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At least 253 records · Page 14Linked to original sources
PubMed1996

Psychological aspects of nipple pain in lactating women.

The aim of the study was to assess the psychological impact of nipple pain in lactating women. Forty-eight lactating women with nipple pain completed mood scales at their first visit and following resolution of their pain, and 65 lactating women without nipple pain completed one set of mood scales. At the first visit, the mean score on the Edinburgh Postnatal Depression Scale (EPDS) in the nipple pain group was 12.4 and the control group was 7.6 (p < 0.0001). Eighteen women (38%) scored above the threshold for depression (> 12), compared to nine in the control group (14%): p < 0.01. Following pain resolution, the mean score on the EPDS decreased to 7.3 (p < 0.001); and six women (16%) scored 13 or over on the EPDS, significantly less than initially (p < 0.05). Similarly, on the Profile of Mood States (POMS), the nipple pain group scored significantly higher than control group on all mood factors (Tension, Depression, Fatigue, Confusion, Vigor [lower]), except Anger which did not reach a level of significance. After pain resolution, POMS scores returned to similar levels as the control group. In conclusion, both the EPDS and POMS indicated women with nipple pain were experiencing high levels of emotional distress. However, once the pain had resolved their distress also resolved.

Adult↗
PubMed1991

Skin circulation in the nipple after reduction mammaplasty with a bipedicle vertical dermal flap.

Necrosis of the nipple after a reduction mammaplasty with transposition of the nipple is a serious complication. A study was undertaken to measure the skin circulation in the nipple before, during and after this operation. In 16 patients undergoing reduction mammaplasty according to the method of McKissock, the skin circulation was measured in both breasts by laser Doppler flowmetry (LDF) and fluorescein flowmetry (FF). LDF showed that the skin circulation increased after de-epithelialization to 245.7 +/- 39.3% of the preoperative blood flow (100%) (mean +/- SEM, p less than 0.01). When 40 ml of 0.25% adrenaline was injected into the incision lines, the corresponding increase in blood flow was 153.4 +/- 15.6% (p less than 0.01). After the medical and lateral glandular resections the blood flow in the nipple of the vertical dermal pedicle was 125.6 +/- 21.2% of the preoperative blood flow and when adrenaline was given the corresponding value was 79.3 +/- 6.5%. After the skin had been sutured, the blood flow was 128.4 +/- 25.9% of the preoperative value and in the breast in which adrenaline was injected it was 177 +/- 96.9%. One to four days postoperatively the blood flow was 123.1 +/- 19.9% of the preoperative value and in the breast that received adrenaline 130 +/- 24%. At FF homogeneous fluorescence was observed in the nipple postoperatively in all patients but one; in this patient avascular necrosis later developed. Our results thus show that the circulation in the nipple after reduction mammaplasty by the McKissock method is adequate.

Adult↗
PubMed1999

[Adenoma of the nipples. A rare, but essential differential diagnosis].

A case is presented, where a 52 year-old woman with a two month history of nipple discharge was diagnosed with adenoma of the nipple. A total excision of the nipple was performed. Adenoma of the nipple is a rare, but benign condition, which clinically can be confused with Paget's disease of the nipple, intraductal papilloma and adenocarcinoma of the breast. Complete excision of the nipple is an adequate treatment of this condition.

Adenoma↗
PubMed2000

Impacts of breast-care techniques on prevention of possible postpartum nipple problems.

An experimental study was designed to compare the effectiveness of three techniques on the prevention or reduction of nipple pain and cracked nipples during the first ten days postpartum. The methods were to apply warm compresses, to apply expressed breast milk or to give no treatment other than keeping the nipples dry and clean. Applying warm compresses or expressed breast milk was found to be less effective in preventing cracked nipples than simply keeping the nipples dry and clean. The number of cases with nipple pain was less in the group that applied expressed breast milk.

Adult↗
PubMed2005

Nipple reconstruction: the top hat technique.

