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At least 613 records · Page 34Linked to original sources
PubMedDate not supplied

Reconstruction of the nipple and areola after radical mastectomy.

The authors present 8 different methods for reconstruction in order to determine a technique that best creates a nipple-areola complex after reconstruction of the breast mound. The main principles are: 1. preservation of the nipple-areola complex is possible, 2. sharing of the remaining nipple and areola, 3. Use of full thickness graft from other parts of the body and tattooing the areola. Our experience from more than 200 patients is discussed.

Breast↗
PubMed1995

[Reduction mammaplasty with free nipple. Apropos of 5 cases].

Thorek's technique for reduction mammaplasty with free nipple graft, described in 1922, has progressively been superseded by procedures using a dermo-glandular pedicle. Following a description of the surgical procedure used, we present a series of 50 patients operated with an average follow-up of 14.6 months; the outcome of the nipple graft was particularly studied. It appeared that the faults which are usually seen with this technique (loss of pigmentation, loss of sensitivity and contractility of the nipple and areola) were only observed in a minority of cases and were never considered to be unsatisfactory for the patients. Thorek's technique also presents advantages: short surgical procedure, simplicity of the glandular resection, minimising the risk of cytosteatonecrosis. This seems to us to be a preferential procedure for the treatment of major hypertrophy in patients presenting vascular risk factors of with a history of tumour.

Adolescent↗
PubMed1994

Prospective study of outcome in women presenting with nipple discharge.

In this study, 56 women who presented to the breast clinic with nipple discharge have been reviewed. Patients were selected for surgery by a triple assessment of clinical examination, discharge cytology and breast imaging. Surgical intervention was required in 17 women. Significant pathology was found in 11 cases including five with carcinoma (in situ or invasive). Those women who did not have carcinoma detected at their initial presentation have been reviewed after a minimum of 5 years. None has gone on to develop breast cancer. We conclude that women with nipple discharge, but no positive findings on triple assessment, are not at an increased risk of the development of carcinoma. In addition, nipple discharge spontaneously resolves in 73% of women over a 5 year period.

Adolescent↗
PubMed1995

[Dermatoses of the nipple and the areola].

Dermatoses of the nipple and areola are rare. The commonest dermatosis is Paget's disease, which presents in the form of a well demarcated erythematous area, sometimes erosive, oozing or hyperkeratotic. Histological examination reveals an intraepidermal proliferation of large clear cells, either isolated or grouped in clumps, predominantly in the suprabasal layers. Immunohistochemistry shows that these cells express low molecular weight cytokeratins and the epithelial membrane antigen, fairly frequently carcinoembryonic antigen. In 96% of cases, Paget's disease is associated with underlying breast carcinoma, either in situ or invasive. Erosive adenomatosis presents in the form of an erosion of the nipple, which is sometimes increased in size. Histologically, it consists of a benign tumour which may ulcerate the epidermis, composed of tubes and papillae lined by a double layer of epithelial and myoepithelial cells. The syringomatous tumour is exceptional. In places, it forms rudimentary sweat ducts and is considered to have an intermediate malignancy; its resection must be complete. Other tumours may also be observed in this site: leiomyoma, leiomyosarcoma, benign cutaneous lymphocytoma, basal cell carcinoma, naevoid areolar hyperkeratosis. They are exceptional except areolar neurofibromas in case of neurofibromatosis. Infectious dermatoses (viral warts, molluscum contagiosum, scabies) are accompanied by lesions in other sites. They same applied to the majority of inflammatory dermatoses such as eczema or Fox-Fordyce disease. Supernumerary nipples are situated on a line extending from the anterior part of the axillary crease to the medial part of the inguinal crease.

Adenomatoid Tumor↗
PubMedDate not supplied

Adenoma of the nipple: a diagnostic dilemma.

Adenoma of the nipple can pose a diagnostic problem for both clinicians and pathologists. It can be confused clinically with Paget's disease of the nipple and histologically with carcinoma. The majority of nipple adenomas are entirely benign although rare examples have shown malignant changes. Limited surgical excision is the appropriate treatment.

Adenoma↗
PubMed1977

Reduction mammaplasty by the inferior pedicle technique. An alternative to free nipple and areola grafting for severe macromastia or extreme ptosis.

Patients with massive macromastia, or severe ptosis, should be candidates for a reduction mammaplasty by the inferior pedicle transposition technique, instead of by free nipple and areola grafting. With the inferior pedicle technique the blood supply to the nipple and areola remains generous, coming from the entire width of the inframammary fold. By using a keyhole skin flap pattern, a conical breast shape is achieved when the medial and lateral skin flaps are brought together as a skin brassiere. The methods seems safe and simple, and the results have been satisfactory. An unexpected benefit has been the excellent postoperative sensation of the nipple, areola, and the skin of the breasts.

Breast↗
PubMed1995

[One-stage reconstruction of nipple-areola: the beta flap].

The main disadvantage of most methods for nipple reconstruction is shrinkage of the nipple. This paper presents a one-stage procedure using a local flap with a full-thickness skin grafting that has the advantages of high patient satisfaction. Since June 1993, we have been using a technique for nipple reconstruction by raising two opposing beta-shaped random skin flaps. This technique has been performed on 8 breasts in 4 patients.

