola junction, along with the sensation of engorgement and the presence of a hard lump, can be concerning and warrants careful evaluation. Based on your description, there are several potential causes for these symptoms, and it is essential to consider both benign and more serious conditions.

One possible explanation for the white discoloration could be related to a condition known as nipple dermatitis or eczema, which can cause changes in the skin's appearance, including discoloration. This condition can be exacerbated by factors such as irritation from clothing, soaps, or even breastfeeding-related changes. However, the presence of a hard lump and the sensation of engorgement suggests that there may be more than just a skin issue at play.

Another possibility is ductal ectasia, which occurs when a milk duct beneath the nipple dilates, fills with fluid, and thickens. This condition can lead to the formation of a lump and may cause changes in the appearance of the nipple. It is more common in women who have had children and can sometimes be associated with infection or inflammation.

Additionally, the symptoms you describe could indicate a blocked milk duct or mastitis, particularly since you mentioned that you can still express a small amount of milk. A blocked duct can lead to localized swelling and tenderness, and if it becomes infected, it can result in mastitis, which is characterized by redness, warmth, and pain in the breast tissue.

In more serious cases, the changes in the nipple area could be indicative of Paget's disease of the nipple, a rare form of breast cancer that presents with changes in the skin of the nipple and areola. This condition often accompanies underlying breast cancer, so it is crucial to rule it out, especially given the new onset of symptoms.

Given your history of breastfeeding and the current symptoms, it is advisable to consult a healthcare professional, preferably a breast specialist or a gynecologist, for a thorough examination. They may recommend imaging studies, such as a mammogram or ultrasound, to assess the lump and any underlying issues. A biopsy may also be necessary if there are concerns about cancer.

In summary, while there are several benign explanations for the white discoloration and lump you are experiencing, it is essential to seek medical advice to ensure proper diagnosis and treatment. Early intervention can help address any potential issues and provide peace of mind. Remember, it is always better to err on the side of caution when it comes to changes in breast health.

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