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Nipple distortion or retraction – Information for GPs

Referral criteria / commissioning position

Refer to secondary care if:

  • any red flag present (via fast track route)
  • long standing slit like inversion which is correctable and has no associated symptoms or signs reassure

Red flag symptoms

  • Recent onset (usually <3months)
  • Associated lump, ulceration or unilateral blood stained discharge

Investigations prior to referral


Information to include in referral letter

  • Outline problem and duration
  • Family history of breast cancer
  • A clinical photograph may be useful for diagnosis and monitoring
  • Details of treatments and measures tried including outcomes
  • Relevant past medical/surgical history such as breast or ovarian cancer
  • Drug history (prescribed and non-prescribed)
  • Current regular medication
  • BMI
  • Smoking status
  • Alcohol consumption

References and additional information

CRUK Guidelines For Referral of Patients With Breast Problems

SIGN Guideline 84: Management of Breast Cancer in Women

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