A new surgical technique was evaluated in 23 nipple-areola complex reconstructions in 18 consecutive patients who underwent breast reconstruction techniques. The author used 2 rows of pursestring sutures, one at the base of the neonipple and the other at the periphery of the neoareola. The pursestring sutures act as a supporting platform. The nipple projection was created by suturing in a vertical fashion: 4 horizontal incisions creating 4 supporting pillars. The Montgomery tubercles were simulated by secondary healing of 2- or 3-mm randomly placed stab incisions in the neoareola. The micropigmentation of the nipple-areola complex was performed preferably 6 weeks before the nipple-areola reconstructions. The mean follow-up time was 18 months. The average nipple projection was 6 mm, and the average diameter was 10 mm. Two patients presented with partial loss of nipple projection. Overall, more than 90% of the patients were satisfied with this procedure.

Adult↗
PubMed2005

Evaluation of skin perfusion after nipple-sparing mastectomy by indocyanine green dye. Preliminary results.

The aim of the study was to investigate the blood supply of the normal nipple areola complex (NAC) and the spared areola complex after a nipple-sparing mastectomy using the analysis of the fluorescence from the indocianine green dye (ICG) injection. Between December 2002 and July 2003 we performed the ICG analysis in 10 cases of healthy breasts and in 9 patients after a nipple-sparing mastectomy and one patient after subcutaneous mastectomy. In all cases, the resulting fluorescence was measured in three different zones: nipple, areola, surrounding mammary skin. Three parameters of the fluorescence curve (slope, maximum intensity, time to achieve a maximum level) were recorded. On the healthy breast, the nipple showed a very high perfusion as compared to the other zones. On the contrary, after the mastectomy the fluorescent pattern was completely altered, being the perfusion of the nipple very low. In conclusion, these preliminary results confirm the applicability and the importance of the ICG technique for evaluating the perfusion of the healthy and spared areola after surgery. Because of the small number of patients further studies are needed.

Female↗
PubMed2005

Quadrantectomy and nipple saving mastectomy in treatment of early breast cancer: feasibility and aesthetic results of adjunctive latissmus dorsi breast reconstruction.

BACKGROUND AND PURPOSE: Breast conserving surgery has been a recognised method of treatment of early breast cancer. The treatment methods include quadrantectomy or skin sparing mastectomy combined with ipsilateral axillary nodal dissection followed by radiotherapy. In the current study we evaluate the feasibility and oncologic safety of the quadrantectomy and SSM operations with preservation of the nipple and areola, and the cosmetic results of immediate reconstruction by using the latissmus dorsi flap. MATERIALS AND METHODS: A breast conservative surgery (quadrantectomy or nipple sparing mastectomy) was carried out in a group of 55 patients with invasive breast cancer treated at the Department of Surgical Oncology, NCI, between January 2001 and April 2004. The selection criteria included those patients who presented with T1 or T2 breast cancer and were located at least 2 cm from the nipple as the centre for the nipple areola complex. RESULTS: The age of the patients ranged from 32 years to 65 years. The follow up period ranged from 2 to 33 months with an average of 21 months. Pathological assessment of the specimens showed a negative safety margin in all cases. Most of our cases were invasive duct carcinoma grade 1-2 (42) (75%). The complications of the flap reconstruction included one major sloughing of the latissmus dorsi flap, 4 partial flap sloughing, 4 sloughing of the nipple and fat necrosis in 6 patients. The donor site healed normally in all of our cases except for one patient who suffered from a hypertrophic scar which settled down during the follow up period. The aesthetic assessment of the patients, showed an excellent to good results in the majority of cases (42) (75%) while in 6 (12%) results were fair and in 7 (13%) results were poor. CONCLUSION: Breast conservative surgery with quadrantectomy or skin sparing technique with preservation of the nipple and areola combined with immediate LD flap reconstruction is a valid procedure for treatment of early breast cancer. Immediate reconstruction by using the extended latissmus dorsi is as safe, relatively easy procedure which can provide an adequate volume replacement for small to moderate sized breasts.

Adult↗
PubMed1991

[Cytopathology of the breast. 1. Secretion and nipple cytology].

