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PubMed1994

Reduction mammaplasty for gigantomastia using inferiorly based pedicle and free nipple transplantation.

Patients with gigantomastia have severely distorted anatomical breast structures. Reduction mammaplasty in such cases using the inferiorly based pedicle containing the nipple-areola complex can be technically difficult, yield poor results, and cause postoperative complications such as nipple necrosis and loss. Alternative traditional methods such as amputation mammaplasty with free nipple-areola transplantation usually results in a flattened, nonaesthetic breast with poor projection. This unacceptable result is due to the lack of central breast tissue required for normal anatomical projection. Herein, we describe a method of reduction mammaplasty for gigantomastia combining free nipple transplantation and an inferiorly based pyramidal parenchymal flap for augmentation of breast fullness and nipple projection.

Adult↗
PubMed1981

Treatment of impending nipple necrosis following reduction mammaplasty.

Despite careful preoperative planning and accurate surgery, nipple necrosis may follow reduction mammaplasty. Impending nipple necrosis developed following translocation of the nipple and areola on a dermal pedicle in two patients. An excellent result was obtained by converting the nipple-areola complex to a full-thickness graft and removing the avascular portion of the breast. We recommend this technique to the surgeon whose patients develop impending nipple necrosis after reduction mammaplasty.

Adult↗
PubMed1989

Intradermal tattoo as an adjunct to nipple-areola reconstruction.

Improving results in breast reconstruction have encouraged more authentic restoration of the lost nipple-areola. While recreation of nipple shape can be reliably achieved, appropriate color has remained elusive, except when a composite nipple graft has been harvested from the normal breast, often at a significant aesthetic, emotional, and oncologic cost. Extensive experience with intradermal tattooing of the nipple-areola in over 100 patients over a 5-year period has shown this technique to be exceptionally safe and effective. Both medical-grade and commercial machines are available at varying prices, and medical-grade pigments may be obtained in a variety of authentic flesh tones derived from titanium or iron oxides. In nearly every case, tattooing has helped with either nipple-areola color, size, shape, or position, without any significant complications. Some degree of tattoo fading is common, requiring occasional late touch-ups and, more rarely, complete retattooing.

Aged↗
PubMed1998

Nipple-sparing total mastectomy of large breasts: the role of tissue expansion.

Nipple-sparing total mastectomy remains an alternative for management of patients with high risk breast disease or patients with various types of symptomatic breast problems. In a patient with large breasts, however, achieving good cosmesis while still performing a thorough mastectomy remains a challenge. This report includes 10 patients who underwent unilateral nipple-sparing total mastectomy and 10 patients who underwent bilateral nipple-sparing total mastectomy. Tissue expansion was used as the reconstructive technique in this consecutive series done from 1985 through 1988. All expanders were placed in the submuscular position, and hyperbaric oxygen was used when intraoperative fluorescein administration identified marginally perfused areas. The average volume of breast tissue removed was 800 gm. The average permanent implant size was 767 cc. Complications included partial skin or nipple loss, infection, and problems related to the implants themselves. The complication rate, however, was not excessive, and results have been good as measured by cosmetic results, capsule grade, and lack of development of cancer in operated breasts. This reconstructive technique is recommended as an alternative in those patients undergoing nipple-sparing total mastectomy.

Adult↗
PubMed1998

Tissue-engineered nipple reconstruction.

We describe a simple, effective approach to the creation of autologous tissue-engineered cartilage in the shape of a human nipple by injecting a reverse thermosensitive polymer seeded with autologous chondrocytes in an immunocompetent porcine animal model. A biodegradable, biocompatible copolymer of polyethylene oxide and polypropylene oxide (Pluronic F-127), which exists as a liquid below 4 degrees C and polymerizes to a thick gel when it is exposed to physiologic temperatures (body temperatures), was used as a vehicle for chondrocyte delivery and as a scaffold to guide growth. Autologous chondrocytes isolated from porcine auricular elastic cartilage and suspended in 30% (weight/volume) Pluronic F-127 were injected on the ventral surface of the pigs from which the cells had been isolated. A circumferential subdermal suture was used to support the contour of the implant and assist in its projection in the form of a human nipple. After 3 weeks, the skin over and surrounding the implant was tattooed to create the appearance of a human nipple-areolar complex. As controls, an equal number of injections were made using either cells alone (not suspended in hydrogel), or hydrogel alone. After 10 weeks, all specimens were excised and examined both grossly and histologically. Before harvesting, visual inspection of the tattooed chondrocyte-Pluronic F-127 hydrogel implant sites revealed that they closely resembled a human female nipple-areolar complex. Nodules were similar in size, shape, and texture to a human nipple at each injection site. Glistening opalescent tissue was surgically isolated from each implant site. Hematoxylin and eosin, safranine o, trichrome blue, and Verhoeff's stains of the experimental implants showed nodules with the characteristic histologic signs of elastic cartilage. Control injections of copolymer hydrogel alone exhibited no evidence of cartilage formation. Control injections of chondrocytes alone showed evidence of dissociated microscopic nodules of elastic cartilage.

