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PubMed1979

[Adenoma of the nipples].

The adenoma of the nipple (syn.: erosive adenomatosis, papillary adenoma, florid papillomatosis) is a benign tumour of the major nipple ducts and presents chiefly as an eroded oozing and crusted lesion with serous or sanguineous discharge of the nipple or as an indurated nodule. The lesion can be mistaken clinically for Paget's disease of the nipple. The correct diagnosis, however, can easily be established by an incisional biopsy. Pathohistologically, the tumour displays adenomatous and papillomatous proliferation of the milk sinus epithelium. An outer myoepithelial and inner columnar epithelium layer can mostly be distinguished. Atypical cellular features are lacking. Keratin cysts near the mostly eroded epidermal surface are are additional characteristic signs. The resection of the nipple is the therapy of choice. The adenoma of the nipple is no precancerous condition. A typical case of adenoma of the nipple from a 54 year old woman is presented.

Adenoma↗
PubMed1994

Nipple candidiasis among breastfeeding mothers. Case-control study of predisposing factors.

OBJECTIVE: To investigate factors that predispose breastfeeding mothers to nipple candidiasis. DESIGN: A retrospective case-control study of women attending the Calgary Breastfeeding Clinic. SETTING: Ambulatory breastfeeding referral centre. PARTICIPANTS: All women (105) who attended the clinic during a 3.5-month study period. All were referred for problems with breastfeeding; 27 (the case group) had positive diagnostic criteria for nipple candidiasis. The other 78 formed a control group. MAIN OUTCOME MEASURE: A patient information sheet, completed while taking a medical history, recorded the presence or absence of four possible predisposing factors. Two infant variables were also noted on physical examination. Patients were diagnosed as having or not having nipple candidiasis on the basis of specific clinical criteria, and statistics on other variables were compared for those with positive and with negative diagnoses. RESULTS: A statistically significant correlation (P < 0.05) was found between nipple candidiasis and three factors: vaginal candidiasis (P = 0.001), previous antibiotic use (P = 0.036), and nipple trauma (P = 0.001). CONCLUSIONS: Further research is required to establish clear causality. However, we recommend that physicians be suspicious of nipple candidiasis; avoid antibiotics or use the shortest effective course; treat yeast vaginitis during the third trimester and after delivery aggressively; and treat mothers for nipple yeast if babies have oral or diaper candidiasis. Breastfeeding mothers can also be counseled in preventive measures.

Anti-Bacterial Agents↗
PubMed1994

Management of nipple discharge.

In a series of 9,312 women who consulted one of the authors with a complaint of disease of the breast between 1959 and 1991, nipple discharge was the presenting symptom in 448 (4.8 percent). Nipple discharge was spontaneous in 243 (2.6 percent) and provoked in 205 (2.2 percent) of the patients. The ages of the patients ranged from 13 to 75 years (mean of 42.5 years) in the spontaneous and 16 to 70 years (mean of 37.8 years) in the provoked discharge group. When a palpable mass was found, biopsy was undertaken, while in instances of nipple discharge only, subareolar exploration was performed. Of the 115 patients in the spontaneous and 25 patients in the provoked groups who underwent biopsy, the most frequent cause of nipple discharge was intraductal papilloma (47.8 percent). Nipple discharge was the result of carcinoma in 35 patients (14.4 percent) in the spontaneous and six patients (2.9 percent) in the provoked group, respectively. In patients with a palpable mass, the incidence of carcinoma was 61.5 percent compared with 6.1 percent in patients with nipple discharge only. Patients presenting with nipple discharge should undergo biopsy or subareolar exploration based on the presence or absence of a palpable tumor. The patients in whom no clinical findings could be detected should have follow-up evaluation at regular intervals.

Adenofibroma↗
PubMed1993

Preoperative and postoperative nipple-areola sensibility in patients undergoing reduction mammaplasty.

