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PubMedDate not supplied

Double skin island pectoralis major myocutaneous flap with nipple-areola complex preservation: a case report.

A horizontal double skin island pectoralis major myocutaneous flap with preservation of nipple-areola complex is described, a different modification used to reconstruct a complex defect following radical resection of a locally advanced gingival carcinoma. The skin islands are horizontally separated by a distance of 2.5 cm but rely on one vascular pedicle for their blood supply. The muscle between the skin islands provides the soft tissue bulk between the internal mucosal and external skin lining. The need for a separate segmental flap or a split-thickness skin graft for mucosal lining was eliminated.

Aged↗
PubMed2002

Ethnic variation in kallikrein expression in nipple aspirate fluid.

Socioeconomic factors cannot entirely explain why black women have an earlier age of breast cancer onset and higher mortality rates, stage for stage, than whites. We and others have shown that prostate-specific antigen [PSA, also known as human kallikrein (hK) 3] is a marker of breast as well as prostate cancer, that hK2 and hK3 are highly homologous at the DNA and protein level and that the level of progesterone, which appears to upregulate hK3, is influenced by ethnicity. We hypothesized that nipple aspiration fluid (NAF) hK2 and hK3 levels are (i) lower in black than white women; (ii) independently associated with breast cancer; (iii) influenced by menopausal status; and (iv) in combination are more informative about whether a woman has breast cancer than either marker alone. NAF was assayed for hK2 and hK3, and the results were stratified by ethnicity, presence or absence of cancer and menopausal status. Statistical analysis was then performed. When stratified by ethnicity, hK2 (p = 0.003) and hK3 (p = 0.027) levels in blacks were lower than in whites. hK2 was lower in premenopausal black than in white subjects, regardless of cancer status. Overall, hK2, hK3 and the ratio hK2/hK3 were lower in subjects with breast cancer than in normal subjects. hK3 was lower in postmenopausal women with breast cancer, regardless of ethnicity. hK2 and hK3 levels were higher in pre- than in postmenopausal whites. Using logistic regression and considering hK2, hK3, hK2/hK3 and ethnicity, hK3 was significantly associated with breast cancer in both pre- (p < 0.001) and postmenopausal women (p = 0.023). In conclusion, whereas hK2, hK3, hK2/hK3 and ethnicity are each significantly associated with breast cancer bivariately, after entering the strongest predictor, hK3, into a logistic regression model, no other variable accounted for additional variation, although this observation is preliminary due to the limited number of black subjects in the study.

Adult↗
PubMed2004

Association of kallikrein expression in nipple aspirate fluid with breast cancer risk.

Human kallikreins (hK) 2, 3, 6 and 10 are expressed in breast and prostate tissue. hK2 and hK3 (prostate-specific antigen, PSA) are used to screen for prostate cancer. hK6 and hK10 are downregulated in breast cancer compared to normal breast tissue. We demonstrated that levels of PSA in nipple aspirate fluid (NAF) are lower in women with breast cancer than in normal women. We hypothesize that the expression of hK2, 3, 6 and 10 are related and important in detecting breast cancer. The goals of this study are to determine the level of expression of kallikreins in NAF and serum, the association of hK2, 3, 6 and 10 in NAF, and the association of each of the kallikreins with breast cancer. In NAF from 275 women, hK3, 6 and 10 were detectable in >/= 90% and hK2 in 74% of samples analyzed. NAF levels were highest for hK6 and lowest for hK2, regardless of cancer and menopausal status. hK3 was detectable in 15/29 (52%) and hK2 in 0/29 serum samples collected from 6 women. hK2 and hK3 were concentrated in NAF vs. matched serum. The 4 kallikreins were associated with the exception of hK2 with hK6 or hK10. PSA levels were higher in normal pre- than postmenopausal subjects (but not women with breast cancer), whereas levels of hK2, 6 and 10 did not differ by menopausal status. hK2 and PSA were associated with both pre- and postmenopausal breast cancer; hK6 and 10 were not. hK2 and PSA were more associated with pre- than postmenopausal breast cancer. Using logistic regression, PSA and menopausal status provided the best model of breast cancer prediction, with a sensitivity of 91% and specificity of 39%. In conclusion, 4 kallikreins are expressed in NAF. hK2 and PSA, and hK6 and hK10 are highly associated. Higher premenopausal PSA levels suggest the influence of ovarian steroids. PSA shows the most promise in aiding in the early detection of breast cancer.

