Supernumerary Nipples - Types, Causes, Diagnosis, and Management

What Is a Supernumerary Nipple?

A supernumerary nipple is an extra nipple or additional tissue resulting from a minor mammary tissue abnormality. Other names include the additional nipple, ectopic nipple, and accessory nipple. A supernumerary nipple or third nipple is a condition where a person has one or more extra nipples on their body. The supernumerary nipple is in addition to the two normal nipples on the breasts.

A supernumerary nipple or third nipple, is also known as:

• Polythelia- The condition has extra nipples but no accessory glandular tissue.

• Polymastia- Extra breasts that are supernumerary or accessory, with or without nipples.

Supernumerary nipples (SNs) are mild congenital abnormalities that are common. Although they have been seen to grow in other places, SNs often develop within the embryonic milk lines. Although SNs are mostly benign, they can be a symptom of internal disease since they are sensitive to hormonal changes and disease processes.

Classification of the Supernumerary Nipple:

Supernumerary breasts were classified using the Kajava classification in 1915.

They are classified into seven categories, as follows-

• Supernumerary breast without an areola.

• Supernumerary breast without a nipple.

• Aberrant glandular tissue only.

• Nipple and areola with fat (pseudomamma).

• Nipple only.

• Areola only (polythelia areolaris).

• Hair only (polythelia pilosa).

What Are the Causes of Supernumerary Nipple?

Developmental Issues- A human embryo develops a third nipple in the womb. The two milk lines of the embryo, which are made of ridged ectoderm tissue (a type of tissue that eventually becomes a component of the skin), thicken in the fourth week of pregnancy.

Normally, the remainder of the swollen skin softens again, but the milk line tissue remains thick, creating the nipples. However, in rare instances, specific milk line ridges do not return to regular ectoderm tissue. When this occurs, more nipples may form where the milk tissue had previously been dense and rigid following birth and development into maturity.

Association With Other Medical Conditions- Numerous syndromes possess supernumerary nipples but are primarily coincidental findings.

Among these syndromes are-

• Fanconi anemia and other hematologic disorders.

• Turner syndrome.

• Ectodermal dysplasia.

• Kaufman-McKusick syndrome.

• Char syndrome.

• Simpson-Golabi-Behmel syndrome.

• Epibulbar lipodermoid is associated with preauricular appendage syndrome.

• Familial Predisposition- Although family cases of supernumerary nipples have been documented, they are often sporadic. Most familial cases are autosomal dominantly inherited with partial expressivity.

Who Gets a Supernumerary Nipple?

A supernumerary nipple, also known as a third nipple or accessory nipple, is a relatively common occurrence and can affect both men and women. The presence of extra nipples is known as polythelia. These additional nipples usually develop along the embryonic milk line, extending from the armpit region to the groin.

What Is the Long-Term Outlook of Supernumerary Nipple?

• The majority of isolated supernumerary nipples continue to function normally. The same inflammatory and cancerous diseases that affect normal breast tissue can also affect ectopic breast tissue. However, ectopic breast tissue has no higher malignant potential than normal breast tissue.

• Supernumerary nipples are typically not a cause for alarm. An additional nipple may occasionally indicate an underlying illness, such as tumor development or malignancy. But sometimes, people might not even be aware of one. As a result of hormone reactions, additional nipple tissue is frequently found in pregnant and nursing women.

• Regular checkups and informing the doctor about extra nipples will help the person avoid potential problems.

What Are the Signs and Symptoms of a Supernumerary Nipple?

Usually, the supernumerary nipple goes undiagnosed and asymptomatic.

Sometimes, the additional nipple is apparent during adolescence, menstruation, or pregnancy when hormonal changes lead to

• Enhanced pigmentation.

• Swelling.

• Sensitivity.

• Lactation.

How Is Supernumerary Nipple Diagnosed?

Diagnosis of a supernumerary nipple involves-

• Physical Examination- When a neonate is first examined, the additional nipple is frequently missed. It manifests as a little pearl-colored mark, concave lesion, or pigmented mark. When evaluating adolescent girls, the additional nipple may be hidden by the regularly formed breast. 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, to make it easier to spot the extra nipple.

• Dermoscopic Examination- This is done to examine the supernumerary nipple closely. It helps to identify and categorize the supernumerary nipple.

What Are the Different Types of Supernumerary Nipples?

• Axillary (in the armpit) nipples develop along the axillary line and are the most common type of supernumerary nipples. They may appear as small, pigmented bumps.

• Thoracics (along the chest) in this category are located on the chest along the milk line between the normal nipples and the axilla.

• Abdominal (along the abdomen) nipples are found below the normal nipple on the abdomen and are classified as abdominal supernumerary nipples.

• Inguinal (in the groin area), the nipples appearing in the inguinal region near the groin are known as inguinal supernumerary nipples.

• Pectoral (along the pectoral muscles) nipples may appear on the chest, closer to the normal nipples but outside the usual location.

• Laterals (on the sides of the normal nipple) have extra nipples located on the sides of the normal nipples.

What Is the Treatment or Management of Supernumerary Nipple?

• A complete surgical excision should be performed to remove supernumerary nipples that are cosmetically unattractive or cause symptoms. Both male and female supernumerary nipples have the potential to lactate, especially if they are highly developed.

• Supernumerary nipples can be surgically removed in a quick, non-invasive outpatient procedure with minimal discomfort and a short recovery time.

• Although it is more complicated, the removal of polymastia or a fully ectopic supernumerary nipple (with breast) is recommended for women at high risk of developing breast cancer.

• The tumescent liposuction (a procedure for removing subcutaneous fat while using a specific type of local anesthesia) procedure has been recommended to prevent an unattractive scar following the removal of a whole ectopic supernumerary nipple.

• The frequency of physical examination and mammography for ectopic breast tissue in a given patient should be the same as that for normal breast tissue.

What Complications Can Occur Due to the Supernumerary Nipple?

• A third nipple may occasionally indicate malignant growth, a tumor, or a congenital breast abnormality.

• One of the genes, known as the 'Scaramanga gene,' which can result in an additional nipple, also makes it possible for an extra nipple to develop breast cancer, just like a normal breast.

• Polythelia, a category six supernumerary nipple, can be linked to kidney diseases such as end-stage renal disease or cancer of the kidney cells.

Conclusion:

The presence of one or more additional nipples on the body is referred to as having a third nipple or a supernumerary nipple. They frequently manifest in the frontal region of the body from the armpit to the genitalia, known as the "milk line." Third, nipples can be removed with a quick operation and often pose a small health risk. However, if the supernumerary nipple makes the person uncomfortable due to lactation or radiating pain, they must consult a doctor to determine whether any therapies or surgical procedures are needed. Likewise, if the supernumerary nipple develops any lump, hard tissue, discharge, or rash in the area, a doctor should be consulted as soon as possible.