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PubMed1996

[Mammary gland hypoplasia and aplasia (inverted nipples) in female and male swine. 1. Clinical-morphological investigations on the occurrence and development of inverted nipples in female and male swine of various age and production groups].

The development of the shape of teats in 30 female piglets, of which at least one of the parents showed inverted teats, was systematically observed during three to four months. Similar investigations could be carried out in sows with inverted teats from day 60 of pregnancy until the end of lactation. There is no evidence that inflammations or traumatas are causes for teat hypoplasias, and there is no correlation between "teat necroses" of piglets and the incomplete teat development. The wide distribution of teat abnormities is shown by investigations of slaughter pigs: 20% of fattening pigs, 17% of boars and 6% of sows were affected by inverted teats. 75% of the inverted teats were seen periumbilical. The morphology of hypo- and aplastic teats in boars is described. With regard to the selection of affected pigs, a first investigation is recommended in the 12th week of life and a second one at the age of five month is recommended. Particular attention has to be paid to boars for mating and artifical insemination in order to exclude affected boars as early as possible from breeding.

Age Factors↗
PubMed2004

Computerized nipple identification for multiple image analysis in computer-aided diagnosis.

Correlation of information from multiple-view mammograms (e.g., MLO and CC views, bilateral views, or current and prior mammograms) can improve the performance of breast cancer diagnosis by radiologists or by computer. The nipple is a reliable and stable landmark on mammograms for the registration of multiple mammograms. However, accurate identification of nipple location on mammograms is challenging because of the variations in image quality and in the nipple projections, resulting in some nipples being nearly invisible on the mammograms. In this study, we developed a computerized method to automatically identify the nipple location on digitized mammograms. First, the breast boundary was obtained using a gradient-based boundary tracking algorithm, and then the gray level profiles along the inside and outside of the boundary were identified. A geometric convergence analysis was used to limit the nipple search to a region of the breast boundary. A two-stage nipple detection method was developed to identify the nipple location using the gray level information around the nipple, the geometric characteristics of nipple shapes, and the texture features of glandular tissue or ducts which converge toward the nipple. At the first stage, a rule-based method was designed to identify the nipple location by detecting significant changes of intensity along the gray level profiles inside and outside the breast boundary and the changes in the boundary direction. At the second stage, a texture orientation-field analysis was developed to estimate the nipple location based on the convergence of the texture pattern of glandular tissue or ducts towards the nipple. The nipple location was finally determined from the detected nipple candidates by a rule-based confidence analysis. In this study, 377 and 367 randomly selected digitized mammograms were used for training and testing the nipple detection algorithm, respectively. Two experienced radiologists identified the nipple locations which were used as the gold standard. In the training data set, 301 nipples were positively identified and were referred to as visible nipples. Seventy six nipples could not be positively identified and were referred to as invisible nipples. The radiologists provided their estimation of the nipple locations in the latter group for comparison with the computer estimates. The computerized method could detect 89.37% (269/301) of the visible nipples and 69.74% (53/76) of the invisible nipples within 1 cm of the gold standard. In the test data set, 298 and 69 of the nipples were classified as visible and invisible, respectively. 92.28% (275/298) of the visible nipples and 53.62% (37/69) of the invisible nipples were identified within 1 cm of the gold standard. The results demonstrate that the nipple locations on digitized mammograms can be accurately detected if they are visible and can be reasonably estimated if they are invisible. Automated nipple detection will be an important step towards multiple image analysis for CAD.

Algorithms↗
PubMedDate not supplied

Prenatal nipple conditioning for breastfeeding.

