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PubMedDate not supplied

A new method for correction of inverted nipple with three periductal dermofibrous flaps.

The inverted nipple may be congenital or caused by repeated inflammation and breast surgery. The reported prevalence of congenital inverted nipple ranges from 1.77% [1] to 3.26%, and most of them are bilateral and umbilicated [2]. The inversion has been linked to many aesthetic, functional, and psychological problems. Many methods have been proposed to correct this deformity since the first surgical correction by Kehrer in 1879. I propose a new method with three periductal dermofibrous flaps to add bulk to the nipple base and to form a hammock to prevent recurrence. The design also shortens the circumference of the root of the nipple without compromise of the neurovascular supply. We have corrected 46 nipples of 25 patients with this method successfully since 1996. This method can be applied to all types of inverted nipple without significant complications.

Adult↗
PubMedDate not supplied

Correction of inverted nipple with modified star flap technique.

The authors describe the application of the modified star flap technique for correction of inverted nipples. This technique allows easy identification and dissection of the lactiferous ducts under a clear direct view without trans-nipple incision. The secure deep dermal buried sutures around the nipple base in three directions maintain the newly everted nipple. The blood supply to the nipple flap is reliable through the dermal and subdermal plexus from the remaining non-incised site of the nipple and areola region.

Female↗
PubMed2001

Fiberoptic ductoscopy for breast cancer patients with nipple discharge.

BACKGROUND: Breast cancer and precancer are thought to originate in the lining of the milk duct, but until recently, we have not had direct access to this area other than in tissue removed blindly by core biopsy or fine-needle aspiration. Fiberoptic ductoscopy (FDS) is an emerging technique that allows direct visual access of the ductal system of the breast through nipple orifice cannulation and exploration. To date, this technique has been used only in pilot studies. Previously, we have demonstrated that fiberoptic ductoscopy in patients with and without nipple discharge is a safe and effective means of visualizing the intraductal lesion. When combined with cytology, it is a screening technique that has high predictive value. METHODS: We applied ductoscopy to 415 women with nipple discharge with the specific intent of detecting those patients with nipple discharge who had intraductal carcinoma (DCIS) as the basis of their discharge. RESULTS: In this cohort of patients, ductoscopy was successful in visualizing an intraductal lesion in 166 patients (40%). In these cases, ductal lavage following ductoscopy increased the yield of cytologically interpretable ductal epithelial cells 100-fold compared to discharge fluid alone. In the majority of these patients, FDS examination detected lesions that had the appearance of typical papillomas. However, in 10 patients, the intraductal lesion exhibited one of several atypical features, including bleeding, circumferential obstruction, and gross fungating projections. In eight of these patients, the subsequent histopathology turned out to be DCIS. In two of these eight patients, endoscopic biopsy revealed cytologically malignant cells; in two others, ductal lavage (washings) revealed cytologically malignant cells. In three additional patients, although FDS examination uncovered a typical papilloma that was not biopsied, ductal lavage (washings) revealed cytologically malignant cells. On surgical pathology review of the extirpated lesions, all 11 patients were subsequently shown to have DCIS. Of these 11 cases of DCIS that were initially detected with a combination of FDS and ductal lavage cytology, six were completely negative on mammogram and physical exam. CONCLUSION: Although nipple discharge is an unusual presentation for DCIS, in patients with nipple discharge, FDS with ductal lavage cytology is a useful technique for diagnosing DCIS prior to definitive surgery.

Biopsy, Needle↗
PubMed1990

Sensory systems and nipple attachment behavior in neonatal pigs.

