Supernumerary nipple

What is a supernumerary nipple?

A supernumerary nipple is a minor malformation of the breast tissue that produces additional nipple(s) and/or associated tissue. Also known as accessory nipple, ectopic nipple or extra nipple.

A supernumerary nipple is different from:

• Polythelia, which is the presence of supernumerary nipples without accessory glandular tissue.
• Supernumerary or accessory breasts, which may or may not have nipples.

Supernumerary nipples are congenitaland generally harmless. However, they are influenced by hormones and are susceptible to other disease processes.

Who gets a supernumerary nipple?

Supernumerary nipples or breasts are found in up to 6% of the population. They occur as isolated findings or as characteristics of genetic syndromes These include:

• Ruvalcaba-Myhre syndrome
• Hay-Wells syndrome ectodermal dysplasia

There have been some reports of an increased risk of urinary tract abnormalities in patients with supernumerary nipples, although this is disputed.

Most isolated cases of supernumerary nipples are sporadic, however, they are family in approximately 6% of reported cases. They exhibit a autosomal dominant pattern of inheritance with incomplete penetrance.

The embryogenesis of the supernumerary nipple.

The supernumerary nipple forms early in the development of the embryo.

Week 4

Mammary ridges are formed from thick strips of ectoderm, these are the “milk lines” that extend from the armpit to the groin

Week 6

Breast buds develop from the growth of epidermis Of the ridges.

Week 8

Failure of regression of the mammary ridges result in the formation of the supernumerary nipple.

Supernumerary nipples commonly arise anywhere along the two vertical milk lines that originate in the armpit, descend through the region where the nipples are typically located, and end in the groin. Around 5% of supernumerary nipples form outside the milk lines on the skin of the neck, back, vulva or thigh

What are the clinical characteristics of the supernumerary nipple?

A supernumerary nipple is present at birth. Often appears similar to a congenital organoid or melanocytic nevus. Most supernumerary nipples are much smaller than normal nipples. areola and nipple They may be solitary or multiple, arising on one or both sides of the nipple line.

They can be pink or brown, and at least the central nipple is raised from the surface of the skin. There may be a central dimple. Supernumerary nipples may develop prominently hair in puberty

If the supernumerary nipple contains glandular tissue, it may enlarge during puberty, become swollen and tender before menstruation, and suffer from lactation.

See more images of supernumerary nipple…

How is a supernumerary nipple diagnosed?

A clinical classification tool is Kajava's (1915) classification of supernumerary nipples.

• Complete supernumerary nipple: nipple and areola and glandular breast tissue
• Supernumerary nipple: nipple and glandular tissue (without areola)
• Supernumerary nipple: areola and glandular tissue (no nipple)
• Aberrant glandular tissue only
• Supernumerary nipple: nipple and areola and pseudomamma (adipose tissue that replaces glandular tissue)
• Supernumerary nipple: nipple only (the most common supernumerary nipple)
• Supernumerary nipple: areola only (polythelia areolaris)
• Patch hair only (polythelia pilosa)

Histology provides a definitive diagnosis, as it often resembles the normal nipple.

• Epidermal thickening
• Tempered papillomatosis and basal hyperpigmentation
• pilosebaceous structures
• Smooth muscle
• mammary ducts
• Sometimes presence of underlying breast tissue

What is the treatment for a supernumerary nipple?

Treatment is usually not required. Surgical removal may be considered for cosmetic purposes or if there is discomfort from breastfeeding or sensitivity.

Supernumerary nipples can suffer from diseases similar to normal breast tissue. There are reported cases of developing supernumerary nipples:

• Fibroadenoma
• Adenoma
• Cyst
• Abscess
• Mastitis
• Chest Cancer