Cytological examinations of breast secretions, nipple smears and breast fine needle aspirates can establish important diagnostic findings provided that technical conditions and methodical advantages and disadvantages are taken into consideration. The first part of the paper is dealing with clinically relevant aspects of secretion and nipple cytology. These simple examinations are applicable by every gynaecologist. The source of cell material is the spontaneous exfoliation, which should be increased in nipple smears by additional procedures. Diagnostic findings of secretion cytology can be obtained in breast cancer, duct papilloma, cystic fibrosis, and inflammatory lesions. The value of secretion cytology for breast cancer detection is limited, because pathological secretion is only induced in a small number of patients. Cytological examinations of nipple lesions are useful especially in the presence of Paget's disease and other tumors of the nipple. Limitations are caused by difficulties in cell sampling. Easy practicability and little alteration of the patient are the major advantages of the secretion and nipple cytology, which stands opposite a limited sensitivity as disadvantage.

Biopsy, Needle↗
PubMed1990

Mastectomy and breast reconstruction preserving the nipple.

Total mastectomy and immediate reconstruction using the latissimus dorsi myocutaneous flap with nipple preservation has been performed in 87 women. The palpable tumours were all more than 3 cm from the nipple. No recurrence in the preserved nipple was seen in 63 women who underwent the procedure for tumour recurrence after previous radiotherapy. Nipple recurrence occurred in 3 out of 24 women (12%) where the indication was multifocal disease and no radiotherapy was given. This non-irradiated group should either not have the nipple preserved or should undergo postoperative electron field therapy to the nipple-areolar complex.

Adult↗
PubMed1986

Construction of the nipple with a mushroom-shaped pedicle.

Construction of the nipple-areolar complex has been the subject of much interest and many papers. We believe that the best way to ensure nipple protrusion is by the entrapment of tissue above the skin surface so that it cannot retract. This, in principle, is similar to creating an irreducible hernia. This technique for nipple construction employs a circular split-thickness island of skin which has its central circulation preserved through its attachment at the new nipple site. This central stalk represents about one-quarter of the total surface area of the constructed areola. The total diameter of the areolar disk is usually determined by the size of the opposite nipple-areolar complex. The new areola is developed from a full-thickness skin graft taken from the area below the inguinal crease. Once removed, it is sutured over the elevated nipple segment with its central island. The full-thickness graft is sutured into place before a small cruciate incision is made in the center. It should be just large enough to permit the delivery of the dermal-epidermal flap on its stalk up through the opening. Nothing more need be done to the raw undersurface of the split-thickness skin. Its raw surface has no place to reattach because its bed is now covered with the full-thickness graft.(ABSTRACT TRUNCATED AT 250 WORDS)

Breast↗
PubMed1986

Nonpuerperal nipple discharge in Nigerian women.

100 Nigerian women were entered into a prospective study of spontaneous occurring nipple discharge over a seven year period. The patients consisted of 25 study group patients and three groups of 25 patients comprising the controls. In the study group, seven types of nipple discharge were identified, namely: bloody (40%), watery (4%), and milky (4%). Intraductal papilloma and other benign breast disease were the cause of nipple discharge in 23 of 25 (88%) study group patients. Only 28% of breast cancer patients in control group A, 16% of bloody or serosanguineous and 16% of benign breast tumor patients of control group B presented with nipple discharge. Nipple discharge was an incidental finding in 16% of normal control group C patients. Thus Nigerian women are more likely to seek medical intervention for bloody and serosanguineous discharge. Surgical management remains the optimal management for nipple discharge.

Adult↗
PubMed1983

Results of nipple areola reconstruction.

Reconstruction of the nipple-areola complex is being performed for about a quarter of postmastectomy breast reconstruction patients. The methods used and results achieved in thirteen reconstructions were reviewed. Full thickness skin grafts from the upper inner thigh were used for the areola, with 100% success. For the nipple proper, most (eight) had a composite graft from the opposite nipple, with 100% take if the dressing was kept in place for 10-12 days. Earlobe tissue made an excellent nipple reconstruction for bilateral cases (four). It is concluded that nipple-areola reconstruction is safe, simple and predictable. A second operation is recommended for this surgery to ensure symmetry of nipple position, a fundamental requirement for a good result.

