Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Supernumerary Nipple Clinical Presentation

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

History

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.

Next

Physical

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.
Previous
Next

Causes

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]

Previous
 
 
Contributor Information and Disclosures
Author

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.

Coauthor(s)

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.

Acknowledgements

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.

References
  1. Conde DM, Kashimoto E, Torresan RZ, Alvarenga M. Pseudomamma on the foot: an unusual presentation of supernumerary breast tissue. Dermatol Online J. 2006 May 30. 12(4):7. [Medline].

  2. De Cholnoky T. Supernumerary breast. Arch Surg. 1939. 39:926-41.

  3. Grossl NA. Supernumerary breast tissue: historical perspectives and clinical features. South Med J. 2000 Jan. 93(1):29-32. [Medline].

  4. Leichtenstern D. Uber das Vorkommen und Bedeutung Supernumerarer (accessorischer ) Bruste und Brustwarzen. Arch Pathol Anat Physiol Klin Med. 1878. 73:222.

  5. Aslan D, Gürsel T, Kaya Z. Supernumerary nipples in children with hematologic disorders. Pediatr Hematol Oncol. 2004 Jul-Aug. 21(5):461-3. [Medline].

  6. Goldschmidt E, Jacobsen N. Epibulbar lipodermoids, preauricular appendages and polythelia in four generations: a new hereditary syndrome?. Ophthalmic Genet. 2010 Jun. 31(2):81-3. [Medline].

  7. Méhes K. Association of supernumerary nipples with other anomalies. J Pediatr. 1979 Aug. 95(2):274-5. [Medline].

  8. Mehes K. Association of supernumerary nipples with other anomalies. J Pediatr. 1983 Jan. 102(1):161. [Medline].

  9. Varsano IB, Jaber L, Garty BZ, Mukamel MM, Grünebaum M. Urinary tract abnormalities in children with supernumerary nipples. Pediatrics. 1984 Jan. 73(1):103-5. [Medline].

  10. Goedert JJ, McKeen EA, Fraumeni JF Jr. Polymastia and renal adenocarcinoma. Ann Intern Med. 1981 Aug. 95(2):182-4. [Medline].

  11. Kahn SA, Wagner RF Jr. Polythelia and unilateral renal agenesis. Cutis. 1982 Aug. 30(2):225-6. [Medline].

  12. Meggyessy V, Mehes K. Association of supernumerary nipples with renal anomalies. J Pediatr. 1987 Sep. 111(3):412-3. [Medline].

  13. Hersh JH, Bloom AS, Cromer AO, Harrison HL, Weisskopf B. Does a supernumerary nipple/renal field defect exist?. Am J Dis Child. 1987 Sep. 141(9):989-91. [Medline].

  14. Mehes K, Pinter A. Minor morphological aberrations in children with isolated urinary tract malformations. Eur J Pediatr. 1990 Mar. 149(6):399-402. [Medline].

  15. Leung AK, Robson WL. Renal anomalies in familial polythelia. Am J Dis Child. 1990 Jun. 144(6):619-20. [Medline].

  16. Urbani CE, Betti R. Accessory mammary tissue associated with congenital and hereditary nephrourinary malformations. Int J Dermatol. 1996 May. 35(5):349-52. [Medline].

  17. Brown J, Schwartz RA. Supernumerary nipples and renal malformations: a family study. J Cutan Med Surg. 2004 May-Jun. 8(3):170-2. [Medline].

  18. Ferrara P, Giorgio V, Vitelli O, Gatto A, Romano V, Bufalo FD, et al. Polythelia still a marker of urinary trct anomalies in children. Scand J Urol Nephrol. 2009. 43(1):47-50.

  19. Grimshaw EC, Cohen PR. Supernumerary nipple and seminoma: case report and review of polythelia and genitourinary cancers. Dermatol Online J. 2013 Jan 15. 19(1):4. [Medline].

  20. Smith DW. Comment on association of supernumerary nipples with other anomalies. Oska FA, Stockman JA III, eds. Year Book of Pediatrics. Chicago, Ill: YB Medical Publishers; 1981. 437.

  21. Rahbar F. Clinical significance of supernumerary nipples in black neonates. Clin Pediatr (Phila). 1982 Jan. 21(1):46-7. [Medline].

  22. Mimouni F, Merlob P, Reisner SH. Occurrence of supernumerary nipples in newborns. Am J Dis Child. 1983 Oct. 137(10):952-3. [Medline].

