Are the Changes in My Nipples a Cause for Concern?
At 22 years old, I've begun to observe some unsettling modifications in one of my nipples over the past few years. Unfortunately, every time I mention it to a doctor or a family member, they dismiss my worries, labeling them as completely ordinary. However, I have doubts about that assessment. A few years back, I realized that my right nipple tends to invert when I wear snug clothing, only reverting to its original position once I take off the tight garment. I brought this issue to the attention of my general practitioner, who dismissed it as a typical occurrence without conducting a breast examination. Although her response initially eased my anxiety, I've since noticed additional issues that have me worried. For instance, in cold conditions, that nipple remains erect for a significantly longer time than the other, and it can be quite painful in chilly weather. I've also observed that it appears slightly larger and takes on a faintly more purplish hue compared to the other nipple. For context, I struggle with health anxiety and often find myself worrying excessively about medical matters. Consequently, many people, including healthcare professionals, tend to disregard my concerns as mere anxiety. My family, aware of my history of fearing serious illnesses like cancer, doesn’t seem to treat this situation as serious, often interpreting it as another episode of anxiety. I do have an appointment with a gynecologist scheduled in a month, where I plan to request a breast examination to rule out any potential cancer. With all of this in mind, I can't help but wonder: could there be alternatives to a cancer diagnosis for what I'm experiencing? Should I truly be as alarmed as I am, or is this variation considered normal?
Answers (1)
7/9/2025, 4:01:51 PM
OpenHealth AI
It’s understandable to feel concerned about changes in your body, especially when they cause discomfort or anxiety. While many changes in the breasts can be normal, it's wise to stay vigilant and informed about what you’re experiencing.
Key Points:
- Nipple Changes Can Be Normal: Many people experience variations in their nipples and breasts over time due to factors like hormonal changes, clothing fit, and benign conditions.
- Physical Symptoms Matter: It's not uncommon for a nipple to experience temporary changes in position or appearance, but persistent pain, discomfort, or noticeable changes in color or size warrant further investigation.
Explanation:
- Inverted Nipples: It's common for nipples to invert or appear different temporarily, especially with certain clothing. However, if you notice that this inversion is new or accompanied by other changes, it’s good to monitor it.
- Color and Sensation Changes: A persistent color change (like a purplish hue) or notable differences in sensation (like prolonged sensitivity in cold weather) can sometimes indicate hormonal fluctuations, but they can also indicate benign conditions or require further investigation.
- Emotional Considerations: It’s entirely valid to express your health worries, especially if you experience health anxiety. Your feelings are important, and they deserve to be taken seriously.
Next Steps:
- Keep Your Appointment: Your upcoming visit with the gynecologist is a crucial step. Prepare to discuss all the changes you’ve noticed clearly and thoroughly, and ask for a breast examination to address your concerns properly.
- Monitor Your Symptoms: Keep a journal of any changes, noting when symptoms occur, their duration, and any additional feelings like pain or sensitivity. This can provide valuable information for your gynecologist.
- Seek Support: Speak openly with someone you trust about your feelings and worries. Sometimes sharing can help reduce anxiety and provide comfort.
- Self-Care: While you're waiting for your appointment, focus on self-care strategies. Managing stress through mindfulness, exercise, and healthy lifestyle choices can be beneficial for both your physical and mental well-being.
It’s understandable to feel anxious about changes in your body. Remember, seeking clarity through the proper channels is always a wise choice. Your concerns are valid, and it's essential to take them seriously while awaiting your medical evaluation.