The influence of piglet sensory systems and the role of odors from the sow's ventrum on piglet nipple attachment were investigated. In Experiment 1, four sows had their ventrum washed with organic solvents and four were unwashed control sows. Piglets were given one of four treatments shortly after birth: nares that were mechanically blocked (B), a lidocaine flush of the olfactory system (LFO), a saline flush of the olfactory system (SFO) or nontreated controls (C). Time to attach to a nipple, up to a maximum of 600 sec, was recorded. On unwashed sows, nipple attachment was affected (p less than 0.01) by piglet treatment. Piglets have B or LFO treatments took longer to attach to a nipple than SFO or C piglets. Piglets of all treatments took longer to attach to washed sows than to unwashed controls. Seven unwashed sows and their litters were used in Experiment 2. Piglets were tested after birth with one of the following treatments: an olfactory system flushed with lidocaine, lidocaine on nose (LN), lidocaine applied to the tongue (LT) or nontreated controls. All lidocaine-treated piglets took more time to attach than C piglets. Nipple attachment latencies were intermediate for LN or LT piglets. In Experiment 3, three unwashed sows and their litters were used. Treatments were: lidocaine applied to both the nose and the tongue (LNT), an olfactory system flushed with lidocaine or nontreated controls. LFO piglets had an increased latency to attachment compared to controls while LNT piglets were intermediate in latency to attach. Piglet olfaction, gustation and tactile sensory modalities as well as odors on the sow's ventrum influenced nipple attachment.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

Nipple (papilla) development in girls: III. The effects of pregnancy.

Previous cross-sectional and longitudinal studies of girls have documented that they have a significant growth in nipple size during Tanner stages pubic hair (PH)4 and PH5 or breast (B)4 and B5. This study assesses whether there is any effect of pregnancy on nipple development in adolescent girls. Thirty-three pregnant girls were compared to a previously reported group of 390 girls who were not pregnant. Of the 33 girls, ten were followed longitudinally for a period of nine to 79 months, during which time they became pregnant. In each girl, nipple diameter was measured and the Tanner stage assessed. A markedly significant increment in nipple size was noted in the girls who were pregnant (pregnancy nipple size 12.6 mm vs. PH5 9.7 mm and B5 9.9 mm). Comparison of ten girls prior to and during pregnancy revealed a significant increment as well (10.2 mm vs. 12.8 mm, respectively). Pregnancy provides a further stimulus for nipple development in girls beyond that which occurs during normal puberty.

Adolescent↗
PubMed2005

Nipple fluid cytology.

With increasing emphasis on public awareness of breast cancer and screening mammography, more women seek consultation for breast symptoms, including nipple discharge. The presence of nipple discharge is distressing for the patient; however, its origin is fortunately most often benign. Nipple discharge associated with a recognizable mass requires sampling and surgical excision. Currently, clinical breast examination, cytology, ductography, mammogram, and ultrasound are commonly used to evaluate patients who have nipple discharge. Ductal lavage and ductoscopy, in association with emerging new technology, may be of help in increasing the sensitivity of nipple fluid cytology. In addition, nipple fluid cytology may offer a new way to study the spectrum of premalignant breast lesions, and to identify women at risk for breast cancer.

Breast Diseases↗
PubMedDate not supplied

Mammary ductoscopy for the evaluation of nipple discharge and comparison with standard diagnostic techniques.

STUDY OBJECTIVE: To describe performance of breast duct endoscopy and compare the method with conventional diagnostic techniques. DESIGN: Canadian Task Force classification III. SETTING: Interdisciplinary Breast Unit of a university hospital. PATIENTS: Consecutive and unselected series of 15 female patients including 20 breasts with nipple discharge. INTERVENTIONS: Prospective data assessment on all patients with ductoscopy for nipple discharge between April 2003 to April 2004. All preoperative (mammography, ultrasonography, nipple smear) and minimally invasive (galactography, fine needle aspiration cytologic study) diagnostics were evaluated and compared with ductoscopy. MEASUREMENTS AND MAIN RESULTS: Mammography on 20 breasts showed BI-RADS-I (5%), BI-RADS-II (50%), and BI-RADS-III (45%). Breast ultrasound scanning showed abnormalities, classified as BI-RADS-III equivalent lesions in all cases. Nipple smear showed in 69.2% a normal cytology and in most cases revealed a papilloma later (n=8/9). Unilateral galactography was performed in 46.7% who had spontaneous nipple discharge. Two galactography results were unremarkable, and open biopsy demonstrated 1 atypical ductal hyperplasia and papilloma. On 20 breasts of 15 women, 19 ductoscopies were successfully performed (95%). In 17 cases open biopsy followed ductoscopy, and 1 ductal carcinoma in situ (DCIS), 3 atypical ductal hyperplasia (ADH), 1 ductal hyperplasia without atypias, and 12 ductal papillomas were found. CONCLUSION: Compared to nipple smear, the diagnostic value of ductoscopy in this study is superior but marginally inferior to galactography and highly specialized breast ultrasound scanning. Therefore ductoscopy needs to be evaluated on a larger scale, preferably in multicenter trials to further determine its potential and indications.

