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The nipples on the female or male chest are well recognized but their embryologic origin is not. They develop from outgrowths along the congenital vertical milk lines which extend from the armpit down into the groin. The post birth nipples and their ultimately developing breast tissue emerge into their recognized position on the chest wall along these lines.

But as part of this embryologic process other nipple areas along the milk line can ‘inadvertently’ develop even though the dominant nipple site develops. Known by a variety of names, accessory and supernumerary nipples as the most common, but the medial name is polythelia.They can occur in both male and females and are not uncommon with occurrence rates of around 1 in 20 births. They can occur either on one side or bilateral. Often confused as a congenital nevi or mole, close inspection will reveal that its surface is textured and not flat. It will like a miniaturized nipple. When seen bilaterally it is a dead giveaway for accessory nipples.

Such supernumerary nipples usually grow with development and are even capable of producing a small amount of secretions after puberty in some cases. Their removal can be easily done though a small horizontal elliptical excision making sure that any attached breast tissue to the nipple is removed as well. A small fine lie scar is the tradeoff for their removal.

Dr. Barry Eppley

Indianapolis, Indiana

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