Objective data on nipple and areola sensibility are scarce. For women with macromastia, there is little published information available indicating the incidence and intensity of postoperative nipple and areola sensibility. This prospective study was undertaken to evaluate nipple and areola sensibility in "small-breasted" control subjects as well as in patients with macromastia before and after reduction mammaplasty. Preoperative and postoperative Semmes-Weinstein pressure threshold testing was performed on 84 breasts in 43 patients and on 12 breasts of A or B cup size in the control group. The patients underwent reduction mammaplasty by the central parenchymal pedicle technique or the laterally based inferior pedicle technique. Nipple-areola sensibility was retained in 96 percent of breasts when the excision of breast tissue was less than 550 gm and 85 percent of breasts when the excision was greater than 550 gm. Overall, nipple-areola sensibility was retained in 90.5 percent of the 84 breasts tested. In those breasts in which nipple-areola sensibility was retained after surgery, there was no statistical difference in the preoperative and postoperative Semmes-Weinstein pressure threshold values. When pressure threshold values were compared in patients who had less than 550 gm of tissue resected, patients who had greater than 550 gm of tissue resected, and controls who had not undergone surgery, the trend of decreasing nipple-areola sensibility with increasing breast size was clearly seen.

Female↗
PubMed1997

Comparison of nipple projection with the modified double-opposing tab and star flaps.

This study compared nipple projection after nipple reconstruction (following breast mound reconstruction) with either the modified double-opposing tab flap or the star flap. Areolar reconstruction and pigmentation of the nipple were achieved with tattooing. Nipple projection for 153 nipples was measured at least 6 months after the reconstruction, when projection was believed to have become stable. Mean follow-up was 2.27 years. In the 106 nipples reconstructed with modified double-opposing tab flaps, the mean projection was 2.4292 mm, while in the 47 nipples reconstructed with star flaps, the mean projection was 1.9681 mm (p = 0.021). We conclude that although both methods are effective, the modified double-opposing tab flap has slightly more projection after approximately 2 years. It is not known, however, whether this is because of reduced flap atrophy or longer initial projection by the modified double-opposing tab flap; further studies are ongoing.

Female↗
PubMed1992

Effectiveness of a handsewn nipple valve for reflux prevention in bladder reconstruction.

The intussuscepted nipple has proved to be a versatile mechanism to provide continence or prevent reflux in urological reconstructive surgery. Early in its use detussusception of the nipple was recognized as a common complication, which was usually prevented by using several rows of staples to stabilize the nipple. The use of staples has reduced the rate of reoperation for eversion or obstruction but it has led to a higher stone formation rate, ranging from 10 to 18% in recent series. Since 1983 we have used a handsewn intussuscepted ileal nipple stabilized without staples as our antireflux mechanism in bladder augmentations and continent diversions. This technique has been performed in 30 patients with an average followup of greater than 3 years. A small bladder stone developed in only 1 (3%) of the patients, who was completely dependent on intermittent catheterization, while 4 (13%) required reoperation due to eversion of the nipple. This incidence compares well with nipple reoperation rates in recent series, which range from 7 to 28%. We conclude that absorbable sutures are as effective as staples in stabilizing the antireflux nipple, and that they result in a lower incidence of subsequent stone formation.

Child↗
PubMed2001

Effect of milkflow rate and presence of a floating nipple on abnormal sucking between dairy calves.

The aim of this study was to investigate if access to an artificial teat compared to an open bucket would decrease abnormal sucking in calves held in pairs, and if the calves would perform less abnormal sucking if they spent more time drinking or sucking the milk. In total 16 calves of Swedish Red and White cattle housed in pairs were used. The eight groups were given 2.5l of whole milk per calf, twice a day in one of the following treatments; bucket with fast flow (control), bucket with slow flow, floating nipple with fast flow and floating nipple with slow flow. All groups were subjected to the four different treatments in a random balanced order. Two buckets were connected with a rubber pipe in order to control the milk flow. In the fast treatments, the milk poured from one bucket to the other in 40s, and in the slow treatments the milk poured from one bucket to the other in 10min. Each group had the treatment for 6 days before behavioural observations were done on day 7. These were made by instantaneous recordings at 20s intervals for 30min, starting when the calves received their milk in the morning and afternoon. The number of recordings of abnormal sucking was lower than the control in all treatments (P<0.001). The lowest recording of abnormal sucking was found, when the calves had both a floating nipple and a slow flow. Sucking on other objects in the pen had the highest number of recordings, when they had a nipple and a fast flow (P<0.01), but the sucking on the empty nipple represented 95% of this category. The calves tended to lick and bite more on the bucket, the nipple and pen fittings in the two treatments with fast flow (P<0.1) than in the slow treatment with nipple. It is concluded that both the performance of sucking and the time taken to ingest milk are important in order to decrease abnormal sucking between calves.

