Supernumerary Nipple Clinical Presentation

Updated: Mar 05, 2018
  • Author: Nicholas V Nguyen, MD; Chief Editor: Dirk M Elston, MD  more...
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Presentation

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.

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Physical Examination

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. [37] For a more precise examination one can resort to a reflectance confocal microscopy. [38]

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), [39] extremities, neck, face, genitalia, and perineum.

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