Twenty-two primigravida women who planned to breastfeed began conditioning their nipples six weeks before their expected delivery date by nipple rolling twice a day for two minutes each time; providing gentle friction against the nipple with a terry cloth towel for 15 seconds once a day; and nipple airing for two hours a day, allowing outer clothing to rub against the nipple. Each woman served as her own control, conditioning one nipple but not the other. No nipple ointments or soap were used on either nipple during the course of the study. Each woman was given instructions on breastfeeding techniques to be used after delivery. The women completed two checklists: One revealed how consistently they followed the nipple-conditioning regime; with the other, they rated nipple pain on each breast, for every nursing, during the first five days postdelivery. Ratings were: 1--negligible pain or no pain, 2--definite pain, 3--extreme pain. Seventeen women successfully completed the study. Effect of skin color on the amount of nipple pain was also investigated. The prenatal nipple-conditioning regime significantly reduced the amount of total nipple pain experienced during the first few days of breastfeeding. The amount of extreme pain experienced on the conditioned nipple was significantly (p less than .01) reduced compared to the control nipple. Fair-skinned women reported more nipple soreness on unconditioned nipples, and olive-complected women reported significantly (p less than .01) less nipple soreness on unconditioned nipples.

Adult↗
PubMed2004

[Comparison of the nipple projection after reconstruction with three different methods].

The creation of the nipple-areola complex represents the final stage in the surgical treatment of breast cancer patients. Preservation of the nipple projection is important and difficult to achieve. A huge number of different methods for nipple reconstruction have been well described, but some of them fail secondary to scar contraction with loss of projection. Furthermore, there are only few studies investigating the degree of shrinkage over time in nipple projection. Aim of this study was to determine the long-term projection of the reconstructed nipple. We compared three different methods that have been used in our department for nipple-reconstruction. Between May 1994 and December 2001, reconstruction of the breast mound was performed in 146 patients. 86 patients who underwent a unilateral reconstruction of the nipple have been examined. The nipple reconstructions were performed by using either a modified skate-flap (n = 29), a quadrapod-flap (n = 37) or by nipple sharing (n = 20). Nipple projection was measured at least six months after the reconstruction. Patients were followed an average of 10.9 +/- 3.62 months. 38 patients had tissue expansion and implantation for breast mound reconstruction. 29 patients had autologous breast mound reconstruction and 19 patients were treated by a combination of both. The mean projection was 3.45 mm (+/- 1.23) in the nipple sharing group, 6.03 mm (+/- 1.86) in the quadrapod-flap group and 9,24 mm (+/- 2.45) in the skate-flap group. The mean decrease in projection for the nipple sharing was 27.6 +/- 18.2 % while the skate flap lost 45.0 +/- 11.1 % and the quadrapod flap 49.9 +/- 11.56 %. Comparison between the three groups using a Student-t test showed a statistical significance between the nipple sharing and the two other groups (p < 0.001), while there was no significance between the local flap groups (p = 0.082). The best long-term nipple projection was obtained by the nipple sharing, but the indication therefore is rare whereas local flaps are used more often. We conclude that although both methods are effective, the skate flap allows the surgeon to overbuild the nipple and achieve a higher projection. In addition, the results also indicated that nipple projection on the breast mound reconstructed with autologous tissue achieved a better long-term outcome.

Breast Implants↗
PubMed2004

Investigation into the possible cause of subjective decreased sensory perception in the nipple-areola complex of women with macromastia.