Journal Article↗
PubMed1997

Water consumption by broilers in high cyclic temperatures: bell versus nipple waterers.

Broilers were maintained on litter in environmental chambers to study water consumption from bell and nipple waterers. The chambers were set at high cyclic temperatures of either 24-35-24 C or 24-32-24 C daily cycles in three trials. Water consumption was recorded by computer each 30 min and calculated as a percentage of body weight. Daily water consumption from nipples was always less than from bell waterers. Water consumption by quarter-day revealed that consumption from nipples was often similar to that from bell waterers during the lowest temperatures but was less during the periods of highest temperatures. Further study revealed that water consumption from nipple waterers was related to the height of the nipples such that consumption was greater for lower nipples. The results suggest that panting broilers have difficulty drinking from high nipple waterers.

Analysis of Variance↗
PubMed2005

Does the choice of bottle nipple affect the oral feeding performance of very-low-birthweight (VLBW) infants?

BACKGROUND: There is a continuous debate regarding the best bottle nipple to be used to enhance the bottle-feeding performance of a preterm infant. AIM: To verify that feeding performance can be improved by using the bottle nipple with the physical characteristics that enhance infants' sucking skills. METHODS: Ten "healthy" VLBW infants (941+/-273 g) were recruited. Feeding performance was monitored at two time periods, when taking 1-2 and 6-8 oral feedings/d. At each time and within 24 h, performance was monitored using three different bottle nipples offered in a randomized order. Rate of milk transfer (ml/min) was the primary outcome measure. The sucking skills monitored comprised stage of sucking, suction amplitude, and duration of the generated negative intraoral suction pressure. RESULTS: At both times, infants demonstrated a similar rate of milk transfer among all three nipples. However, the stage of sucking, suction amplitude, and duration of the generated suction were significantly different between nipples at 1-2, but not 6-8 oral feedings/d. CONCLUSION: We did not identify a particular bottle nipple that enhanced bottle feeding in healthy VLBW infants. Based on the notion that afferent sensory feedback may allow infants to adapt to changing conditions, we speculate that infants can modify their sucking skills in order to maintain a rate of milk transfer that is appropriate with the level of suck-swallow-breathe coordination achieved at a particular time. Therefore, it is proposed that caretakers should be more concerned over monitoring the coordination of suck-swallow-breathe than over the selection of bottle nipples.

Body Weight↗
PubMed1990

Effects of the presence or absence of satellite chick-waterers in conjunction with nipple-drinkers on the mortality and productive performance of broiler chicks from young and old dams.

Two runs of one experiment were conducted to study the effects of the presence or absence of satellite (SAT) chick-waterers in conjunction with nipple-drinkers on the mortality and productive performance of mixed-sex, broiler chicks grown to 42 days of age. Data were combined for analysis. The chicks were obtained from dams 29, 31, 61 and 65 wk of age. The treatments were: 1) chicks from 61- and 65-wk-old dams, nipple-drinkers only; 2) chicks from 29- and 31-wk-old dams, nipple-drinkers only; 3) chicks from 61- and 65-wk-old dams, nipple-drinkers plus one SAT-waterer per replication; 4) chicks from 29- and 31-wk-old dams, nipple-drinkers plus one SAT-waterer. The SAT waterers were removed after 11 days. Routine management procedures were followed. The chicks from the older dams (61 and 65 wk of age) were heavier (1.60 versus 1.58 kg, P less than .05) tha those from the young dams (29 and 31 wk of age). Chicks from the young dams had better feed conversion (1.89 versus 1.93 g/g, P less than .01). The age of dam had no effect on the mortality of the broiler chicks. The presence or absence of SAT-waterers had no effect on body weight or feed conversion. A difference (P less than .05) occurred in mortality through 42 days of age; the chicks using the SAT waterers had a lower mortality level (3.23 versus 4.22%), than those using nipple-drinkers. The presence of ST-waterers in conjunction with nipple-drinkers appears to improve livability in broiler chicks.