Adult↗
PubMedDate not supplied

The significance of nipple discharge: diagnosis and treatment regimes.

Breast cancer is one of the most dreaded diseases affecting women and is associated with a high degree of morbidity and mortality. Any breast complaint has the potential for creating a great deal of anxiety for patients and providers alike. An in-depth understanding of the pathophysiology of common breast complaints, particularly those with low probability of association with cancer such as nipple discharge, can serve to allay anxiety and prevent the financial and emotional burden of unnecessary diagnostic evaluations. It will then improve the quality of care for each patient experiencing the symptom. Although the greatest incidence of nipple discharge is not secondary to malignant processes, the fact that some are requires that all persons with nipple discharge receive the benefit of a thorough assessment. When planning a course of action to assess and treat nipple discharge, a thoughtful stepwise, planned approach is necessary. The evaluation of nipple discharge can be undertaken with minimal difficulty by performing a thorough history, a careful physical examination, and following a logical thought process in linking the type of discharge with the suitable adjunct diagnostic testing. Appropriate management evolves from this process. It is important to view the patient in total, considering such issues as family history, other risk factors, how disruptive the level of anxiety about the symptom. Primary care providers, working with their parents, are well positioned to design appropriate diagnostic and treatment regimes to assess and treat nipple discharge. A thoughtful, prudent approach to this symptom can save both health care dollars and lives.

Breast Diseases↗
PubMed1998

Report of a nipple nevus and an overview of accessory mammary tissue.

Supernumerary nipples, also known as accessory nipples, are the most frequently encountered congenital anomaly of the breast. Once associated with fertility or divine powers, they are now widely held to be of cosmetic significance only. During the past 20 years, however, there has been a steady number of articles reporting the suspected association of supernumerary nipples with numerous benign and malignant medical conditions. We describe a previously unreported accessory nipple variant occurring as a nevoid nodule surmounting an otherwise normal primary nipple. The patient was otherwise healthy. The embryogenesis of this anomaly is hypothesized to result from in utero nipple dichotomy, rather than a failure of regression along the embryonic milk line.

Adult↗
PubMed1980

The ontogeny of nipple-shifting behavior in albino rats: mechanisms of control and possible significance.

Nipple-shifting behavior was studied in rats 3--30 days old in 4 experimental paradigms. The incidence of nipple-shifting of rats tested in groups of 3 on their nonlactating, anesthetized mother was age-related. Rats 12 days of age and younger did not leave the nipple first suckled during the 2-hr test period. Starting by Day 15, however, nipple-shifting increased and reached its maximum in 24-day-old rats. This behavior's incidence was directly related to maternal (and, therefore, nutrient and water) deprivation (Experiment I). Milk letdown reduced the incidence of nipple-shifting behavior at all ages studied and synchronized its occurrence, as almost all shifts occurred immediately aftet letdown and almost none during the 15-min interval between successive milk letdowns (Experiment II). Testing rats individually on the nonlactating, anesthetized mother produced age-related effects. Shifting was virtually eliminated in 15-day-old rats, markedly reduced in 21-day-old rats, and not affected in 27-day-old rats tested individually (Experiment III). Rats 27 and 30 days of age, upon leaving a nipple, ate and did not return to suckle. Rats 15 days old never ate and always returned to suckle (Experiment IV). Twenty-one-day-old rats suckled, and many ate in the mother's presence. The significance of these findings relates to maximizing milk intake and facilitating the process of weaning.

Aging↗
PubMed1984

The use of tactile and olfactory cues in neonatal orientation and localization of the nipple.

