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PubMed1985

Papillary adenoma of the nipple: analysis of fifteen new cases.

Fifteen cases of papillary adenoma (florid papillomatosis, erosive adenomatosis) of the nipple were compared with forty examples of syringadenoma papilliferum, twenty-four of hidradenoma papilliferum, and one hundred of breast carcinoma metastatic to skin. Clinically, papillary adenoma of the nipple typically occurred in a female patient as an erosion, ulceration, or mass that was sometimes accompanied by serous or bloody discharge from the nipple and was frequently misdiagnosed as Paget's disease. Histologically, there was usually a papillary and adenomatous growth in the corium that connected with the surface and showed a lining of apocrine type secretory epithelium, a sometimes plasmacytic stroma, and horn cysts in the upper corium. Papillary adenoma of the nipple is often histologically misinterpreted as syringadenoma papilliferum, hidradenoma papilliferum, or low-grade adenocarcinoma, but it has received almost no attention in the dermatology literature.

Adenoma, Sweat Gland↗

PubMedDate not supplied

Nipple pain in breastfeeding women: causes, treatment, and prevention strategies.

This article identifies problems and conditions that contribute to nipple pain during lactation and that may lead to early cessation or noninitiation of breastfeeding. Signs and symptoms of poor latch-on and positioning, oral anomalies, and suckling disorders are reviewed. Diagnosis and treatment of infectious agents that may cause nipple pain are presented. Comfort measures for sore nipples and current treatment recommendations for nipple wound healing are discussed. Suggestions are made for incorporating in-depth breastfeeding content into midwifery education programs.

Breast Diseases↗

PubMed2001

A utility of ductography and fiberoptic ductoscopy for patients with nipple discharge.

BACKGROUND: Breast carcinoma and precancer are thought to start in the lining of the milk duct or lobule. While ductography has been advocated as the main procedure in patients with nipple discharge, fiberoptic ductoscopy (FDS) is an emerging technique allowing direct visual access to the ductal system of the breast through nipple orifice exploration. METHODS: We applied ductography and FDS to 65 women who had nipple discharge, and compared their utility. RESULTS: Intraductal lesions occurred in the segmental duct and the first, second, third, fourth, fifth, and sixth branches in decreasing frequency with ductography and FDS screening. The detection rates of intraductal abnormal lesions by ductography and FDS and the their combination were 89.1 (37 patients), 97.4 (38 patients), and 97.5% (39 patients) respectively. Ductal washings performed during FDS were effective to obtain representative exfoliated ductal cells which could be evaluated (sensitivity 50%, specificity 94.3%, and diagnostic accuracy 89.7%). As a result, we diagnosed 35 cases of benign lesions and four cases of malignant lesions by cytological or/and histological examination. CONCLUSION: Ductography and fiberoptic ductoscopy are useful procedure in guiding subsequent breast surgery in the treatment of nipple discharge.

Adult↗

PubMed2002

Proteomic analysis of nipple aspirate fluid to detect biologic markers of breast cancer.

The early detection of breast cancer is the best means to minimise disease-related mortality. Current screening techniques have limited sensitivity and specificity. Breast nipple aspirate fluid can be obtained noninvasively and contains proteins secreted from ductal and lobular epithelia. Nipple aspirate fluid proteins are breast specific and generally more concentrated than corresponding blood levels. Proteomic analysis of 1 microl of diluted nipple aspirate fluid over a 5-40 kDa range from 20 subjects with breast cancer and 13 with nondiseased breasts identified five differentially expressed proteins. The most sensitive and specific proteins were 6500 and 15 940 Da, found in 75-84% of samples from women with cancer but in only 0-9% of samples from normal women. These findings suggest that (1) differential expression of nipple aspirate fluid proteins exists between women with normal and diseased breasts, and (2) analysis of these proteins may predict the presence of breast cancer.

Adult↗

PubMed2001

Cellular characteristics of nipple aspiration fluid during the menstrual cycle in healthy premenopausal women.