Adult↗
PubMed1993

Paget's disease of the nipple without clinically and radiologically detectable breast tumor. Histochemical and immunohistochemical study of 44 cases.

Paget's disease of the nipple is a rare lesion nearly always associated with an underlying breast cancer, clinically impalpable and radiologically undetectable in about 40% of the patients. Fourty-four cases (28 mastectomies and 16 biopsies of the nipple) of Paget's disease of the nipple without clinically and radiologically detectable breast tumor were retrospectively studied by means of histochemistry and immunohistochemistry. Histochemical study showed that Paget cells were PAS positive and diastase resistant, and alcian blue positive at pH 2.5 in 32% and 18%, respectively. Immunohistochemical study showed that Paget cells were EMA and c-erbB-2 positive in 100% and 84%, respectively. Four of the six EMA positive and c-erbB-2 negative cases of Paget's disease of the nipple in which the underlying tumor could be pathologically analyzed were associated with ductal carcinoma in situ of cribriform or mixed types. These findings are helpful for differentiating Paget's disease from other lesions of the nipple, namely Bowen's disease and eczema which do not react with both antibodies, and from nipple adenoma which exhibits a positive staining with anti-EMA antibody and no reactivity with anti-c-erbB-2 antibody.

Adult↗
PubMed1998

Prediction of nipple and areola involvement in breast cancer.

AIMS: To find a pre-operative test for nipple and areola involvement in breast cancer. METHODS: Areola-tumour distance was measured in 140 consecutive patients (median age 45, range: 23-83) undergoing a mastectomy. We analysed whether nipple and areola correlated with areola-tumour distance, tumour size, nodal status, perinodal involvement and lymphatic embolization. RESULTS: The nipple was involved in 22 (16%) cases and this correlated with tumour size, number of lymph nodes, perinodal extension and presence of lymphatic emboli. In all these 22 cases, the tumour was within 2.5 cm of the areola. Tumour size, however, could not predict nipple involvement in tumours within 2.5 cm of the areolar edge. CONCLUSIONS: In the one-fifth of cases where the tumour is over 2.5 cm from the areola, preserving the nipple and areola for reconstruction may be worthwhile. In remaining cases, some other predictive test for nipple involvement would be necessary.

Adult↗
PubMed1998

Nipple and areola diameter in Turkish pubertal girls.

The nipple and areola diameter of 498 girls aged 8-17 years were studied with the aim of finding measurable criteria for sexual maturation, including breast and pubic hair development during female puberty. All measurements were made holding a transparent ruler on both sides by the same observer. The smaller of the two measurements was used in the analysis. Significantly nipple and areola development occurred between breast stages B1 (2.56 and 14.35 mm), B2 (3.32 and 20.26 mm), B3 (5.21 and 28.84 mm), and B4 (6.28 and 32.03 mm). The nipple and areola diameter were also significantly greater in pubic hair stage (PH)3 (5.05 and 25.24 mm) with respect to PH2 and PH1 (3.46, 2.62 mm and 19.32, 15.37 mm, respectively), in PH5 (6.79 and 35.62 mm) with respect to PH4 (6.55 and 32.56 mm). A significant increase in nipple and areola diameter occurs between premenarchal girls and girls older than 0-2 years postmenarche. Sexual maturation staging by nipple size and by areola size appears to be feasible for female adolescent. However, staging by nipple size does not appear to be feasible for B4 and B5 stage, because the incremental gradations are small.

Adolescent↗
PubMed2003

Cytology of abnormal nipple discharge: a cyto-histological correlation.

Spontaneous or expressible nipple discharge may occur in palpable and nonpalpable breast lesions. The aim of the study was to evaluate the sensitivity and specificity of nipple discharge cytology in palpable and nonpalpable breast lesions. One hundred and seventy-four nipple discharge specimens were reviewed, of which 82 had corresponding surgical pathology, including 34 palpable breast lesions and 48 nonpalpable breast lesions. There was good correlation between nipple discharge cytology and concomitant fine needle aspiration (FNA) cytology. Nipple discharge cytology is as specific as concomitant FNA cytology but is slightly less sensitive in detecting papillomas or malignant lesions. The sensitivity and specificity of the nonpalpable and palpable breast lesions were similar. Nipple discharge cytology is very helpful in detecting an underlying breast lesion even if the case has no palpable mass in the breast.