A good deal of effort has been directed toward determining the sensory cues employed by neonatal animals in orienting to, and localizing, the nipple. The results of previous studies are contradictory. Some investigators have claimed that olfactory cues are critical, while others suggest that tactile cues are of primary importance in these behaviors. The present studies indicate that, in kittens, there are two essential components of the suckling process: orientation to the mother and localization of the nipple. In these experiments, the ability and time involved in localizing and attaching to the nipple of the anesthetized mother were measured in several conditions. With tactile input impaired, kittens had no difficulty locating the mother, but could not locate the nipple. In contrast, olfactory disruption never impaired nipple localization and attachment when the kitten was in contact with the mother, but interfered with the kitten's ability to locate the mother when removed from her. These data suggest that olfactory cues are employed in locating the mother, and tactile cues from the perioral region are employed in locating the nipple.

Animals↗
PubMed1998

Reconstruction and undiversion of the short or severely dilated ureter: the antireflux ileal nipple revisited.

PURPOSE: Patients undergoing reconstruction of short or severely dilated aperistaltic ureters are at significant risk for mechanical or functional obstruction and reflux, particularly when the ureters are being reimplanted into gastric or intestinal segments. For this problem we describe a simple handsewn, "stapleless" antireflux ileal nipple, which serves as a useful bridge between a short ureter and the bladder or reservoir. MATERIALS AND METHODS: A total of 12 patients, 4 to 42 years old (mean age 19), 9 with severely dilated and 3 with short ureters have received the stapleless antireflux ileal nipple as part of various reconstructive efforts. Briefly, a 12 to 15 cm. segment of ileum is isolated and the mesentery is stripped from the middle 8 cm. of the isolated segment, preserving the blood supply to the proximal and distal 2 cm. of ileum. Intussusception is created and maintained with multiple (5 to 7) circumferential rows of 4 to 6 interrupted seromuscular stitches of 3-zero silk. RESULTS: Mean followup is 27.5 months (range 6 to 60). Upper tract dilatation has stabilized or improved in all patients, deteriorating temporarily in 1 who had distal nipple stenosis. All patients underwent followup video urodynamic studies, which demonstrated no reflux. Nipple related complications included nipple stenosis in 1 patient and dessusception in another. Both complications were corrected without sequelae. Ureteroileal stenosis or stone formation has not occurred. CONCLUSIONS: The stapleless antireflux ileal nipple is safe and reliable in preventing reflux. It is a versatile adjunct to urinary reconstruction in patients with short or severely dilated, aperistaltic ureters in whom the alternative of a tapered reimplantation into a segment of bowel or stomach poses a significant complication threat.

Adolescent↗
PubMed2006

Long-term followup of the intussuscepted ileal nipple and the in situ, submucosally embedded appendix as continence mechanisms of continent urinary diversion with the cutaneous ileocecal pouch (Mainz pouch I).

PURPOSE: We analyzed stoma related complications and continence rates in patients who underwent continent urinary diversion with the cutaneous ileocecal pouch (Mainz pouch I). We compared the intussuscepted ileal nipple and in situ, submucosally embedded appendix as continence mechanisms. MATERIALS AND METHODS: A total of 401 patients were included in a retrospective followup study. Continence mechanisms were the intussuscepted ileal nipple in 205 patients and the in situ, submucosally embedded appendix in 196. RESULTS: A total of 144 patients (36%) required intervention for a stomal complication. Of patients who received an intussuscepted ileal nipple 34 (17%) had stomal stenosis at a mean time to first stenosis of 43.8 months, 41 (20%) had stones at a mean interval to the first stone of 62.8 months, 12 underwent reoperation for stomal incontinence, including 1 because of nipple necrosis, and 82% were completely continent. Of patients who received an in situ, submucosally embedded appendix 63 (32%) had stomal stenosis at a mean time to first stenosis of 31.4 months, 20 (10%) had stones at a mean interval to the first stone of 47.5 months, 3 underwent reoperation for stomal incontinence, 4 had appendiceal necrosis and 92% were completely continent. CONCLUSIONS: Of stomal complications 63% were treated endoscopically. The higher rate of stomal stenosis with the appendiceal stoma is most likely due to the smaller diameter of the appendix. The higher rate of stone formation in patients with the intussuscepted ileal nipple is related to metal staples. Continence rates of the 2 outlets are good with somewhat larger amounts of mucous secretion from the larger stoma of the intussuscepted ileal nipple.

Adolescent↗