  23. Robertson A, Sale P, Sathyanarayan. Lack of association of supernumerary nipples with renal anomalies in black infants. J Pediatr. 1986 Sep. 109(3):502-3. [Medline].

  24. Kenney RD, Flippo JL, Black EB. Supernumerary nipples and renal anomalies in neonates. Am J Dis Child. 1987 Sep. 141(9):987-8. [Medline].

  25. Hoyme HE. Minor malformations. Significant or insignificant?. Am J Dis Child. 1987 Sep. 141(9):947. [Medline].

  26. Bortz J, Parker S, Ray TL. Lack of associated renal anomalies in familial polythelia. Am J Dis Child. 1989 Aug. 143(8):883. [Medline].

  27. Armoni M, Filk D, Schlesinger M, Pollak S, Metzker A. Accessory nipples: any relationship to urinary tract malformation?. Pediatr Dermatol. 1992 Sep. 9(3):239-40. [Medline].

  28. Jojart G, Seres E. Supernumerary nipples and renal anomalies. Int Urol Nephrol. 1994. 26(2):141-4. [Medline].

  29. Casey HD, Chasan PE, Chick LR. Familial polythelia without associated anomalies. Ann Plast Surg. 1996 Jan. 36(1):101-4. [Medline].

  30. Schmidt H. Supernumerary nipples: prevalence, size, sex and side predilection -- a prospective clinical study. Eur J Pediatr. 1998 Oct. 157(10):821-3. [Medline].

  31. Grotto I, Browner-Elhanan K, Mimouni D, Varsano I, Cohen HA, Mimouni M. Occurrence of supernumerary nipples in children with kidney and urinary tract malformations. Pediatr Dermatol. 2001 Jul-Aug. 18(4):291-4. [Medline].

  32. Newman M. Supernumerary nipples. Am Fam Physician. 1988 Aug. 38(2):183-8. [Medline].

  33. Baruchin A, Rosenberg L. A supernumerary nipple in a rare site. Report of a case. J Dermatol Surg Oncol. 1981 Nov. 7(11):918-9. [Medline].

  34. Hanson E, Segovia J. Dorsal supernumerary breast. Case report. Plast Reconstr Surg. 1978 Mar. 61(3):441-5. [Medline].

  35. Jaber L, Merlob P. The prevalence of supernumerary nipples in Arab infants and children. Eur J Pediatr. 1988 May. 147(4):443. [Medline].

  36. Oztas MO, Gurer MA. Dermoscopic features of accessory nipples. Int J Dermatol. 2007 Oct. 46(10):1067-8. [Medline].

  37. Kanitakis J. In vivo reflectance confocal microscopy of supernumerary nipple and differential diagnosis from melanocytic lesions. J Cutan Pathol. 2010 Jul. 37(7):797-801. [Medline].

  38. Schewach-Millet M, Fisher BK. Supernumerary nipple on the shoulder. Cutis. 1976 Feb. 17(2):384-5. [Medline].

  39. Toumbis-Ioannou E, Cohen PR. Familial polythelia. J Am Acad Dermatol. 1994 Apr. 30(4):667-8. [Medline].

  40. Shewmake SW, Izuno GT. Supernumerary areolae. Arch Dermatol. 1977 Jun. 113(6):823-5. [Medline].

  41. Willman JH, Golitz LE, Fitzpatrick JE. Clear cells of Toker in accessory nipples. J Cutan Pathol. 2003 Apr. 30(4):256-60. [Medline].

  42. Sladden MJ, Sladden JA. A novel treatment for accessory nipples. Br J Dermatol. 2008 Feb. 158(2):405. [Medline].

  43. Madej B, Balak B, Winkler I, Burdan F. Cancer of the accessory breast--a case report. Adv Med Sci. 2009. 54(2):308-10. [Medline].

  44. Fan J. Removal of accessory breasts: a novel tumescent liposuction approach. Aesthetic Plast Surg. 2009 Nov. 33(6):809-13. [Medline].

  45. Cinpolat A, Bektas G, Seyhan T, Ozad U, Coskunfirat OK. Treatment of a supernumerary large breast with medial pedicle reduction mammaplasty. Aesthetic Plast Surg. 2013 Aug. 37(4):762-6. [Medline].

 
Previous
Next
 
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.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.