Adult↗
PubMed1992

The use of leeches for treatment of venous congestion of the nipple following breast surgery.

The medicinal leech, Hirudo medicinalis, played a central role in the evolution of medieval and folk medicine. Today, for the first time in history, the leech actually has a real and valuable purpose in medicine as a useful adjunct for the plastic surgeon: It provides relief of venous congestion. For over 2000 years, leeches were needlessly applied for a multitude of maladies as an adjunct to blood-letting. Their use in Europe peaked between 1830 and 1850, however, shortages led to a subsequent decline in leech application. Today there is a real clinical use for leeches which had led to a resurgence in their use in plastic surgery. Plastic surgeons use leeches in microsurgery to salvage congested flaps, whose viability is uncertain due to venous congestion. We present our experience with two patients where leeches were used to treat isolated venous engorgement of the nipple following breast surgery. Leech therapy is painless, well tolerated, and does not result in significant scarring. Prompt initiation of treatment is mandatory and produces dramatic resolution of venous congestion.

Adult↗
PubMed1990

Factors associated with obtaining nipple aspirate fluid: analysis of 1428 women and literature review.

Studies of cytologic and biochemical constituents of nipple aspirates of breast fluid have contributed to understanding the natural history of benign and malignant breast disease. We conducted multivariate analyses using 1428 women from a recent case-control study of breast disease to determine which factors were independently associated with the ability to obtain breast fluid from nonlactating women. We then compared results from these analyses to the results from five previous studies that also used the aspiration technique of Sartorius. Four factors were consistently associated across studies with increased ability to obtain breast fluid: 1) age up to 35 to 50 years; 2) earlier age at menarche; 3) non-Asian compared to Asian ethnicity; and 4) history of lactation. Exogenous estrogen use, endogenous estrogen concentrations, phase of menstrual cycle, family history of breast cancer, type of menopause, and less than full-term pregnancy consistently did not influence ability to obtain fluid. New findings from this study shed light on some apparently contradictory findings from the previous studies. In particular, this study showed that the effects of age on ability to obtain fluid appeared to be independent of the effects of menopause. Furthermore, discrepancies in previous findings on the effects of parity on ability to obtain fluid may be explained by our finding that the increased ability to obtain fluid from parous compared to nulliparous women applied only to parous women who had breastfed.

Adult↗
PubMedDate not supplied

The correction of inverted nipples without scars: 17 Years' experience, 452 operations.

The surgical correction of one of the most frequent congenital malformations, inverted nipples, is analyzed here following a long series of cases, some of which, among the first, date back 17 years and more. The article describes the previous surgical methods and the reasons why they failed, as well as the principle, technique, and long-term results of the author's personal method. It also emphasizes the need for the medical profession and the public to be widely informed, to avoid the problems this malformation creates among a large number of women.

Adult↗
PubMed2002

Galactography: method of choice in pathologic nipple discharge?

Our objective was to assess the role of galactography in the diagnostic work-up of patients with pathological nipple discharge together with exfoliative cytology, and investigation of secretion colour. All galactographies performed in this center between 1993 and 1998 were evaluated retrospectively. In 134 cases, outcomes, defined as either a postoperative histology or a negative follow-up over 2 years after galactography, were available. In 96 of these cases, exfoliative cytology was performed, and in 65 cases the colour of the secretion was determined. Galactograms, cytological findings and colour of the secretions were compared with the outcomes. At galactography, the radiographic findings had the following individual sensitivities/specificities in detecting carcinomas: filling defect 55.6%/62.1%; ductectasia 22.2%/94%; and filling stop 5.6%/77.6%. Normal galactograms (n=33, 25%) had a sensitivity of 78% and a specificity of 93% in predicting absence of disease. Technically inadequate investigations occurred in 16 (12%) cases. Cytology showed 69.2%/66.8% for papillomatous borderline or malignant cells; 53.8%/75.3% for borderline or malignant cells; and 7.7%/100% for one case of malignant cells. For the assessment of pathological secretions, galactography is a sensitive but unspecific method for the detection of papillomas or carcinomas. Filling defects, ductectasia and ductal distortion carry the highest levels of suspicion for carcinoma. A normal galactogram is a specific yet moderately sensitive indicator of absence of localized disease. Exfoliative cytology shows low sensitivity but better specificity for carcinomas when borderline or malignant cells are found. In the present series, the colour of the secretions does not add significant information about underlying pathology.