Animals↗
PubMed2000

The sensitivity of the nipple-areola complex: an anatomic study.

Although preservation of the sensitivity of the nipple and areola is an important goal in breast surgery, only scant and contradictory information about the course and distribution of the supplying nerves is found in the literature. The existing controversy might be due to the difficulty in dissecting the thin nerves and to frequent anatomic variations that bias the results if only a small number of cadavers are dissected. We dissected 28 female cadavers and found that the nipple and areola were always innervated by the lateral and anterior cutaneous branches of the 3rd, 4th, and 5th intercostal nerves. The most constant innervation pattern was by the 4th lateral cutaneous branch (79 percent) and by the 3rd and 4th anterior cutaneous branches (57 percent). The anterior cutaneous branches took a superficial course within the subcutaneous tissue and terminated at the medial areolar border in all dissected breasts. The lateral cutaneous branches took a deep course within the pectoral fascia and reached the nipple from its posterior surface in 93 percent of the dissected breasts. In 7 percent of the dissected breasts, the lateral cutaneous branches took a superficial course within the subcutaneous fat and reached the nipple from the lateral side. These findings suggest that the nerves innervating the nipple and areola are best protected if resections at the base of the breast and skin incisions at the medial areolar border are avoided.

Female↗
PubMed2006

Vasospasm of the nipple presenting as painful lactation.

BACKGROUND: Breast pain is a common complaint among lactating women. Vasospasm of the nipple should be considered in the differential diagnosis of breast pain, particularly when no other signs of infection or trauma are encountered. This report demonstrates a case of vasospasm successfully treated with nifedipine. CASE: A 26-year-old breastfeeding multipara presented with intermittent episodes of extreme pain associated with blanching of the nipple. The pain subsided upon return of normal color to the nipple. She was able to continue breastfeeding after successful treatment with nifedipine. CONCLUSION: Vasospasm of the nipple causes severe episodic breast pain and may lead to discontinuation of breastfeeding if not appropriately treated. This phenomenon is not well reported in the obstetric and gynecologic literature, although the obstetrician may be the first physician to evaluate a patient with symptoms. Patients with episodic nipple pain and pallor can be successfully treated with nifedipine.

Adult↗
PubMed2006

Nipple reconstruction: technical aspects and evolution in 14 patients.

BACKGROUND: During breast reconstruction after mastectomy, the long-term deterioration of the projection of neonipples led the authors to modify Thomas's technique in its design and use. METHODS: The results were evaluated after at least 10 months, in 14 patients, by comparative measurement of diameters and projection of the neonipple and contralateral nipple. RESULTS: In two cases, the authors had a 3-mm loss of height; in six cases, the authors had a variation of 1 mm compared with the referent nipple; and the heights appeared identical in the six other cases. The height variation was thus lower or equal to 1 mm compared with the contralateral nipple in 80 percent of cases. There was no or little diameter variation of approximately 1 mm in 12 cases (85.7 percent). CONCLUSION: This technique allows rebuilding of a nipple that remains identical to the contralateral nipple over the long run.

Female↗
PubMed2004

Correction of the inverted nipple with an internal 5-point star suture.

To date, many of the methods reported for the surgical treatment of the inverted nipple include insertion of autologous or heterologous material to provide volume and projection to the nipple, thereby avoiding recurrence. In cases of severely inverted nipple with severe fibrosis and shortening of the lactiferous ducts, the authors' technique combines the pulling out of the nipple and the release of the fibrosis and retracting ducts with the introduction of a stitch of polyglactin as filling material, performing an internal star suture in only one surgical intervention, without the need for using graft material, or local flaps that introduce scars around the nipple. The technique is simple, with excellent and long-lasting results.

Adolescent↗
PubMed2003

Skin-sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction is an oncologically safe procedure.

