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Proteomic analysis of nipple aspirate fluid throughout the menstrual cycle in healthy pre-menopausal women.

A proteomic approach to nipple aspiration fluid (NAF) has been used in a number of studies comparing women with breast cancer and healthy women. However, to make useful comparisons between women with breast cancer and healthy women it is necessary to establish whether there is physiological variation in the proteomic profiles of NAF. The purpose of this study was, for the first time, to examine how the proteomic profile of NAF using surface-enhanced laser desorption ionisation time-of-flight mass spectrometry varies across the menstrual cycle in healthy pre-menopausal women. Twelve women were recruited and nipple aspiration was carried out weekly from both breasts of each subject for two menstrual cycles. Matching serum samples for luteinising hormone, follicle stimulating hormone and oestradiol were obtained at each aspiration attempt. Statistically significant peaks were found for three healthy volunteers (p < 0.05). However, the peaks that varied across the menstrual cycle were different from one healthy volunteer to another and the differences were small compared with the large variation in proteomic profiles between healthy volunteers. This study provides proof of concept that the NAF proteomic profile does not vary substantially during the menstrual cycle and that therefore it is valid to compare NAF profiles from pre-menopausal women that have been taken at different stages in the menstrual cycle.

Biomarkers↗

Custom-made nipple-areola prostheses in breast reconstruction.

The nipple-areola prosthesis is a useful temporary or permanent adjunct to breast reconstruction. The commercially available prostheses, however, are unable to reflect the remarkable normal variation in this anatomical feature. We describe the production and use of custom-made prostheses using the remaining nipple-areola complex as a template. Their success in 72 patients has led us to adopt such prostheses as routine in breast reconstruction.

Breast↗

Maternal aggression of rats is impaired by cutaneous anesthesia of the ventral trunk, but not by nipple removal.

Aggression toward conspecific and allospecific individuals by female mammals is much more likely during lactation than during other reproductive states, a behavior that serves to protect the young. Previous research revealed that removal of nipples (thelectomy) prepartum greatly reduces the likelihood of postpartum aggression in house mice, but not in Sprague-Dawley Norway rats. The present work shows that prepartum thelectomy has no effect on the likelihood or intensity of postpartum aggression toward a strange male intruder in Long-Evans rats. In contrast, anesthesia of each nipple and surrounding skin prevents or severely impairs the elicitation of biting and attacking by the intruder, but does not impair normal retrieval of pups. Following removal of the litter, maternal aggression occurs readily at 1 h and somewhat less so at 5 h, but is absent at 24 h. These data suggest that while maternal aggression in postpartum rats does not require suckling, it is dependent on somatosensory stimulation of the ventral trunk by pups; this stimulation apparently produces a motivational change that lasts several hours.

Aggression↗

Intraepidermal squamous carcinoma (Bowen's disease) of the nipple.

A case of Bowen's disease of the nipple clinically resembling Paget's disease is reported. This lesion was differentiated from other pagetoid lesions by negative histochemical stains for mucin and melanin, positive immunohistochemical preparation for high-molecular weight cytokeratin 66 kd (904) using adequate controls, and electron microscopic findings of squamous cell features. The therapeutic implications of such a pagetoid nipple lesion in the absence of an underlying breast carcinoma are discussed.

Aged↗

Cerebrospinal fluid leakage from the nipple after ventriculoperitoneal shunt: case report.

A case of ventriculoperitoneal shunt malfunction is presented, in which cerebrospinal fluid was discharged from the nipple. A pseudocyst was found at the end of peritoneal catheter in the right subphrenic abdominal cavity. In addition, a fibrous tract was formed around the peritoneal catheter and communicated with the lactiferous duct probably injured incidentally during the subcutaneous insertion of catheter. Consequently, cerebrospinal fluid accumulated in the pseudocyst in the abdominal cavity and then flowed backward in the fibrous tract to the lactiferous duct during the respiration to discharge from the nipple.

Abdomen↗

Effect of a traditional and of a new nipple shield on sucking patterns and milk flow.

The effect of a traditional (Mexican Hat) and of a new (Thin Latex) nipple shield on the sucking patterns and milk intake of 5-8-day-old babies was examined. Milk intake was determined accurately by test weighing using a Sartorius electronic balance with animal weighing keyboard, and sucking patterns by filming the mouth of the baby. The Mexican Hat reduced milk transfer by 58% (P is less than 0.01), and increased sucking rate (P is less than 0.05) and time spent resting (P is less than 0.01). The Thin Latex nipple shield reduced milk intake by a smaller amount (22%), and had no significant effect on sucking patterns.

Breast Feeding↗

Breast tumors associated with nipple discharge. Correlation of findings on galactography and sonography.

