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


Supernumerary Nipple

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


Supernumerary nipples are common minor congenital malformations that consist of nipples and/or related tissue in addition to the nipples normally appearing on the chest. Supernumerary nipples are located along the embryonic milk lines. Ectopic supernumerary nipples are found beyond the embryonic milk lines. The embryonic milk line is the line of potentially appearing breast tissue as observed in many mammals. In humans, the embryonic milk line extends bilaterally from a point slightly beyond the axillae on the arms, down the chest and the abdomen toward the groin. It is generally thought to end at the proximal inner sides of the thighs, although supernumerary nipples have been described on the foot.[1] Supernumerary nipples can appear complete with breast tissue and ducts and are then referred to as polymastia, or they can appear partially with either of the tissues involved.

The classification established by Kajava in 1915 remains valid[2] :

  • Complete supernumerary nipple - Nipple and areola and glandular breast tissue
  • Supernumerary nipple - Nipple and glandular tissue (no areola)
  • Supernumerary nipple - Areola and glandular tissue (no nipple)
  • Aberrant glandular tissue only
  • Supernumerary nipple - Nipple and areola and pseudomamma (fat tissue that replaces the glandular tissue)
  • Supernumerary nipple - Nipple only (the most common supernumerary nipple)
  • Supernumerary nipple - Areola only (polythelia areolaris)
  • Patch of hair only (polythelia pilosa)

Although this classification is clear, encountering interchangeable terms and misnomers when dealing with the supernumerary nipple complex is not surprising due to variability in morphologic patterns.

The paucity of descriptions of supernumerary nipples in medical writings is probably due to its relatively minor clinical significance. The occurrence of supernumerary nipples has been documented since Roman times and featured in legends and ethnic mythology prior to that time. Supernumerary nipples, and particularly polymastia, were attributed to increased femininity and fertility. Ancient artists depicted the goddess of Artemis of Ephesus and the Phoenician goddess of fertility, Astrate, like other ancient deities, as having row upon row of breasts on their chests.[3] Anne Boleyn, the wife of King Henry VIII, was known to have a third breast. Supernumerary nipples in men were a sign of virility and endowed them with divine powers. Nowadays, film stars expose their supernumerary nipples in the cinema with this same effect.[3]

The first medical report dates back to 1878 when Leichtenstern estimated the prevalence of supernumerary nipples to be 1 in 500 (0.2%).[4] In recent years, supernumerary nipples and their association with other congenital anomalies and malignancies has been a topic of considerable debate.

Associations with other diseases

Supernumerary nipple features are found in a number of syndromes, but, in most cases, it is probably a chance finding. These syndromes include Turner syndrome, Fanconi anemia, and other hematologic disorders[5] ; ectodermal dysplasia; Kaufman-McKusick syndrome; Char syndrome; Simpson-Golabi-Behmel syndrome; and epibulbar lipodermoids associated with preauricular appendages syndrome.[6] Isolated reports have linked supernumerary nipples to a number of other conditions, but in light of the fact that supernumerary nipples occur with a relatively high frequency in the general population, further studies are needed to validate the following associations:

Central nervous system associations are as follows:

  • Epilepsy
  • Migraine
  • Neurosis
  • Familial alcoholism
  • Fetal alcohol syndrome
  • Intracranial aneurism
  • Neural tube defect
  • Developmental delay

Gastrointestinal associations are as follows:

  • Peptic ulcer
  • Pyloric stenosis

Ears, nose, throat, and lung associations are as follows:

  • Laryngeal web
  • Ear abnormalities
  • Accessory lung lobe

Skeletal associations are as follows:

  • Hand malformation
  • Vertebral anomaly
  • Absence of rib
  • Coronal suture synostosis
  • Hemihypertrophy
  • Arthrogryposis
  • Scalp defects and microcephaly
  • Dental anomalies

Cardiac associations are as follows:

  • Essential hypertension
  • Conduction defect
  • Bundle-branch block
  • Patent ductus arteriosus
  • Congenital heart disease, atrial septic defect, and ventricular septal defect

Publications concerning renal and urinary tract involvement in the presence of supernumerary nipple

In 1979, Méhes drew attention to the association of supernumerary nipples and other anomalies.[7] The claim that 40% of supernumerary nipples investigated also had renal involvement was striking. This figure was later corrected to 23-27%[8, 9] ; however, more recent studies have not validated this association. In addition to renal and urinary tract malformations, supernumerary nipples have also been reported in association with solid organ malignancies such as renal adenocarcinoma, testicular cancer, prostate cancer, and urinary bladder carcinoma.

Claiming close association are as follows:

  • Méhes, 1979 [7]
  • Goedert et al, 1981 [10]
  • Méhes, 1983 [8]
  • Kahn and Wagner, 1982 [11]
  • Varsano et al, 1984 [9]
  • Meggyessy and Méhes, 1984 [12]
  • Hersch et al, 1987 [13]
  • Méhes and Pinter, 1990 [14]
  • Leung and Robson, 1990 [15]
  • Urbini and Betti, 1996 [16]
  • Brown and Schwartz, 2004 [17]
  • Ferrara et al, 2009 [18]
  • Grimshaw et al, 2013 [19]

Denying support for association are as follows:

The Medscape article Disorders of the Breast may be of interest.



Saint-Hilaire in 1836 and Darwin in 1871 supported the notion that the supernumerary nipple is an atavistic structure derived from the milk line of mammals. Conceivably, even the ectopic supernumerary nipple falls in line with Darwin's theory of atavism. Supernumerary nipples on the vulva are consistent with the location of breasts in dolphins and whales; whereas, ectopic supernumerary nipples on the back, scapula, and shoulder[32, 33, 34] are reminiscent of breast tissue in nutria and hutia (rodents).

Between the fourth and fifth weeks of embryogenesis, an ectodermal thickening forms symmetrically along the ventral lateral sides of the embryo. This epidermal ridge extends from the axillary region to the inner side of the thigh to form the embryogenic milk (or mammary) line. During the second and third months of embryonic development, the glandular elements of the breast are formed near the fourth and fifth ribs, with regression of the rest of the thickened ectodermal streaks. In the case of failure of a complete regression, some foci may remain, resulting in a supernumerary nipple. This can develop into a supernumerary complete breast (polymastia) or into any other supernumerary nipple variant according to the Kajava classification.




The prevalence of supernumerary nipples varies geographically. The prevalence is 0.22% in a Hungarian population,[6] 1.63% in African American neonates,[20] 2.5% in Israeli neonates,[21] 4.7% in Israeli Arabic children,[35] and 5.6% in German children.[29]


The incidence of supernumerary nipples is similar in males and females. Some studies have supported a slight male predominance with estimates of male-to-female ratio as high as 1.7:1.



Most isolated supernumerary nipples persist without complication. Ectopic breast tissue can be associated with the same inflammatory and neoplastic conditions that affect normal breast tissue. Ectopic breast tissue does not have an increased malignant potential compared with normal breast tissue.


Patient Education

Once a supernumerary nipple is diagnosed, inform the parents or the patient that it is a benign skin lesion in an otherwise healthy individual. Patients should be made aware that supernumerary nipples can go through changes like any regular nipple or breast; these changes may be physiological during puberty or pathological, such as inflammation, mastitis, abscess formation, cysts, adenomata, fibroadenoma, carcinoma, melanoma, or Paget disease.

Contributor Information and Disclosures

Nicholas V Nguyen, MD Director of Pediatric Dermatology, Akron Children's Hospital

Nicholas V Nguyen, MD is a member of the following medical societies: American Academy of Dermatology, American Academy of Pediatrics, 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.

  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].

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.