I Had a Lumpectomy Five Weeks Ago and Just Noticed a Nipple Inversion on That Side. What Has Caused This?

Diagnosed with invasive mucinous ductal cancer and had surgery five weeks ago. Yesterday , I noticed a nipple inversion on that same side. My breast and nipple have been very sore all that time. Any reason to be concerned? France

Doctor Answers 7

Nipple appearance has changed after lumpectomy

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It is not uncommon for the appearance of a woman's breast and or nipple to change after lumpectomy. Sometimes the breast tissue will "settle out" and the appearance will improve. Unfortunately, however, when nipple inversion is present, it is often because the removal of the diseased tissue created a void behind the nipple, and this is unlikely to improve over time. In fact, the degree of inversion may become even more pronounced after radiation therapy. A recent studies have shown that standard breast conserving procedures such as lumpectomy yield poor cosmetic results up to 30 percent of the time.

Your breast surgeon should be able to give you a good idea about what the eventual appearance of your nipple is likely to be. I would also suggest , if possible before you begin radiation, that you consult with a board certified plastic surgeon (or two or three) who specialize in breast reconstruction and oncoplastic surgery. Oncoplastic surgery may be ableto improve the final shape of the breast after breast-conserving surgery without compromising cancer care.

Significance of Nipple Retraction or Inversion

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The nipple is the exit site of all the ducts of the breast. Any significant inflammation involving a group of ducts tends to shorten them and retract the nipple. In extreme cases, this may result in inversion of the nipple. Such inflammation, as in your cases, is explicable by the surgery you just had. Sudden retraction in other instances, need to be worked up for occult breast cancer causing inflammation which shortened the breast ducts. Nipple retraction CAN be corrected. Allow yourself to recover from your procedure and have your surgeon refer you to a Plastic surgeon. Dr. Peter Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon

NIpple inversion following a lumpectomy

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This nipple inversion most probably is secondary from the surgery, the absence of the more supportive underlying tissue and developing scar contracture. You should discuss this with your surgeon who may very well ant to re-examine you.

Lumpectomy and skin and areola changes

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Without an exam I can not be sure but, this may be related to the surgery and scar contracture. You should check it out with your surgeon to be sure.

Breast Conservation Therapy (Lumpectomy) Can Create Breast Deformities

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If you have undegone a lumpectomy for breast cancer, your breast surgeon has cored out tissue to remove your tumor with a healthy margin of noncancerous tissue.  It is not uncommon for patients to see deformities  manifest over time.  Also, you will require radiation therapy to complete your breast conservation therapy.  Radiation is effective for killing microscopic cancer cells but it damages the normal tissue.  Many lumpectomy (breast conservation therapy) patients also experience significant deformities post radiation.  Please visit with your breast surgeon first for a followup exam.  After you have completed your radiation and are cancer free - I would recommend you visit with a board certified plastic surgeon.

Nipple inversion after breast biopsy

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A breast biopsy can create a cavity that will collapse and pull surrounding breast tissue into the scar. As this occurs it may pull on ducts that connect directly with the nipple producing nipple inversion. This is greatest at 6 weeks after biopsy and may persist for up to a year before softening significantly.

Nipple inversion after lumpectomy

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Sorry for your diagnosis.  The reason the nipple retracts is that scar tissue may have formed from the lumpectomy.  Sometimes this will improve with massage and time, but speak to your breast surgeon and possibly have him refer you to a plastic surgeon for a consultation.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.