Patients with macromastia often comment on a lack of sensation in their nipple-areola complex. A study was designed to investigate the cause of this decreased sensation. Two hypotheses were proposed. First, the decreased sensation could result from neuropraxia of the sensory nerve fibers secondary to traction caused by the heavy breast parenchyma. The second hypothesis proposed that tissue expansion of the nipple and areola by the voluminous breast parenchyma caused a decrease in nerve fibers per surface area and hence decreased sensory perception. Sixty-one patients were assessed in the study. All patients underwent surgery in which histological biopsy of either the areola alone (31 reduction mammaplasty patients) or the nipple and areola (30 mastectomy patients) was possible. Before surgery, each nipple-areola complex was tested with Weinstein Enhanced Sensory Test monofilaments as a quantitative test of tactile sensation. Breast cup size, ptosis, and weight of tissue excised were recorded to allow general assessment of the breast size. The nipple and areola biopsy specimens were assessed using immunohistochemistry (S-100 polyclonal antibody, Dako Z311) to measure nerve fiber count per unit area. Statistical analysis was undertaken to find any association among sensitivity, breast cup size, ptosis, weight of tissue resected, and nerve fiber density in the nipple and areola biopsy specimens. Sensitivity at the areola decreased with increasing breast cup size (r = 0.47, p < 0.001) and ptosis (r = 0.42, p = 0.002 for increasing distance between inframammary crease and nipple; r = 0.49, p < 0.001 for increasing manubrium to nipple distance). There was a weak correlation between nerve fiber density at the areola and breast cup size (r = -0.22, p = 0.1). Sensitivity at the nipple was higher than at the areola. Nerve fiber density count at the nipple was higher than at the areola, but there was no statistically significant correlation between nipple sensitivity and breast cup size, ptosis, or weight of tissue resected. The results suggest that the areola and nipple are different in their neuroanatomy. The areola is a thin, pliable structure that is predisposed to stretch as the breast enlarges and therefore experience a decrease in nerve fiber density. The nipple is a compact structure that is less likely to stretch with breast enlargement. In the nipple, neither sensory perception nor nerve fiber density varied with size or breast ptosis. The perceived lack of sensation in the nipple-areola complex is multifactorial. This study shows that neither traction injury to the sensory nerves nor decreased nerve density alone can explain the subjective numbness reported by patients with macromastia. Psychological factors, such as dissatisfaction with body form or interpretation of lack of sensation in the areola as also affecting the nipple, may influence the patient's assessment of the nipple-areola sensitivity.

Adolescent↗
PubMed1998

Mammography in the evaluation of nipple inversion.

OBJECTIVE: The purpose of this study was to correlate the clinical and mammographic appearances of the nipple, determine the effects of breast compression on nipple position, and describe the mammographic findings in women with nipple inversion. SUBJECTS AND METHODS: We examined 312 consecutive women who were referred for mammography using routine craniocaudal and mediolateral oblique views, which resulted in 595 breasts imaged Nipple position (normal or inverted) was assessed visually, both with and without breast compression, and correlated with the findings at mammography. RESULTS: Of the 312 women, 29 (9%) had visually inverted nipples without breast compression; similarly, of the 595 breasts, 36 (6%) had visually inverted nipples without breast compression. Clinical nipple inversion was chronic in 33 (92%) of 36 breasts and acute in the remaining three breasts (8%) Nipple inversion occurred at birth in one (3%) of 36 breasts, during puberty in 21 (58%), and during adulthood in 14 (39%). Reported causative factors were pregnancy in one (3%) of 36 breasts, nursing in one (3%), prior benign biopsy in one (3%), and prior cancer in one (3%). In the other 32 breasts (89%), causative factors were not known. Both visually and mammographically, 29 (81%) of 36 clinically inverted nipples remained inverted with breast compression, but seven (19%) became normal in position. Of the 312 women, 23 (7%) had inverted nipples on mammography; likewise, of the 595 breasts, 29 nipples (5%) were inverted on mammography. Mammographic findings in the 33 breasts with chronically inverted nipples were normal in 29 (88%), probably benign masses in two (6%), multiple cysts in one (3%), and axillary lymphadenopathy in one (3%). Mammographic findings in the three breasts with acutely inverted nipples were normal in two (67%) and revealed a suspicious mass in one (33%). CONCLUSION: Mammography often failed to reveal nipple inversion; nearly one in five clinically inverted nipples became normal in position as a result of breast compression. In the vast majority of women with nipple inversion, the process was long-standing and without causative factors. Also, these women typically lacked mammographic findings suggestive of malignancy. Of the 14 patients with nipple inversion that had occurred during adulthood, two women (14%) had an underlying malignancy.

Aged↗
PubMed1997

Breast MR and the appearance of the normal and abnormal nipple.