Age Factors↗
PubMed1992

[Endoscopic findings of nipple fixation in Kock pouch].

Fixing the nipple to the pouch wall is indispensable to reduce the incidence of late complications of the Kock pouch. We performed endoscopy of the Kock pouch in 28 patients to evaluate the nipple valve fixation. We carried out submucosal fixation of nipple in 17 patients, fixation using staples in 2 patients and full layer fixation in last 9 patients. On endoscopy, both efferent and afferent nipples were poorly fixed or completely detached in 8 of the 17 patients who underwent submucosal fixation. On the other hand, there were no patients in whom the nipple was poorly fixed or completely detached among the other 11 patients. We experienced nipple malfunction in only one of the last 9 patients. Based on endoscopic findings and clinical results, we concluded that full layer fixation was reliable and useful to reduce the incidence of nipple valve complications.

Cystoscopy↗
PubMed1998

Thermal, olfactory, and tactile stimuli increase oral grasping of an artificial nipple by the newborn rat.

Caesarean-delivered rat pups tested before any suckling experience show oral grasp responses after stimulation with an artificial nipple. Manipulating the sensory stimuli present at the time of testing alters behavioral responses to the nipple. Specifically, when the nipple is warm, when pups are tested in the presence of amniotic fluid or milk odor, or when pups are tested in the presence of a conspecific, oral grasping of the artificial nipple is increased. Pups respond to the nipple with a shorter latency, show more oral grasp responses, and the individual grasp responses are longer in duration. The experiments suggest that the newborn rat pup exhibits a basic set of behaviors in response to the nipple early in development and that sensory stimuli normally present during the expression of suckling increase oral appetitive behaviors evoked by the nipple.

Animals↗
PubMed1998

Sore nipples in breast-feeding women: a clinical trial of wound dressings vs conventional care.

BACKGROUND: Sore nipples in breast-feeding mothers are a common cause of premature weaning, and are difficult to treat owing to recurrent trauma and exposure to the infant's oral flora. OBJECTIVE: To compare the safety and efficacy of a hydrogel moist wound dressing (Elasto-gel, Southwest Technologies Inc, Baltimore, Md) with the use of breast shells and lanolin cream in the treatment of maternal sore nipples associated with breast-feeding. DESIGN: Randomized controlled trial comparing the above treatments for sore nipples. Patients were seen for a maximum of 3 follow-up visits within 10 days, or until the resolution of symptoms. SETTING: The Maternal-Infant Lactation Center at the Mercy Hospital of Pittsburgh, Pittsburgh, Pa, a tertiary care teaching hospital in inner-city Pittsburgh. PATIENTS: A referred sample of 42 breast-feeding women who presented to the Maternal-Infant Lactation Center for the treatment of sore nipples. All patients with breast infection or chronic unrelated pain conditions were excluded from the study. INTERVENTION: After informed consent, patients were randomized to receive either a hydrogel wound dressing or breast shells and lanolin. All patients underwent a history, physical examination of the infant and the mother's breasts, assessment of breast-feeding technique, and breast-feeding instruction. MAIN OUTCOME MEASURES: The degree of pain on self-report questionnaires and the change in scores for physical examination, breast-feeding technique, and pain behaviors during breast-feeding. RESULTS: Although both treatments, in association with instruction in breast-feeding technique, were effective, greater improvement was seen in the group using breast shells and lanolin. This reached statistical significance for physician-rated healing (P<.01) and self-reported pain (P<.05). There were significantly more infections in the dressing group (P<.05), which resulted in early discontinuation of the study. CONCLUSIONS: Prevention of sore nipples by teaching proper technique on the initiation of breast-feeding should be instituted. For those cases in which sore nipples do develop, breast shells and lanolin in association with instruction in breast-feeding technique are more effective than moist wound dressings. Lanolin and shells should remain first-line therapy.

