Nipples look in many different directions

The word for nipple used by the Anbarra First Nations People of north-central Arnhem Land is kungal mipulakidfera, which means 'the milk's eye'. When I am checking out a lactating woman's breastfall, I like to think of her nipple as an eye which looks in a particular direction, depending on her unique body.

• Normal nipples look in many different directions.

• The direction your nipples look can be different on one side compared to the other.

Nipple sizes and shapes are highly variable

For example

• The woman breastfeeding next to you in a mothers' group might have nipples which are five times wider than yours, and yet you are both normal! This is because nipple width at the base can range from 6-34 mm.

• Your nipple might be level with the areola, hers might be 20 millimetres high, and yet you are still both very normal!

• The top surface (or face) of your nipple might be circular, hers might be oval.

• Your nipple might be cylindrical in shape, hers might be narrower at the base than at the top. Actually, a variety of nipple shapes are normal.

• It's common for the right nipple to be significantly longer than the left.

Nipples and areolas are highly variable in colour

You'll have noticed that from puberty, women's nipples and areola are usually significantly more darkly pigmented than the rest of the skin of the breast. But nipple and areolar colour is still highly variable. Most areolas darken further with pregnancy.

The number of duct openings on the face of your nipple is highly variable

The face of your nipple has somewhere between four to 18 openings of the milk ducts. That is, you might have more than four times the number of duct orifices than the breastfeeding woman sitting next to you at playgroup! The average number of duct openings is nine.

The number of milk ducts you have, and the number of ductal orifices on the face of your nipple, doesn't relate to your capacity to produce or transfer milk. REF 16

Areola sizes and shapes are highly variable

Areolas are also highly variable, and not just in colour. For example

• Your areola might be seven centimetres wide. You notice that the woman breastfeeding next to you at mother's group has areola which is just two centimetres wide, less than a third the width of yours - but both your areolas are absolutely normal!

• Areolas usually aren't circular, either.

• Some women's areolas increase in size with pregnancy, perhaps by half a centimetre in diameter.

• Hairs are common on the areola, usually towards the periphery, though they tend not to grow on the nipple.

  Areolas have sebaceous glands, which can look quite prominent. Some women even notice that there are some drops of milk made in areolar glands, which is nothing to worry about.

The way your baby is positioned relative to the areola when you bring baby on isn't relevant to breastfeeding, and is not something you need to pay attention to. You'll notice I never mention the areola when talking about how you might bring baby on.

Do you have an extra nipple?

Up to 6% of women have a supernumerary nipple, which can look like a mole or naevus located somewhere on an imaginary line linking the armpit, the nipple, and the groin. If you have a supernumerary nipple and it swells with milk in the early days, just leave it well alone and any milk secretion will quickly settle.

Recommended resources

Nipples look in many different directions, and nipples and areolas enjoy diverse size, shape, and colour

The four main directions in which nipples look: what to do

What to notice in front of the mirror before you bring baby on to the breast

The protective powers of nipple and areolar skin when you're lactating

Things to know about your nipple and areola skin and microbiome when you're lactating

Your nipple skin knows how to adapt to the mechanical pressures of breastfeeding (or pumping)

The biological vulnerability of your nipple and areola skin when lactating

Selected references

Ramsay DT, Kent JC, Hartmann RA, Hartmann PE. Anatomy of the lactating human breast redefined with ultrasound imaging. Journal of Anatomy. 2005;206:525-534.

Sanuki J-i, Fukuma E, Uchida Y. Morphologic study of nipple-areola complex in 600 breasts. Aesthetic Plastic Surgery. 2008;33(3):295-297.

In a study of 119 Californian women, who were 69% white and 23% Hispanic/Latino, nipple base width ranged between 15 to 34mm, and height between 5 to 20 mm high (with right nipples significantly longer than left nipples