To compare the specific information provided by ultrasound (US) and galactography and to appreciate the clinical applicability of US as a primary diagnostic method for breast tumors associated with nipple discharge, a comparative study of each method in 15 patients with ductal tumors of the breast was performed. To evaluate the smallest anatomical unit of the lactiferous system demonstrable by US, 30 patients with normal lactating breasts were examined prospectively. The smallest anatomical ductal unit that could be evaluated with US in the normal lactating breast was the terminal duct lobular unit (TDLU). US is superior to galactography in detecting masses smaller than 0.5 cm or lesions involving multiple ducts. Galactography is better for visualizing the duct system and detecting calcification. In conclusion, US serves as a primary noninvasive diagnostic tool in patients with clinically suspicious breast tumor associated with bloody nipple discharge, but galactography also should be done in specific circumstances.

Adult↗

Total skin-sparing mastectomy without preservation of the nipple-areola complex.

BACKGROUND: We hypothesized that total skin-sparing mastectomy (TSM) including where the skin overlying the nipple and areola is preserved would be oncologically safe and facilitate improved cosmetic reconstruction. METHODS: A review (May 2003 through January 2005) was completed on all procedures that were performed through an inframammary incision or a previous scar with reconstruction using Botox, AlloDerm, and a subpectoral tissue implant. RESULTS: Thirty-one patients had 50 TSMs. Twelve percent (6/50) of TSMs had the skin of the nipple and areola resected: 4 (14% of tumors) because of tumor involvement and 2 (4%) because of skin necrosis. Fourteen percent of patients had other complications: 4% (2/50) had infection and/or flap necrosis and 10% (5/50) had superficial epidermolysis requiring no intervention, for a total complication rate of 18%. Average cosmetic score was 8.5 (range 4 to 10). No recurrences are evident after mean follow-up of 7.9 +/- 5.4 months. CONCLUSION: Our short-term experience suggests that TSM has an acceptable complication rate, is theoretically oncologically safe, and facilitates an improved cosmetic result.

Adult↗

Identification of breast cancer in patients with pathologic nipple discharge: does ductoscopy predict malignancy?

OBJECTIVE: The purpose of the current study was to review characteristics of patients with nipple discharge who underwent ductoscopy-assisted excisional biopsy who had a final diagnosis of carcinoma. METHODS: A retrospective review was performed of patients presenting with pathologic nipple discharge (PND) who underwent ductoscopy-assisted excisional biopsy and had a final diagnosis of carcinoma. RESULTS: A total of 14 (7%) of 188 patients who underwent ductoscopy-assisted excision had a final pathology of ductal carcinoma-in-situ (DCIS) (12/14, 86%) or invasive breast cancer with DCIS (2/14, 14%). Duct wall irregularities or intraluminal growths were visualized during ductoscopy in 8 of the 14 (57%) breast cancer patients. There were no visual abnormalities noted during ductoscopy that accurately predicted a final diagnosis of malignancy. CONCLUSIONS: Although occult malignancies can be identified in patients undergoing ductoscopy-assisted biopsy for PND, no clear morphologic changes visualized during ductoscopy definitively indicated the presence of malignancy.

Adenocarcinoma↗

Is there still a place for free nipple areolar grafting in breast reduction surgery? A review of cases over a three year period.

Breast reduction using the technique of free nipple areolar grafting still has a place in selected cases. The surgical technique used by the senior author is described together with an analysis of the 22 cases operated on including the results of a questionnaire from 20 of these patients. The results confirmed that the technique still has a use. Relief of pre-operative symptoms by the surgery was obtained in all and there was a high degree of satisfaction with both the cosmetic results and maintaining of shape. The main criticisms relate to scars and poor return of nipple sensation, appearance, and function. Overall this did not appear to be a major issue in this cohort of patients.

Adolescent↗

Syringomatous adenoma of the nipple.

Infiltrating syringomatous adenoma (SA) of the nipple is a rare but distinct benign clinical entity affecting the breast. It needs to be included in the differential diagnosis of patients who present with a lump in the nipple/areola complex. It is similar histologically to a syringoma, a benign tumour originating in the ducts of the dermal sweat glands, and importantly needs to be distinguished from a tubular carcinoma. SA of the nipple is locally infiltrating but is not known to metastasise. It often presents as a subareolar lesion with clinical, mammographic and ultrasound findings suspicious for malignancy. Whilst it may be possible to suspect the diagnosis on fine needle cytology, core biopsy or excisional biopsy is usually required to establish the diagnosis. There is a tendency to recurrence if excision is incomplete. The following is a case report, literature review and discussion of the surgical management options available in this unusual condition.

Adenoma↗

Bowen's disease of the nipple-a new method of treatment.

Squamous cell carcinoma in situ (Bowen's disease) is a common skin condition but has only rarely been described on the nipple. All reported cases have been treated with wide local excision and observation. A new treatment for Bowen's disease is photodynamic therapy. This has been reported as being able to treat Bowen's disease in other sites effectively with an acceptable local recurrence rate. We describe two patients presenting with itching and scaling of the nipple which were histologically proven Bowen's disease, one of these patients was treated successfully with a combination of photodynamic therapy and cryotherapy: this is the first time such a lesion has been treated in this way.