Adolescent↗
PubMed1995

[An improved technique for preserving the nipple sensation in McKissock reduction mammaplasty].

An improved technique for preserving the nipple sensation in McKissock's reduction mammaplasty is described. Altogether four patients (seven breasts) have been operated on, and the primary results are highly satisfactory. The advantages of this technique are as followings: 1) The fourth lateral cutaneous nerve of the thorax, which mainly innervates the nipple, is preserved. All the patients retain the tactile sensation and the erectile reaction of the nipple after mammaplasty. 2) The operation is so modified that the suture line is smooth and has less tension. 3) The procedure ensures that both breasts are symmetrical after the operation.

Adult↗
PubMed1996

Prostate-specific antigen levels in nipple aspirate fluid correlate with breast cancer risk.

Despite the fact that breast cancer is the most common non-cutaneous cancer and a leading cause of cancer deaths in women, accepted markers of breast cancer risk miss up to 40% of these tumors. Moreover, screening methods involving the analysis of tissue or cells are limited by the need for a surgical biopsy. Nipple aspiration is a quick, efficient, noninvasive method to obtain breast epithelial cells, the cells at risk for transformation to carcinoma. Prostate-specific antigen (PSA), a protein thought to be specific to the prostate but recently found in a subset of breast tumors, has been correlated with improved survival. The purpose of this study was to measure PSA in a group of women with increasing breast cancer risk (no risk or family history of breast cancer, precancerous mastopathy, and invasive cancer) and determine if PSA correlates with risk. Nipple aspirate fluid was obtained from the intact breast and from surgical specimens using a modified breast pump. PSA was then measured in the fluid using a highly sensitive and specific immunofluorometric procedure. PSA was found at levels ranging from 0-13,423 ng/g of total protein, and there was a significant relationship between PSA level and breast cancer risk (P = 0.001). That is, all women with no risk factors and 90% of those with a family history had high PSA levels, whereas 68% of subjects with precancerous mastopathy or invasive cancer had low PSA levels. PSA was higher in premenopausal subjects (P = 0.002). After adjusting for the effect of menopausal status, there remained a significant association between PSA and breast cancer risk. These findings suggest that PSA in nipple aspirate fluid may be a useful marker of breast cancer risk.

Adult↗
PubMed1997

[Clinical research of nipple-areola preserved mastectomy and one-stage breast reconstruction with rectus abdominis musculocutaneous flaps].

OBJECTIVE: To discuss the method for nipple-areola preserved mastectomy with one-stage breast reconstruction in cancer surgery. METHODS: Because of the merits of sufficient blood supply and plasticity of rectus abdominis musculocutaneous flap, we used one-stage breast reconstruction after modified radical mastectomy. The incision line was covered and the nipple-areola was preserved. The reconstructed breast was naturally in contour. RESULTS: 21 cases were treated from 1990 to 1995, and 18 of them received horizontal-rhombus shaped rectus abdominis musculocutaneous flaps and 3 longitudinal-rhombus flaps for breast reconstruction. Nipple-areola was preserved in 16 cases. Objective evaluation after operation showed that the excellent and satisfied rate reached to 90.5%; and subjective evaluation showed that the excellent and satisfied rate reached to 95.2%. Thirteen cases have been followed up for 3 years, and 9 for 5 years. Three-year survival rate was 100% (13/13), and 5-year 88.9% (8/9). CONCLUSION: The method is recommendable for the treatment of stage I-II breast cancer.

Adenocarcinoma↗
PubMed1996

Biomechanical stabilization of the nipple valve in continent ileostomy.

Despite stapler stabilization, sliding complication of nipple valve function occur in 19 per cent of continent ileostomies. Because the tendency of the ileum to desuscept is triggered by traction forces on the mesentery of the nipple during filling of the reservoir, a technique was developed to neutralize this biomechanical strain. In addition, to obtain fibrous healing between the muscular layers, the mucosa of contacting intestinal walls was removed by selective ultrasonic fragmentation. The valves of 18 consecutive patients were operated on with this technique. In six of these, a sliding valve was restabilized in a median time of 1.2 (range 0.4-2.9) years after conventional construction of the pouch. All are functioning well after a median of 4.6 (range 3.0-6.0) years. Between 1.8 and 4.8 years after operation a healed area between the musculature of the nipple and pouch of 4.5-7.2 cm2 was shown by endosonography. This procedure may provide long-term prevention of sliding complications in continent ileostomies.

Adenomatous Polyposis Coli↗
PubMed1988

Sensory determinants of nipple-attachment behavior in 2-4-day-old kittens.

Fourteen kittens, 2-4 days of age, were studied on their anesthetized dams for nipple attachment behavior. In agreement with a previous report (Larson, M. A., & Stein, B. E., 1984, Dev. Psychobiol., 17: 423-436) we find that olfaction contributed rather little to nipple attachment in kittens. The major determinants appear to be tactile, centering in the mouth and trigeminal projection field. The behavior of kittens with temporary oral and/or trigeminal deafferentation is described in detail to provide some understanding of the contribution of each of those areas to nipple attachment in kittens.

