Nipple retraction: don,t stop your reasoning

CLINICAL CASE: A 45-year-old woman was attending the oncology clinic in a normal follow-up for a sarcoma on her left leg, now disease-free for at least three years. At the last visit she referred a nipple retraction. Her oncologist could have considered this finding as something common and without importance…but she didn,t stop thinking

COMMENTS: In this patient a second tumor, a breast cancer, was diagnosed. Usually it,s not easy for a doctor to be aware of all the details and the risk of misdiagnosis is always present when the patient has another important disease.

The nipple can be erected o everted, inverted (normal in around 3% of women) or retracted. The inverted nipple usually change after stimulation.

A retracted nipple could be related with aging, duct ectasia and the most critical situation with breast cancer. Central tumors sometimes without a palpable lump (inflamatory)  or even tumors around the areola (Paget,s disease) can be responsible.

The mechanism for retraction is fibrosis and ductal retraction and also we have to remember that there are cilindric muscles that are responsible of the erected nipple.

ANALYSIS: No premature closing. The doctor in charge tried to find an explanation for the nipple retraction.