OBJECTIVE: Is skin-sparing mastectomy (SSM) with conservation of the Nipple-Areola Complex (NAC) and immediate autologous reconstruction as safe in oncologic terms as SSM with resection of the NAC as modified radical mastectomy (MRM)? SUMMARY BACKGROUND DATA: The originally described technique of SSM included the removal of gland, NAC, and biopsy scar. However, the risk of tumor involvement of NAC in patients with breast cancer has been overestimated. PATIENTS AND METHODS: Between 1994 and 2000, 286 selected patients with an indication for MRM and tumor margins of greater than 2 cm from the nipple were presented with the alternative of a SSM. Regular follow-up data were evaluable of 112 patients with SSM and 134 patients with MRM. Immediate reconstruction was achieved by latissimus dorsi flap or TRAM flap. The mean follow-up time was 59 (18 to 92) months. RESULTS: Patients with SSM were significantly younger than those with MRM but were comparable regarding clinical data, tumor parameters, adjuvant treatment, and overall complications. After intraoperative frozen sections of the NAC-ground, the NAC could be conserved in 61 (54.5%) but was resected in 51 (45.5%) of the 112 patients with SSM. The aesthetic results after SSM were evaluated as excellent or good in 91.1% (102/112) patients and were significantly better after preservation of the NAC (P = 0.001). Six (5.4%) recurrences occurred in 112 patients with SSM compared with 11 (8.2%) cases after MRM. Only 1 recurrence in a conserved nipple was treated by wide excision of nipple with conservation of the areola. This patient is still free of disease after 52 months. CONCLUSION: In patients who are candidates for a mastectomy and tumors distant from the nipple, SSM with intraoperative frozen section of the NAC ground offers the opportunity of NAC conservation without increasing the risk of local recurrences.

Adult↗
PubMedDate not supplied

Leiomyoma of the nipple.

Leiomyoma is a rare, benign neoplasm of the nipple. We report the case of a patient with a leiomyoma arising from her left nipple who presented with persistent nipple pain and tenderness which led to the eventual complete excision of her left nipple and areola complex. The clinical characteristics, gross and microscopic pathologic findings, and management of this lesion are discussed. Surgical management should be tailored primarily to the control of symptoms. Clinicians should be aware that this is a rare, but potential cause of chronic persistent pain and swelling in the region of the nipple-areola complex of the breast.

Adult↗
PubMed1997

Hyperkeratosis of the nipple: report of two cases.

Hyperkeratosis of the nipple and areola is a rare condition; its characteristic properties are verrucous thickening and brownish discoloration of the nipples and areola. The nevoid form of the disease is extremely rare, usually seen in women in the second or third decade of life. The nipple is seldom affected alone. We report two cases of the nevoid form of hyperkeratosis of the nipple. In both female patients, lesions developed after puberty and were confined to both nipples alone. One of the patients' lesions became darker and more verrucous during pregnancy, making breast feeding impossible.

Adolescent↗
PubMed1998

Mohs micrographic surgery for an erosive adenomatosis of the nipple.

BACKGROUND: Erosive adenomatosis of the nipple is a rare but distinct benign tumor of the nipple. It is usually considered to be derived from the apocrine sweat ducts of the nipple epithelium but probably of lactiferous duct origin. Total excision is the treatment of choice. OBJECTIVE: We report the clinical and histological features of this rare tumor, and the surgical technique employed. METHODS: Treatment consisted of Mohs micrographic surgery (MMS), fresh tissue technique, followed by primary closure. RESULTS: The described procedure resulted in a cure of the erosive adenomatosis of the nipple. CONCLUSION: Total excision of erosive adenomatosis of the nipple can be obtained by MMS. This technique prevents recurrence of the disease and minimizes resulting deformation of this important anatomic area.

Adenoma↗
PubMedDate not supplied

The effect of nipple shields on maternal milk volume.

This study was conducted to evaluate nipple shields and determine whether altered nipple shield design would change the amount of milk obtained during breast pumping. The study also sought to determine whether milk volume would change depending on the presence or absence of a nipple shield during breast pumping. Among the 25 participants, pumping without a shield yielded statistically significantly larger milk volumes than pumping with either one of the two kinds of shields evaluated, regardless of the order of nipple shield use. The slight difference in milk volumes obtained when comparing the shields used was not statistically significant. The article includes several questions designed to alert the clinician to the risks of nipple shield use, particularly when the mother and neonate are still learning to breastfeed.

