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Accessory Nipples

Supernumerary/ Accessory nipples are common

minor congenital malformations that consist of
nipples and/or related tissue in addition to the
nipples normally appearing on the chest.
These are located along the embryonic milk lines.
Supernumerary nipples can appear complete with
breast tissue and ducts and are then referred to as
polymastia, or they can appear partially with either of
the tissues involved.

Etiopathogenesis: During the fourth to fifth week of embryogenesis, thickened strips of ectoderm known as
mammary ridges or lines (milk lines) appear, extending from the axilla to the inner side of the thigh . Mammary
buds start to develop as solid, epidermal downgrowths from the mammary ridges during the sixth week of
development. Normally the mammary ridges only persist in the pectoral region where breasts develop with
regression of the rest of the thickened ectodermal streaks. In the case of failure of a complete regression, some
foci may remain, resulting in an accessory nipple.
Clinical Presentation & Diagnosis : Accessory nipples are diagnosed clinically. These nipples are often
overlooked at the first examination of the neonate. They appear as a small pigmented or pearl-coloured marks or as a
concave or umbilicated lesion. These are sometimes noticed in late infancy or childhood but largely remains
undetected. Occasionally, the accessory nipple becomes apparent during puberty, menstruation, or pregnancy when
hormonal change occurs.

Differential diagnosis : Dermatofibroma, Lymphangioma, neurofibroma, non-genital warts,pigmented nevus.

Treatment : Usually, treatment of an SN is unnecessary, but if the patient is unhappy cosmetically or if the SN
causes discomfort from lactation or tenderness, it can be removed surgically. If the SN has undergone a malignant
change, then a more aggressive treatment is necessary. Cosmetically undesirable or symptomatic accessory
nipples should be removed with complete surgical excision, although the use of liquid nitrogen cryotherapy has
been described.
Prognosis : Normally accessory nipples are benign in nature and treatment is cosmetically indicated. However,
they are subject to the same hormonal changes and disease processes that affect normal breast tissue. If there is
glandular tissue, these nipples can enlarge during puberty, swell and become tender premenstrually, and
lactate.They are known to develop fibroadenomas,adenomas,cysts,abscesses and mastitis as well as breast
carcinoma. They have been associated with a number of medical conditions. A number of studies have identified a
relationship between kidney and urinary tract malformations. Other medical conditions sporadically associated
with SNs include vertebral anomalies, cardiac arrythmias, hypertension, peptic ulcer disease,migraine,
neurosis,gonadal hypoplasia,pyloric stenosis, epilepsy,intracranial aneurysm, double gallbladder, malformation of
the limbs, etc.