Animals↗
PubMed1996

Detubularized right colonic reservoir with intussuscepted ileal nipple valve or stapled ileal ("Lundiana") outlet. Clinical and urodynamic results in a prospective randomized study.

In a prospective randomized study, patients undergoing cystectomy and continent urinary diversion by means of a detubularized right colonic reservoir were randomized to one of two types of outlet: either an intussuscepted ileal nipple valve (n = 15) or a stapled ileal ("Lundiana") outlet (n = 15). There were no early complications from the reconstruction. Subsequently, one ileal nipple outlet required revision because of progressive catheterization difficulties. In the Lundiana group, perforation of the reservoir occurred in one case and a narrow stomal opening was revised in local anesthesia in two cases. Urodynamic assessment revealed similar pressures at rest for the two outlets. At stress (concomitant with reservoir contraction), there was a distinct increase in outlet pressure in the nipple valves, but this was rarely encountered in the Lundiana group. Questionnaires showed episodes of urinary leakage to be more common in the Lundiana group, whereas the reverse applied to catheterization difficulties. In both groups, however, the great majority of patients were satisfied or very satisfied with the function of the urinary tract.

Adult↗
PubMed1990

Ileocolic nipple valve anastomosis for preventing recurrence of surgically treated Crohn's disease. Long-term follow-up of six patients.

To prevent coloileal reflux after ileocecal resection, an ileocolic nipple valve anastomosis was constructed in six patients with Crohn's disease. The patients were observed for more than 7 years and were compared with 21 Crohn patients in whom conventional end-to-end ileocolic anastomosis was performed during the same period. The outcome was more favorable in the group with nipple valve anastomosis, i.e., longer interval between surgery and symptomatic relapse, and tendency to less frequent recurrence and re-resection. An association was found between radiologically preserved nipple valve and remission, and two patients with intact valve at long-term follow-up remained symptom-free. The observations implied that protection of the terminal ileum from coloileal reflux after ileocecal resection for Crohn's disease may favorably influence the prognosis.

Adolescent↗
PubMed1992

Technique for nipple valve fixation to prevent valve slippage in continent ileostomy.

There have been several developments in the evolutionary process associated with continent ileostomy. Despite a progressive decline of the early and late complications associated with this procedure, nipple valve slippage remains a common complication. A technique that provides additional stability to the nipple valve is described here. This procedure involves stapled anchorage of the nipple valve to the anterior pouch wall.

Follow-Up Studies↗
PubMed1988

MRI visualization of the aortic nipple.

The aortic nipple, a small "pseudotumor" adjacent to the aortic arch, is the left superior intercostal vein. In our series of 40 patients it was demonstrated in six; all had a right upper thoracic mass and four had a superior vena caval syndrome. Coronal magnetic resonance images (MRI) of the thorax were superior to all other imaging methods in demonstrating the nipple. It is concluded that in patients with masses in the right upper chest, coronal MR chest examinations are valuable in demonstrating an aortic nipple, a sign of impending present superior vena caval or innominate vein obstruction.

Aged↗
PubMed1998

Enhancement of the Nipple-Areolar-Complex on Contrast-Enhanced MR Imaging of the Breast.

OBJECTIVE: To evaluate patterns of enhancement in the nipple-areolar-complex (NAC) on contrast-enhanced MRI. METHODS: We reviewed the MR images of 37 patients in which enhancement of the NAC was demonstrated on gadolinium-enhanced dynamic fast radiofrequency spoiled gradient recalled echo (fast-SPGR) images. Time intensity profiles derived from signal intensity values were constructed, and findings correlated with histological results. RESULTS: Three types of curve were observed. In the first type seen in adenoma of the nipple, rapid initial increase in signal intensity with an early peak (1 min) occurred followed by gradual washout. In the second type seen in direct invasion from carcinoma, subareolar intracystic papilloma, or Paget's disease, rapid initial increase in signal intensity followed by a more gradual increase or plateau was seen. In the third type seen in carcinoma without nipple invasion, fibrocystic disease and fibroadenoma, a gradual increase in signal intensity was observed throughout the examination period. CONCLUSION: Early and prominent enhancement of the NAC on contrast-enhanced MRImay indicate the presence of a primary lesion in the NAC or secondary involvement by a primary tumor elsewhere in the breast.

Journal Article↗
PubMed1994

A Case with Breast Cancer under the Nipple Who Underwent Breast Conserving Treatment.

Although breast conserving treatment (BCT) had become the standard therapy for early breast cancer, breast removal is still recommended for patients with a tumor beneath the nipple or with Paget's disease. We have employed transposition of a latissimus dorsi myocutaneous (LD-MC)flap after wide local excision of a tumor with the nipple-areola complex. A new nipple-areola complex was reconstructed on the LD-MC flap after breast irradiation. Utilizing reconstructive techniques, BCT will likely become the treatment of choice for more patients with early breast cancer.

Journal Article↗