Cellular characteristics of nipple aspiration fluid during the menstrual cycle in healthy premenopausal women Fifteen healthy premenopausal female volunteers underwent weekly nipple aspiration of ductal fluid from both breasts during two menstrual cycles to investigate the variability of the cellular profile of the ductal fluid. Ductal fluid was successfully obtained using breast massage and nipple-areolar suction from 247/280 (89%) breasts. 83% of samples available for cytological analysis were cellular and 30% of cellular aspirates contained ductal epithelial cells identified using standard morphological criteria. No significant variation in cell number or cell type was identified during the menstrual cycle. All samples tested had an 'H' score of zero for oestrogen receptor. Seven out of 14 women expressed the proliferation marker Mcm-2 in the cells of at least one of the specimens, with no evidence of a menstrual cycle influence on expression. In conclusion, the cellular profile of breast ductal fluid did not vary consistently during the menstrual cycle, permitting future breast cancer screening studies incorporating serial nipple aspirations to be performed independent of the phase of the cycle.

Adult↗

PubMed2003

Clinical management of nipple discharge in neonates and children.

Bloody nipple discharge is a rare but distressing finding in neonates and infants. We report an 8-month-old boy who showed bilateral bloody nipple discharge for 5 months without signs of infection. Ultrasound examination revealed dilated mammary ducts. This benign phenomenon is most likely caused by mammary duct ectasia. On the background of the reviewed literature, intensive investigations should only be performed in neonates and infants if bloody nipple discharge is unilateral, continues, expands in size or shows signs of inflammation. We discuss the clinical management of nipple discharge during infancy and childhood.

Blood Chemical Analysis↗

PubMed2001

Nipple-sparing mastectomy in breast cancer: a viable option?

BACKGROUND: In women with breast cancer for whom breast-conserving therapy (BCT) is not the best option, a nipple and areola complex-(NAC) sparing mastectomy with immediate reconstruction has been proposed as a good and safe alternative to conventional, more radical mastectomy. Surgeons hesitate to perform this operation for fear of recurrence of tumour in the NAC due to undetected nipple involvement (NI) of the tumour. In order to determine whether a NAC-sparing mastectomy is a viable option, the frequency and predictive factors of NI by the tumour were studied in the literature. METHODS: A literature survey was performed by searching the Medline database. Other references were derived from the material perused. RESULTS AND CONCLUSIONS: NI is found in up to 58% of mastectomy specimens and correlates with tumour size, tumour-areola or tumour-nipple distance, positive lymph nodes and clinical suspicion. Best candidates for NAC-sparing mastectomy are patients with a small tumour (T1) at a large distance (>4-5 cm) from the nipple. However, in these patients BCT has excellent results with low complications and recurrence rates. Considering the incidence of NI in larger tumours (T2 average 33%, T3 average >50%) a NAC-sparing mastectomy may carry an unacceptable high risk for local relapse and should therefore not be advocated.

Breast Neoplasms↗

PubMed2001

The use of Munsell colour charts in nipple-areola tattooing.

Tattooing is an excellent, simple and quick option in nipple-areola reconstruction. Colour mismatch is one of the commonest problems with this procedure. Use of Munsell colour charts allows the premixing of common colours for different patient populations using pigments from various manufacturers. There are significant correlations between nipple colour and Fitzpatrick skin type and between nipple colour and parity. Three nipple-areola colours were more common than others and were found in 50% of patients; these can be premixed ready for use. Adjustment of premixed colours for individual patients can be performed prior to tattooing, speeding up the procedure. Accurate recording of colours also facilitates audit.

Color↗

PubMed2003

[Repeated attacks of pain in the nipple of a pregnant woman. Unusual manifestation of Raynaud's phenomenon].

HISTORY AND FINDINGS: A 38-year-old woman, in her 13th week of pregnancy, presented for angiological investigation of repeated episodes of pain in the right index finger. She also reported painful paleness of the right nipple evoked particularly by cold. This was her fifth pregnancy; she had miscarried twice. The nipple pain occurred spasmodically and in three phases, while the left nipple was unaffected. The attacks lasted c. 15 min, progressing from an ischemic to a hyperemic phase, accompanied by unbearable pain. When first examined there was circumscribed, purplish network-patterned discoloration of the right hand with blackened discoloration of the distal nail-bed of the index finger. INVESTIGATIONS: Duplex-sonography revealed patency of the large arteries of the arm and hand. Transesophageal echocardiography showed a persistent foramen ovale and echo-density suspected to be a right atrial thrombus. Laboratory tests demonstrated anticardiolipin antibodies, suggesting an antiphospholipid syndrome. TREATMENT AND COURSE: On administration of low-molecular heparin, its dosage weight-adjusted, and 100 mg aspirin daily the discoloration of the finger quickly disappeared, but Raynaud's syndrome remained unchanged until she had stopped breast feeding (left breast only) after 8 months. A healthy girl had been delivered by cesarean section in the 39th week, weighing 3100 g. There were no further thromboembolic complications. CONCLUSION: This very rare case of Raynaud's phenomenon in a nipple was associated with an anti-phospholipid syndrome.