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# 7-Month-Old Child with Abernethy Malformation - Exploring Treatment Options ## [7-Month-Old] Identified with Abernethy Malformation (Congenital Portosystemic Shunt) - Treatment Methods? **Age:** 7 months **Gender:** Female **Height:** Age-appropriate **Weight:** Currently 9 kg, was 2.8 kg at birth **Ethnicity:** Asian **Duration of Symptoms:** Present since birth **Location:** Uzbekistan **Pre-existing Health Issues:** Abernethy malformation (congenital portosystemic shunt), liver hemangiomas, chronic jaundice, anemia **Current Treatments:** Supportive management --- ## INITIAL PRESENTATION (June 2025 - July 2025) Our daughter arrived on **June 27, 2025**, presenting with: - Birth weight: **2.8 kg** - Marked jaundice (yellowing of skin and sclera) - Pale or clay-colored stools - **Bilirubin level: 245 μmol/L** (typically <20) An immediate ultrasound indicated multiple liver anomalies, initially thought to be hemangiomas. --- ## FIRST COMPREHENSIVE ASSESSMENT (August 1, 2025 - 1 Month Old) ### Multislice Computed Tomography (MSCT) with 3-Phase Contrast (August 1, 2025): **RESULTS:** - **Portocaval shunt size: 9.9 mm** (blood bypassing the liver into the inferior vena cava) - **Arteriovenous shunt size: 4.4 mm** - **Portal vein size: 6.1 mm** (patent) - **Three nodular cystic lesions** located in the perivascular area, with largest measuring 11.6×20.7 mm, enhancing during the venous phase - Liver features a heterogeneous architecture, exhibiting irregular enhancement - Gallbladder appears elongated and slightly enlarged - Other abdominal organs exhibit normal findings **RADIOLOGIST’S ASSESSMENT:** "Congenital portosystemic shunt indicative of Abernethy malformation; less likely arteriovenous malformation (AVM); cannot dismiss the possibility of localized liver lesions." **ADVICE:** Seek consultations with an abdominal and vascular surgeon. ### Blood Tests (August 1, 2025): **Complete Blood Count:** - WBC: 10.44 × 10⁹/L (normal range) - **RBC: 2.1 × 10¹²/L** (LOW - indicating severe anemia) - **Hemoglobin: 69 g/L** (CRITICALLY LOW; normal is 117-166) - Platelets: 403 × 10⁹/L (elevated) **Biochemistry Analysis:** - 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WBC: 5.8 × 10⁹/L (SHOWS IMPROVEMENT) - **RBC: 2.93 × 10¹²/L** (IMPROVED but still low) - **Hemoglobin: 72 g/L** (SHOWS IMPROVEMENT but still low) - Platelets: 223 × 10⁹/L (BACK TO NORMAL) - Neutrophils: 30.0% - Lymphocytes: 64.8% - Monocytes: 4.6% ### Biochemistry (January 28, 2026): - Total protein level: 67 g/L (slightly deficient) - Creatinine: 20.7 μmol/L - **Total Bilirubin: 242 μmol/L** (STILL HIGH - unchanged) - **Direct Bilirubin: 142 μmol/L** (VERY HIGH) - **ALT: 50 IU/mL** (DRASTICALLY LOWER from >1000!) --- ## OVERVIEW OF PROGRESS OVER 6 MONTHS | Parameter | August 2025 | January 2026 | Change | |------------------|-------------|---------------|--------------------------| | **Hemoglobin** | 69 g/L | 72 g/L | ↗ Slight improvement | | **RBC** | 2.1 | 2.93 | ↗ Improved | | **ALT** | >1000 | 50 | ✓✓ MAJOR IMPROVEMENT | | **Bilirubin** | 245 | 242 | → Unchanged (still elevated) | | **Portal vein** | 6.1 mm | 3.9 mm (US) | ↗ Decreased | | **Platelets** | 403 | 223 | ↘ Normalized | | **Shunt size** | 9.9 mm | 9.9 mm | → No Change | --- ## CURRENT SITUATION (February 2026 - 7 Months Old) - **Weight:** 9 kg (good growth rate in spite of condition) - **Jaundice:** Continues to be present (yellow skin) - **Stools:** Remain pale/clay-colored - **Development:** Achieving appropriate milestones - **Energy:** Appears to have a good energy level - **Feeding:** Normal appetite --- ## QUESTIONS FOR r/AskDocs We have been informed this is **Type 2 Abernethy malformation** (portal vein present). **Three treatment avenues have been proposed:** ### Option 1: **Endovascular Coil Embolization** (minimally invasive approach) - A catheter is inserted via the leg vein to access the shunt and deploy coils/plugs to close the abnormal vessels - Pros: No surgical incision, minimal discomfort, short hospital stay (2-4 days), no scars, enhanced safety - Duration: 1-2 hours - Recovery: 2-4 weeks for jaundice to show improvement ### Option 2: **Open Surgical Intervention** - An incision in the abdomen to ligate abnormal vessels and redirect blood to the liver - Pros: Direct visualization, effective results - Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. Seeking expert advice on optimal treatment strategy and timing.