Adolescent↗
PubMed2001

Nipple discharge: current diagnostic and therapeutic approaches.

Nipple discharge is a complex diagnostic challenge for the clinician. A variety of diseases (such as intraductal papillomas, mammary duct ectasia, breast cancer, pituitary adenomas, breast abscesses/infections, etc.) can manifest as nipple discharge. The importance of nipple discharge for both the patient and the physician is the possible association of this condition with an underlying carcinoma. With heightened public awareness of breast cancer, an increasing number of women are asking their health care providers about nipple discharge. A detailed clinical evaluation is invaluable to determine the pathophysiology, assess the risk of malignancy, and plan treatment of the patient with nipple discharge. A combination of diagnostic tests, including mammography, breast ultrasonography, and possibly galactography can help the clinician to establish the diagnosis and plan proper management. Depending on the underlying breast pathology, a central or single lactiferous duct excision is the procedure of choice. Breast carcinoma associated with nipple discharge should be treated by either a modified radical mastectomy of breast-conservation therapy (i.e. duct-lobular segmentectomy with adequate, free margins [ideally>1cm], levels I and II axillary lymph node dissection, followed by breast irradiation).

Breast Diseases↗
PubMed1980

[The significance of the nipple in carcinoma of the female breast (author's transl)].

In 1,000 specimens of mastectomy with microscopically proven carcinoma of the breast, cancer was found in the nipple in approximately every fifth case. Extension of the carcinoma into the nipple is more frequent in the higher age group of women. Extension into the nipple is more common with larger tumor size. The microscopic growth pattern of the carcinoma has an influence on the presence of tumor in the nipple whereas the microscopic grading for malignancy according to WHO has no clear cut correlation to tumor in the nipple. The frequency of extension of carcinoma of the breast in the nipple in our series and in most series in the literature is in our opinion a contra-indication to conservative types of operation.

Adult↗
PubMed2002

Nevoid hyperkeratosis of the nipple and areola: a distinct entity.

Although nevoid hyperkeratosis of the nipple and areola was initially described in 1923, there are only case reports or reviews about it; no large series have been documented to date. The clinical features of the reported cases in the literature are not uniform, and it is questioned whether nevoid hyperkeratosis of the nipple and areola is a distinct clinicopathologic entity or a clinical presentation of various dermatoses. We describe 7 cases with hyperkeratotic nevoid lesions localized on the nipple and areola with different clinical features. None of them had any other associated dermatologic or systemic disease. Histopathologic examination was performed in 6 patients. Four of them had common histopathologic features suggesting a distinct entity, namely, nevoid hyperkeratosis of the nipple and areola; 2 of them had histopathologic features consistent with seborrheic keratosis. Seborrheic keratosis presents as sharply demarcated papules or plaques, whereas nevoid hyperkeratosis of the nipple or areola presents as a plaque diffusely involving the nipple or the areola.

Adolescent↗
PubMed1998

Nipple reconstruction with a modified S-flap technique.

A modified S-flap method for nipple reconstruction with two local opposing skin flaps, was used for a series of 21 women with a mean age of 50 years (range 30-64). Four patients had bilateral breast reconstructions, so the total number of reconstructed nipple areola complexes (NAC) was 25. The patients were examined 29-46 months (mean 36) after the reconstruction with particular reference paid to projection, size, sensation, and colour of the nipples. The patients also answered a questionnaire about their assessment of the final result. The mean projection of the nipples was 3.9 mm (range 0-9). Five patients had various degrees of necrosis of the skin flaps. One third of the women had some sensation in their reconstructed nipples. Two thirds of the nipples were pale. The patients estimated the final result as 8.2 (range 1-10) on a visual analogue scale.

Adult↗
PubMed2002

Male rats exposed to linuron in utero exhibit permanent changes in anogenital distance, nipple retention, and epididymal malformations that result in subsequent testicular atrophy.