Adult↗

PubMedDate not supplied

Simultaneous nipple and areola reconstruction: a review of 50 cases.

Nipple areola complex reconstruction has historically been a staged procedure, the nipple being reconstructed first by graft or local flap techniques and the areola on a later procedure to gain colour. This paper presents a one-stage combined reconstruction procedure using a local flap and immediate areola tattoo: it presents the advantage of reducing the total number of needed procedures and subsequently diminishes the total time needed to obtain a complete result. In this series of 50 consecutive combined procedures with a mean follow-up of ten months, no necrosis of reconstructed nipple was observed and a total of six patients needed minor revision surgery to correct nipple projection or fading of the tattoo. No local infection or wound complications were observed, underlying the safety of the procedure. Patient satisfaction and compliance were good because the procedure is fast and easy with minimal morbidity.

Adult↗

PubMed1989

Syringomatous tumor of the nipple.

The authors describe two women with locally infiltrative neoplasms of the nipple that exhibited sweat duct differentiation. The findings are compared with those previously recorded for syringomatous adenoma of the nipple. The patients presented with firm, subareolar nodules. Nests, cords, and ducts composed of cytologically uniform squamous cells were dispersed throughout the dermis and also involved subcutaneous tissue and adjacent breast parenchyma. Small keratocysts formed a minor component of the lesions. Additional observations in the present study included connections between tumor and epidermis; distinctive fibrous stroma; sparse mitotic figures; perineural invasion; carcinoembryomic antigen in luminal content and periluminal cytoplasm; tumor cells that contained S-100 protein; and Langerhans' cells within neoplastic cellular aggregates. Neither of the lesions had recurred after follow-up of 9 and 12 months. The foregoing neoplasms of the nipple appear to be part of a family of microscopically similar tumors that have a predilection for the face, breast and possibly the axilla and salivary tissue. Although capable of local recurrence, syringomatous tumors of the nipple and related lesions at other sites have not been reported to metastasize.

Adenoma↗

PubMed1994

Prolactin stimulates emission of nipple pheromone in ovariectomized New Zealand white rabbits.

Using ovariectomized New Zealand white rabbits and the nipple-search behavior of pups as a bioassay, we evaluated the capacity of prolactin to stimulate the emission of an odor signal that allows newborn pups to locate the mother's nipples and suckle. Whereas emission of this so-called nipple pheromone was minimal in untreated, ovariectomized does, emission was stimulated by the administration of progesterone (1 mg/day) to estrogen-treated does (0.5 microgram estradiol benzoate/day) and decreased after withdrawal of progesterone despite continuous administration of estrogen. However, substituting ovine prolactin (1.5 mg/day) for progesterone, under continuous estrogen administration, resulted in an increase in pheromone emission to near-maximal levels. This stimulatory effect of prolactin was not progesterone-dependent since it also occurred in does pretreated with estrogen alone and, to a lesser extent, even in females without estrogen priming. From these and previous data, we propose that emission of nipple pheromone in the rabbit is induced during pregnancy by the combined action of estrogen and progesterone, and maintained during lactation by the dual action of estrogen and prolactin.

Animals↗

PubMed1989

Infiltrating syringomatous adenoma of the nipple. A clinical and pathological study of 11 cases.

The clinical and pathologic findings of 11 infiltrating syringomatous adenomas of the nipple (ISA) were studied. All neoplasms were composed of small ducts and solid strands of epithelial cells surrounded by desmoplastic stroma. Ten of the 11 invaded the smooth muscle of the nipple, four extended to underlying breast tissue, and one showed perineural invasion. All lesions had an infiltrative margin, but 10 were treated successfully by local excision, even though five (45%) recurred. None metastasized. ISA must be distinguished from nipple duct adenoma and tubular carcinoma. Its clinical significance lies primarily in its recognition as a distinctive benign neoplasm. In the past, a variety of terms have been used to describe this lesion, whether it occurred in the skin, nipple, or substance of the breast. "Infiltrating syringomatous adenoma" is the preferred term to avoid using "carcinoma" for lesions involving the breast.

