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Supernumerary Nipple Clinical Presentation

  • Author: Nicholas V Nguyen, MD; Chief Editor: Dirk M Elston, MD  more...
Updated: Apr 08, 2016


The supernumerary nipple typically remains asymptomatic and undetected. Occasionally, the supernumerary nipple becomes apparent during puberty, menstruation, or pregnancy when hormonal changes result in increased pigmentation, swelling, tenderness, or even lactation.



The supernumerary nipple is often overlooked at the first examination of the neonate. It appears as a small pigmented or pearl-colored mark or as a concave or umbilicated lesion.

Supernumerary nipple in a neonate. Courtesy of Dr Supernumerary nipple in a neonate. Courtesy of Dr P. Merlob.

In 75% of patients, it measures no more than 30% of the diameter of the normal nipple (at times no more than 0.2-0.3 cm in diameter). In the other 25% of patients, it is as large as 50% of the normal size of the nipple. Rarely, a supernumerary nipple is as large as a normal nipple.[30]

Supernumerary nipple in an adolescent boy. Courtes Supernumerary nipple in an adolescent boy. Courtesy of Dr B. Fisher.

Most supernumerary nipples are single. Multiple supernumerary nipples may be present and as many as 8 have been reported in the same individual. When multiple supernumerary nipples are present, they may be distributed bilaterally or unilaterally, symmetrically or asymmetrically. Most supernumerary nipples are located inferior to the normal nipple, while approximately 13% appear above it along the milk line.[22]

When examining adolescent girls (note the image below), the normally developed breast may hide the supernumerary nipple. A number of studies have indicated a preponderance of supernumerary nipples on the right side.[27]

Supernumerary nipple (bilateral) in an adolescent Supernumerary nipple (bilateral) in an adolescent girl.

For easier detection of the supernumerary nipple, a wet gauze pad is passed along the mammary line (milk line) from the axillary region to the upper part of the thigh on each side. This technique is particularly helpful in the dry and desquamating skin of full-term and postterm infants.[22] When the suggested lesion is concave, folding it between fingers shows a typical wrinkling.

A dermoscopic examination of supernumerary nipple shows a pattern similar to the dermatofibroma with a central, white, scarlike area and a peripheral fine-pigment network. The supernumerary nipple may also present with a cleftlike appearance centrally in the absence of lateral pressure, thus allowing differentiation from dermatofibroma.[36] For a more precise examination one can resort to a reflectance confocal microscopy.[37]

Approximately 5% of supernumerary nipples are identified in ectopic locations outside of the milk line, such as on the back,[34] shoulder (note the image below),[38] extremities, neck, face, genitalia, and perineum.

Ectopic supernumerary nipple on the shoulder. Cour Ectopic supernumerary nipple on the shoulder. Courtesy of Dr B. Fisher.


Most supernumerary nipples are sporadic, although familial cases have been reported, including 1 report of a family who had supernumerary nipples in 4 successive generations. Familial cases are typically inherited in an autosomal dominant fashion with incomplete expressivity.[39]

Contributor Information and Disclosures

Nicholas V Nguyen, MD Resident Physician, Department of Dermatology, Children's Hospital Colorado, Denver Health Medical Center, University of Colorado Hospital, VA Eastern Colorado

Nicholas V Nguyen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, International Society of Dermatology, Society for Pediatric Dermatology

Disclosure: Nothing to disclose.


Craig G Burkhart, MD, MPH Clinical Professor, Department of Medicine, Medical College of Ohio; Clinical Assistant Professor, Department of Medicine, Ohio University College of Osteopathic Medicine

Craig G Burkhart, MD, MPH is a member of the following medical societies: Association of Military Dermatologists, American College of Aesthetic and Cosmetic Physicians; American Society of Aesthetic/Cosmetic Physicians, Michigan Dermatological Society, Academy of Medicine of Toledo and Lucas County, Ohio Dermatological Association, American Academy of Dermatology, Ohio State Medical Association, Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.


Mark A Crowe, MD Assistant Clinical Instructor, Department of Medicine, Division of Dermatology, University of Washington School of Medicine

Mark A Crowe, MD is a member of the following medical societies: American Academy of Dermatology and North American Clinical Dermatologic Society

Disclosure: Nothing to disclose.

Aryeh Metzker, MD Consulting Staff, Department of Pediatric Dermatology, Senior Clinical Lecturer, Department of Dermatology, Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University

Disclosure: Nothing to disclose.

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Supernumerary nipple in a neonate. Courtesy of Dr P. Merlob.
Supernumerary nipple (bilateral) in an adolescent girl.
Supernumerary nipple in an adolescent boy. Courtesy of Dr B. Fisher.
Ectopic supernumerary nipple on the shoulder. Courtesy of Dr B. Fisher.
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