Prenatal exposure to the herbicide linuron, a weak androgen receptor antagonist, has been shown to perturb androgen-dependent male rat reproductive development as evidenced by slight decreases in anogenital distance (AGD), increased retention of areolae/nipples, and induction of epididymal malformations in combination with testicular atrophy in the adult rat over dose levels ranging from 12.5 to 100 mg/kg/day. Studies were undertaken to determine whether linuron-mediated changes in AGD and nipple retention are permanent, whether linuron is a direct testicular toxicant, and if there was an association between areola/nipple retention and malformations. Pregnant rats were administered corn oil vehicle or linuron by gavage at 0 or 50 mg/kg/day (n = 8 controls, 20 treated) from gestation days 12 to 21. Male offspring were necropsied on postnatal days (PND) 35 and 56. Linuron-exposed male rats exhibited a significant (8%) decrease in AGD on PND 1 and a similar decrease was also observed on PND 56. Linuron-exposed male rats displayed an increase in areola retention on PND 13, as evidenced by 0.6 +/- 0.5 and 3.3 +/- 0.4 areolae per rat in the control and exposed groups, respectively. Male rats displayed a significant increase in nipple retention on PND 35 and 56 (collectively) of 0 +/- 0.5 and 1.7 +/- 0.3 nipples per rat in control and exposed groups, respectively. On PND 35, 4/51 rats (3/9 litters) from linuron-treated dams displayed enlarged testes in combination with malformed epididymides. Epididymal malformations were observed in 19/51 rats (6/9 litters) in the linuron-exposed dose group. On PND 56, grossly enlarged and edematous testes were seen in 16/56 linuron-exposed rats (6/9 litters). Epididymal lesions were observed in 23/58 rats (6/9 litters). Microscopically, all linuron-exposed animals that exhibited a testicular lesion on PND 56 also displayed an epididymal lesion. These lesions were not seen in control animals. Approximately 25 and 60% of the male offspring that had malformations of the epididymis and vas deferens did not exhibit either areolae on PND 13 or nipples at necropsy, respectively. These data indicate that in utero linuron exposure to 50 mg/kg/day results in permanent changes in AGD and nipple retention in male rats. Moreover, these findings indicate that linuron-induced testicular atrophy, which is observed in adult rats, is secondary to increased intratubular pressure resulting from obstruction of testicular fluid outflow subsequent to malformation of the epididymides. These data also suggest that although linuron-mediated retention of areolae on PND 13 and nipples at necropsy may be suggestive of altered testosterone-mediated reproductive development seen in adult rats, these endpoints are not predictive.

Abnormalities, Drug-Induced↗
PubMed1992

Bilateral reconstruction of the male nipple.

The opportunity to reconstruct the male nipple rarely presents itself. The loss of the nipple due to trauma or surgery is itself rare. Most patients consider its loss a minor problem and the nipple not worth reconstructing. The only description of a male nipple reconstruction in the literature is that of a unilateral reconstruction using a split-thickness graft from the opposite side with a suboptimal result. In this report, I detail the reconstruction of bilateral male nipples in the survivor of a severe burn. The final result is a culmination of three successive procedures performed to improve each previous result. The result of each procedure is critically analyzed, with an excellent final result. We conclude that the best male nipple reconstruction is that in which the areola and papilla are given independent attention during reconstruction. We recommend a single, safe, procedure that fulfills this requirement and can be performed under local anesthesia.

Adult↗
PubMed1993

Nipple-areola reconstruction with intradermal tattoo and double-opposing pennant flaps.

Reconstruction of the nipple-areolar complex is an important part of postmastectomy breast reconstruction. Intradermal tattooing is effective for creating areolar pigmentation and is simpler than skin grafting. However, a simple method for the construction of a normal nipple using local tissues remains a challenge. Several techniques achieve long-term nipple projection but at the expense of complicated flap design, multidirectional scars, and often a need for skin grafting to obtain a uniform-appearing areola. Our one-stage method of nipple-areola reconstruction uses intradermal tattooing for pigmentation and double-opposing pennant flaps for nipple reconstruction. The entire procedure is simple and fast, routinely performed in < 30 minutes under local anaesthesia in the office. From September 1989 to March 1992 we performed 102 reconstructions. The method produces a realistic appearing nipple. We have had no flap necrosis.

Female↗