Adenocarcinoma↗

PubMed1990

Polyurethane nipple prosthesis.

Long-term nipple projection remains the elusive ingredient for measuring the success of a nipple reconstruction. Augmentation of this projection without sacrifice of autogenous donor tissues may be achieved using a polyurethane-coated silicone gel implant affectionately and descriptively called the "gumdrop" nipple. Two patients who agreed to implantation with this device have each been observed over a one-year period with no loss of projection. The role of an internal nipple prosthesis, although perhaps of some value as a salvage procedure, appears to offer few advantages over other accepted methods of reconstruction that do not use any foreign body.

Adult↗

PubMed1997

Twin flap technique for nipple reconstruction.

A technique of nipple reconstruction using two local flaps is described. The central 'core' flap is surrounded by a peripheral 'wrap' flap, producing a natural nipple. Results of 24 nipple reconstructions in 22 cases are presented. This technique is useful when the neo-nipple location falls on the mastectomy scar.

Breast Implants↗

PubMed2001

Nipple piercing may be contraindicated in male patients with chest implants.

The authors present a man who underwent chest augmentation and nipple piercing. The patient developed chronic nipple infection, which led to unnecessary invasive diagnostic procedures, serious implant infection, and eventually urgent explantation. This unfavorable scenario illustrates the distinct features of the procedure in men, which includes close proximity of the nipple to the implant and reduced awareness by health care providers. Based on this case the authors recommend avoiding nipple piercing in men with chest implants.

Cosmetic Techniques↗

PubMed2002

Viability and sensation of the nipple-areolar complex after reduction mammaplasty.

Reduction mammaplasty with nipple-areolar transposition on a medial pedicle was designed as an alternative to amputation and free nipple graft for women with severe mammary hypertrophy. The purpose of this study was to review the viability and sensory outcome of the nipple-areolar complex (NAC) in 72 women (133 breasts) after medial pedicle and inferior pedicle reduction mammaplasty between 1996 and 2000. The medial pedicle was used for 41 women (79 breasts) with moderate to severe mammary hypertrophy. An inferior pedicle was used for 31 women (54 breasts) with mild to moderate mammary hypertrophy. Mean follow-up for all patients was 25 months. Total sensation of the NAC was obtained in 68 of 79 breasts (86%) after medial pedicle reduction mammaplasty and in 50 of 54 breasts (92%) after inferior pedicle reduction mammaplasty. Total viability of the NAC occurred in 74 of 79 breasts (94%) after medial pedicle reduction mammaplasty and in 53 of 54 breasts (98%) after inferior pedicle reduction mammaplasty. Quantitative sensory testing of the NAC using the pressure-specified sensory device demonstrated that static and moving sensory thresholds of the NAC are lowest in the inferior pedicle group followed by the control group and the medial pedicle group. It can be concluded from this study that the medial and inferior pedicle techniques are capable of supporting vascularity and innervation to the NAC. The medial pedicle technique for severe mammary hypertrophy is a good alternative to free nipple grafting. The amount of breast tissue removed does not correlate with sensory outcome for both inferior and medial pedicle techniques. The pressure-specified sensory device is an excellent means of assessing sensory outcome.

Adult↗

PubMed1979

Spread to the nipple and areola in carcinoma of the breast.

In 40 breasts with primary carcinoma, the nipple and areola were cut horizontally in order to investigate the frequency of intraductal and invasive cancer. In 20 of these breasts the nipple and/or areola were found to be involved at a depth of 1 cm (50%; 95% confidence limits: 33.8-66.2%). Eleven neoplasms were purely intraductal, eight intraductal as well as stromal, and only one purely stromal. By means of clinical or physical findings, it was not possible to select the breasts in which the nipple and/or areola were not involved. It is concluded that the general use of surgical methods preserving the nipple and areola in treating breast cancer leaves a focus of invasive or intraductal carcinoma in about half the patients. The implications of this are not known.

Breast↗