Breast Feeding↗
PubMed1993

Paget disease of the nipple: radiologic-pathologic correlation.

PURPOSE: To correlate the range of clinical presentations with mammographic and histologic findings in patients with Paget disease of the nipple. MATERIALS AND METHODS: The clinical, pathologic, and mammographic records of 58 patients who had biopsy-proved Paget disease of the nipple were retrospectively reviewed. The results of two previous studies were also included. RESULTS: Among 34 patients who had typical findings of Paget disease, the mammograms of 17 (50%) showed normal findings, those of 10 (29%) showed nipple, areolar, or subareolar abnormalities, and those of seven (21%) showed evidence of masses or calcifications. Of the mammograms of 24 women with Paget disease but without clinical findings, 19 (79%) showed evidence of suspicious masses or calcifications, four (17%) showed nipple or areolar abnormalities, and one was negative. CONCLUSION: Nonspecific findings of nipple-areolar complex thickening should be correlated with findings at breast physical examination to confirm or exclude Paget disease.

Adult↗
PubMedDate not supplied

The nipple-sparing mastectomy: early results of a feasibility study of a new application of perioperative radiotherapy (ELIOT) in the treatment of breast cancer when mastectomy is indicated.

BACKGROUND: Breast cancer surgery has become less and less mutilating, however a mastectomy is required in the case of multicentric, large tumors or recurrences after conservative treatment. The removal of the nipple areola complex during the mastectomy dramatically increases the feeling of mutilation. To reduce this negative psychological impact, in cancers located outside of the central area of the breast, we propose a new type of nipple-sparing mastectomy associated with intraoperative electron beam radiotherapy (ELIOT) delivered on the region of the areola. The nipple-sparing mastectomy is performed leaving 5 mm of glandular tissue behind the nipple areola complex to preserve its blood supply. The reconstruction is immediately performed with a prosthesis or an autologous flap. PATIENTS AND METHODS: Twenty-five patients were included in the study; two of them had a bilateral nipple-sparing mastectomy. RESULTS: Pathological examinations demonstrated the presence of 19 infiltrating carcinomas and 8 ductal carcinoma in situ. Two patients had a superficial skin areolar slough followed by spontaneous healing. One necrosis of the areola occurred due to extensive retroareolar dissection. In the early follow-up, the color of the areola was preserved. All patients except one expressed their satisfaction of having kept their areola. CONCLUSIONS: These preliminary results are encouraging but they require further studies to evaluate the long-term results, the local recurrence rate and the psychological impact.

Adult↗
PubMed2006

History, physical and laboratory findings, and clinical outcomes of lactating women treated with antibiotics for chronic breast and/or nipple pain.

This chart review study describes the history, physical and laboratory findings, and clinical outcomes in patients who presented to a lactation specialist between 1997 and 2002 and were treated with antibiotics for their chronic breast and/or nipple pain. A total of 69 charts were reviewed. Five were excluded because of loss of follow-up. Eighty-two percent of patients described postpartum breast tenderness, 74% had nipple sores postpartum, and 79% were tender on physical examination. Nipple lesions were present among 73% of the women. Breast milk or nipple cultures were performed for 60 of 64 patients and were positive for pathogenic bacteria among 50% of the patients cultured. The average duration of antibiotic treatment was 5.7 weeks, and 94% of the women had pain resolution. Symptoms of deep breast aching, breast tenderness on palpation, and nipple lesions may be suggestive of a bacterial lactiferous duct infection. Treatment with antibiotics for 4 to 6 weeks may be appropriate.

Adult↗
PubMed1996

Clinical use of silicone nipple shields.

Use of nipple shields is controversial. However, when weaning is imminent, they may enable breast-refusing infants to transfer back to the breast. A chart review of 248 clients seen during a 13-month period in a private lactation clinic revealed 32 women who received thin, silicone nipple shields. Among this group, the most common presenting problems were breast refusal (69 percent) and difficulty with latch (25 percent). Bottles had been introduced in 75 percent of these cases. Thirty-eight percent of the mothers using nipple shields weaned their infants during the initial crisis period; 56 percent continued to breastfeed for at least six weeks postpartum. Two ill infants continued to receive human milk by bottle for four and 12 months respectively. Parity appeared to correspond inversely with success of the shield intervention. The presence of flat or inverted nipples appeared to contribute to the phenomenon described as "nipple confusion."

Adult↗