Adult↗
PubMed1997

Parity-related differences in suckling behavior and nipple preference among free-ranging Japanese macaques.

Suckling behavior of primiparae in free-ranging Japanese macaques (Macaca fuscata) was compared with that of multiparae at Jigokudani Monkey Park, the Shiga Heights, Nagano Prefecture, Japan, from April 1984 to 1994. The estimated rates of milk secretion in a single preferred nipple among primiparae were lower than those among multiparae from birth to 5 months of age. Milk secretion capabilities of primiparous mothers, hence, appear to be inferior to those of multiparous mothers. In nutritive suckling, although Japanese macaque infants preferred one single nipple, nipple preferences in primiparae were weaker than those in multiparae. With supplementary two-nipple use during suckling, however, the infants of primiparae appear to overcome a suckling flaw of their primiparous mothers. After infants were 5 months of age and after a drop (from approximately 10% to approximately 5%) in the rates of milk secretion, however, milk secretion rates in a single preferred nipple among primiparae were similar to those in multiparae and the supplementary two-nipple use in primiparous mother-infant dyads disappeared.

Animals↗
PubMed1997

Nerve supply of the breast with special reference to the nipple and areola: Sir Astley Cooper revisited.

Cooper in 1840 described mammary branches from the 2nd-6th intercostal nerves, and noticed that the nipple was supplied by branches which lay close to the surface of the gland. Eckhard (1850) divided the mammary branches into superficial branches to the skin and nipple, and deep branches to the glandular tissue and nipple, but many later authors ignored those findings. After the second World War, cosmetic surgery of the breast made further research critical, as surgeons strove to design operations which would retain its shape and preserve postoperative sensation. Craig and Sykes (1970) described mainly anterior branches from the 3rd, 4th and 5th intercostal nerves passing through the glandular tissue of the breast and along the line of the ducts to the nipple, while Farina et al. (1980) concluded that the nipple was supplied solely by superficial lateral branches of the 4th nerve. Using improvements in dissecting technique learned from microsurgery, Sarhadi et al. (1996) found that the nipple was innervated by the lateral cutaneous branch of the 4th intercostal nerve, by two branches, one passing superficial to the gland, and the other through the retromammary space, and by variable lateral and medial additional branches from the 2nd-5th nerves. These branches came to lie superficially and formed a subdermal plexus under the areola. This account is uncannily close to Cooper's original description; it is a reassuring, if sobering, conclusion that his early account remains one of the most reliable.

Anatomy↗
PubMed2004

Feasibility of breast-conserving surgery for patients with breast carcinoma associated with nipple discharge.

BACKGROUND: Few studies in the literature address the surgical management of patients with breast carcinoma who present with associated nipple discharge. The purpose of the current study was to determine the feasibility of breast-conserving surgery (BCS) for these patients. METHODS: The medical records of patients who presented with pathologic nipple discharge and underwent diagnostic or curative surgery between January 1990 and December 2002 were retrospectively reviewed. RESULTS: A total of 188 patients presented with nipple discharge during the study period. Of those, 47 had breast carcinoma. One patient had metachronous bilateral nipple discharge associated with malignant disease. Therefore, medical records associated with a total of 48 cases were reviewed. The median patient age was 52 years (range, 29-87 years), and the median follow-up duration was 45 months (range, 6-109 months). Twenty-nine patients had ductal carcinoma in situ (DCIS), 14 had Stage I disease, 3 had Stage II disease, and 2 had Stage III disease. Twenty-four patients were ultimately treated with mastectomy. For 16 of these patients, mastectomy was required because extensive disease was found in reexcisional segmental mastectomy specimens. Among patients with Stage 0 or I disease, the incidence of occult nipple-areola complex (NAC) involvement was 16% (3 of 19 patients). Twenty-four patients were ultimately treated with BCS with (n = 13) or without (n = 11) adjuvant radiotherapy. Local disease recurrence was noted at 14, 28, and 40 months, respectively, in 3 patients who declined adjuvant radiotherapy after BCS for DCIS. Among patients treated with BCS, comedonecrosis, multifocality, and the absence of adjuvant radiotherapy were associated with decreased local recurrence-free survival (P = 0.0005, P = 0.045, and P = 0.013, respectively). However, disease-free survival (mean +/- standard error) was similar for patients who underwent mastectomy and patients who underwent BCS (90 +/- 6 months; 95% confidence interval [CI], 78-101 months vs. 82 +/- 6 months; 95% CI, 69-94 months; P = 0.528). One patient with Stage I disease died of distant metastases at 99 months. CONCLUSIONS: Patients with breast carcinoma accompanied by nipple discharge presented primarily with early-stage breast carcinoma associated with DCIS. Occult NAC involvement was not an uncommon finding in patients with early-stage breast carcinoma. Nonetheless, BCS can be performed safely if negative margins are achieved and if appropriate adjuvant radiotherapy or systemic therapy is administered.