Aged↗

When mastectomy becomes inevitable: the nipple-sparing approach.

The preservation of the nipple areola complex (NAC) could improve the quality of life in cases of mastectomy. A novel radiosurgical treatment combining subcutaneous mastectomy with intraoperative radiotherapy is proposed. Three hundred nipple-sparing mastectomies (NSM) were performed. Invasive (58%) and in situ (42%) carcinomas were included. Clinical complications, aesthetic results, oncological and psychological results were recorded. The NAC necrosed totally in 10 cases and partially in 29 and it was removed in 12. Nine infections (3%) were observed and 10 prostheses removed. Good results were rated by 82.3% of the patients and by 84.8% of the surgeons. In 7.5% a radiodystrophy was observed. The sensitivity of the NAC recovered partially in 48%. Two local recurrences occurred outside the radiated field. Overall, we observed three metastases and no deaths. Sixty-eight of the patients were satisfied with their reconstructed breast and 85.5% were satisfied having preserved the NAC.

Adult↗

Prostate-specific antigen expression in nipple aspirate fluid is associated with advanced breast cancer.

We previously demonstrated that prostate-specific antigen (PSA) is present in breast nipple aspirate fluid (NAF) and its expression is inversely associated with the presence of breast cancer. The purpose of this study was to determine if PSA levels in NAF decrease with disease progression from DCIS to metastatic breast cancer. One hundred and forty-nine women underwent nipple aspiration before or in conjunction with surgery to treat their breast cancer. PSA levels decreased with more advanced disease stage (P = 0.016), larger tumor size (P = 0.031), and nodal involvement (P = 0.041). PSA levels were lower in women with than without distant disease spread (P = 0.049). We also evaluated the association of PSA with these clinical parameters based on menopausal status. In general, PSA predicted disease involvement better in pre- than in post-menopausal women. There was no association between PSA and race. Spearman's rank analysis demonstrated that PSA was inversely related to tumor size (P = 0.009), nodal status (P = 0.005), disease stage (P = 0.004), and distant metastases (P = 0.04). NAF PSA provides useful prognostic information which may assist with breast cancer treatment.

Adult↗

Immediate nipple pain relief after frenotomy in breast-fed infants with ankyloglossia: a randomized, prospective study.

PURPOSE: Ankyloglossia ("tongue-tie") occurs in nearly 5% of neonates, but its clinical significance relating to breast-feeding difficulties is controversial. We tested the hypothesis that in infants with ankyloglossia referred because of breast-feeding difficulties, frenotomy alleviates the symptoms. METHODS: Twenty-five mothers of healthy infants with ankyloglossia were recruited because of sore nipples. Infants were randomized to either of 2 sequences: (1) frenotomy, breast-feeding, sham, breast-feeding (n = 14) or (2) sham, breast-feeding, frenotomy, breast-feeding (n = 11). The mothers as well as all personnel taking care of the child after each sham or frenotomy procedure were masked as to the study sequence. In every sequence, and after each sham or frenotomy procedure, a standardized latch score and pain score were obtained from the mother. RESULTS: There was a significant decrease in pain score after frenotomy than after sham (P = .001). There was also a nearly significant improvement in latch after the frenotomy in these mothers (P = .06). CONCLUSION: Frenotomy appears to alleviate nipple pain immediately after frenotomy. We speculate that ankyloglossia plays a significant role in early breast-feeding difficulties, and that frenotomy is an effective therapy for these difficulties.

Breast Feeding↗

A prospective evaluation of nipple stimulation techniques for contraction stress testing.

Nipple stimulation techniques for achieving a contraction stress test were evaluated prospectively in 1271 nipple stimulation contraction stress tests in 753 patients. Success was unrelated to parity, gestational age, or warm, moist towels but was related to the presence of spontaneous prestimulation contractions. Various stimulation techniques were equally successful in achieving a completed test in the presence of prestimulation contractions; however, continuous stimulation was more successful when contractions were absent. Hyperstimulation test results occurred in 21.5% of attempts and increased to 28.8% when bilateral, continuous stimulation was performed.

Breast↗

The superomedial dermal pedicle for nipple transposition.

A new method for nipple transposition employing a superomedial dermal pedicle is described for use in reduction mammaplasty and dermal mastopexy. The advantages include superior mobility, viability, sensation and normal appearing nipples and areolae.

Breast↗

Is the nipple the preferred landmark for selecting chest electrode positions in infants? Preliminary report.

The relation on roentgenograms between the intercostal spaces and routinely selected chest electrode Position 4 on the one hand and the mammary nipple on the other was determined in 15 infants. The nipple was more frequently located over the fifth intercostal space than the electrode position selected by palpation. This difference is ascribed to poor delineation of the angle of Louis in this age group.

Electrocardiography↗