AIM: To identify the magnetic resonance (MR) morphological and enhancement characteristics of the normal and diseased nipple. MATERIALS AND METHODS: The MR appearances of the nipple in 35 patients with known primary breast cancer who went on to mastectomy was reviewed by two radiologists (blinded to the clinical, mammographic and histopathological information) and correlated with histology. The appearance of the contra-lateral nipple in 31 patients was reviewed and compared with that of the affected side. MR was performed at 1.0T using a receive-only double breast coil in 33 patients and a single breast coil in two patients. Three dimensional (3-D) T1-weighted gradient-echo images were made before and immediately after a fast hand injection of gadolinium-DTPA (0.1 mmol/kg). RESULTS: Twenty-six breasts had histopathologically normal nipples and retroareolar tissue, four had evidence of tumour within the nipple and four had retroareolar tumour but with nipple sparing. Fifteen normal nipples were everted and 11 were inverted (flat). All showed superficial linear dermal enhancement above a non-enhancing zone in the nipple areolar complex. Linear or patchy enhancement deep to the non-enhancing zone was seen in four breasts and linear enhancement through the non-enhancing zone was seen in two. The nipple in all four breasts with tumour involvement showed increased thickening/bulkiness and enhancement of the nipple-areolar complex and retroareolar tissue. The four breasts with retroareolar tumour and nipple sparing showed increased thickening and enhancement of the retroareolar tissue only. There was one false positive result on breast MR for retroareolar tumour involvement. In this case the abnormally enhancing retroareolar tissue adjacent to the focal mass was shown to be an area of sclerosing adenosis on histology. The 31 contra-lateral nipples had the characteristic 'normal' appearance and when compared with its normal ipsilateral nipple showed marked symmetry. When compared with its abnormal ipsilateral nipple showed marked asymmetry. CONCLUSION: MR of the breast can show nipple involvement even when clinically unsuspected. This is important for treatment planning of breast cancer, in particular nipple preserving surgery.

Adult↗
PubMed2000

Parameters that predict nipple involvement in breast cancer.

BACKGROUND: Breast conservation therapy has been shown to produce survival rates equivalent to those seen with modified radical mastectomy. Synchronous occult neoplastic involvement of the nipple may lead to incomplete excision of the tumor in patients undergoing breast conservation therapy, possibly leading to recurrence. STUDY DESIGN: The charts of 803 breast cancer patients treated between 1990 and 1995 at two teaching hospitals were retrospectively reviewed. The patients were divided into three groups: nipple-positive for malignancy (n = 54), nipple-negative for malignancy (n = 404), and nipple-not-removed (n = 345). Ten different clinical and tumor parameters including age, race, primary tumor location, histologic grade, primary tumor size, nodal involvement, TNM stage, estrogen receptor status, DNA ploidy, and S-phase were examined for the ability to predict cancerous nipple involvement. RESULTS: Overall, the rate of nipple positivity was 12%. In univariate analysis pathologic stage, tumor size, lymph node status, histologic grade, and tumor location were significant predictors of positive nipple involvement. Patients with tumors that were stage III or higher were nearly ten times (odds ratio [OR] = 9.8, 95% confidence interval [CI] = 5.5 to 17.7) more likely to have nipple involvement than patients with early-stage tumors. Patients with a tumor size of 4 cm or greater were nearly eight times (OR = 7.8, 95% CI = 4.2 to 14.5) more likely to have nipple involvement than patients with tumor size less than 4 cm. Patients with positive lymph nodes were five times (OR = 5.0, 95% CI = 2.7 to 9.1) more likely to have nipple involvement than patients with negative lymph nodes. Patients with tumors in a central location or that overlapped quadrants were nearly four times (OR = 3.8, 95% CI = 2.2 to 6.8) more likely to have nipple involvement than patients with tumors in other locations. Patients with grade 3 or undifferentiated tumors were three times (OR = 3.0, 95% CI = 1.4 to 6.4) more likely to have nipple involvement than patients with lower grade tumors. In multivariable analysis, stage > or = 3 (OR = 9.2, 95% CI = 4.2 to 20.3) central/ overlap location (OR = 4.1, 95% CI = 2.0 to 8.7) and grade 3 or undifferentiated (OR = 3.1, 95% CI = 1.3 to 7.5) were the only variables that remained significant predictors of nipple involvement. CONCLUSIONS: The decision to perform breast conservation surgical procedures with nipple preservation can be difficult, particularly in patients with larger, more centrally located tumors. The multivariable model developed in this study may be useful in predicting the risk of cancerous nipple involvement and selecting appropriate breast conservation patients for nipple preservation.

Adult↗