Adult↗
PubMed1986

Paget's disease of the nipple: a ten year review including clinical, pathological, and immunohistochemical findings.

Thirty-five women with biopsy-proven Paget's disease of the nipple were treated over a 10 year period at the Breast Cancer Unit, Guy's Hospital. Twenty-four (69%) patients had Paget's disease without a palpable mass in the breast; eleven (31%) presented with a palpable mass and Paget's disease of the nipple. Definitive treatment consisted of modified radical mastectomy in 32 patients, radiotherapy only in 2, and one patient had no definitive treatment. All 11 patients with Paget's disease and an associated lump proved to have invasive ductal carcinoma; five also had associated positive axillary nodes. Nine of the 23 patients with nipple changes only, treated by mastectomy, also had invasive carcinoma; three of these had positive axillary nodes. The remaining 14 patients with nipple changes only were found to have in situ ductal carcinoma, which was extensive in the majority of cases. In 13 cases, histological sections of the nipple were examined by immunohistochemical staining which showed that the Paget's cells expressed a keratin phenotype that was specifically characteristic of simple epithelial cells as seen in glandular epithelium. This was quite unrelated to the normal keratin phenotype of the surrounding skin keratinocytes. Clinical, pathological, and immunohistochemical data suggest a mammary origin of the abnormal cells in Paget's disease of the nipple. Mastectomy appears to be the treatment of choice.

Adult↗
PubMed2002

Routine operative breast endoscopy for bloody nipple discharge.

BACKGROUND: Submillimeter endoscopes are now available and have been described to assist surgeons in the evaluation and management of symptomatic nipple discharge. METHODS: To evaluate its potential use, a microendoscope (0.9 mm Acueity) was used on all patients in a single surgeon's practice who were undergoing nipple exploration for spontaneous hemoccult positive nipple discharge. This procedure was performed at the surgical resection of the symptomatic retro-areolar duct, and 27 patients underwent the endoscopy during the period from January 2000 to August 2001. RESULTS: In 96% (26 of 27) of the patients, the endoscope was successfully introduced into the lactiferous sinus, and the proximal breast ducts were successfully visualized. A lesion accounting for the bleeding was seen in all 26 patients, with 70% (n = 19) having multiple intraluminal defects. Cancers were identified in two cases (7.4%), and in both cases, there was a more proximal papilloma in the same ductal system. Similarly, in 33% of the benign cases, both papillomas and usual or atypical ductal hyperplasia were present. Lesions were identified that extended up to 7.5 cm deep to the nipple. The deepest lesion was one of the endoscopically identified cancers in a patient with normal mammogram and breast ultrasound. Surgical resection could be directed by simple transillumination of the skin during endoscopy. CONCLUSIONS: This series demonstrates the clinical feasibility of routine operative breast endoscopy in the management of bloody nipple discharge. The high incidence of multiple lesion identification suggests that the classic blind resection of a limited distance of duct in the retroareolar space may significantly underestimate the true extent of proliferative disease accounting for pathologic nipple discharge.

Adolescent↗