Aged↗
PubMed2005

Bloody nipple discharge in children: possible etiologies and selection of appropriate therapy.

An understanding of underlying causes of bloody nipple discharge (BND) is necessary to be able to advise treatment guidelines of this rare symptom in the pediatric age group. Of 11 patients with 14 breasts that had BND, data regarding age, sex, side and duration of BND, physical examination findings, laboratory values, culture reports, ultrasonography (US) findings, treatment approach, histopathologic details, and outcomes were obtained, and also, literature was reviewed. The patients were between 3 months and 12 years of age. There were six males and five females. The BND was located in the right breast in six patients, in the left in two, and it was bilateral in three. On physical examinations, seven patients had palpable cystic nodules located at the areolar area and three had a diffuse breast enlargement without skin findings. Laboratory investigations showed normal hormone levels in all patients. At US examinations, seven breasts had cystic lesions, three had hypoechoic tissue in the subareolar region, and others had normal US findings. In a girl with positive culture for Staphylococcus aureus, BND resolved after oral antibiotics. Two cases resolved spontaneously, with 6 months and 4 months follow-up periods, respectively. Surgical intervention was performed for the remaining eight patients, and mean time to operation after onset of symptoms was 10 months (range = 1-34 months). Histopathologic findings showed that the underlying cause of BND was duct ectasia in five breasts, gynecomastia in three, and fibrocystic change in two. Their follow-up periods ranged between 3 months and 6 years, and no recurrences were observed. Classification of breasts with BND for selecting appropriate therapy on the basis of results of careful physical examination, with an US evaluation in selected cases, is effective, and prevents unnecessary investigations.

Algorithms↗
PubMed1999

The incidence of occult nipple-areola complex involvement in breast cancer patients receiving a skin-sparing mastectomy.

BACKGROUND: Surgical treatment of breast cancer traditionally has included resection of the nipple-areola complex (NAC), in the belief that this area had a significant probability of containing occult tumors. The purpose of this study was to investigate the true incidence of NAC involvement in patients who underwent a skin-sparing mastectomy (SSM) and to determine associated risk factors. METHODS: A retrospective chart review was conducted of 326 patients who had a SSM at our institution from 1990 to 1993. NAC involvement was reviewed in 286 mastectomy specimens. The charts were analyzed for tumor size, site, histology, grade, nodal status, recurrence, survival, and NAC involvement. RESULTS: Occult tumor involvement in the NAC was found in 5.6% of mastectomy specimens (16 patients). Four patients would have had NAC involvement identified on frozen section if they had been undergoing a skin-sparing mastectomy with preservation of the NAC. There were no significant differences between NAC-positive (NAC+) and NAC-negative (NAC-) patients in median tumor size, nuclear grade, histologic subtype of the primary tumor, or receptor status. There were significant differences in location of the primary tumor (subareolar or multicentric vs. peripheral) and positive axillary lymph node status. NAC involvement was not a marker for increased recurrence or decreased survival. CONCLUSIONS: Occult NAC involvement occurred in only a small percentage of patients undergoing skin-sparing mastectomies. NAC preservation would be appropriate in axillary node-negative patients with small, solitary tumors located on the periphery of the breast.

Breast Neoplasms↗
PubMed2005

Significant differences in nipple aspirate fluid protein expression between healthy women and those with breast cancer demonstrated by time-of-flight mass spectrometry.

New approaches are needed for the early detection of breast cancer. Proteomic profiling technologies, such as surface-enhanced laser desorption ionization mass spectrometry (SELDI-MS), may be able to identify tumor markers in biological fluids. The objective of this study was to determine whether there are differences in protein expression patterns in nipple aspirate fluid (NAF) from the cancerous and noncancerous breasts of patients with unilateral breast cancer and the breasts of healthy volunteers. Paired NAF samples were obtained from 23 women with stage I or II unilateral invasive breast carcinoma and five healthy female volunteers. Aliquots of the samples were applied to SELDI Protein-chip arrays (WCX2 and IMAC3-Cu++), and protein expression was analyzed using time-of-flight MS. A total of 463 distinct peaks were detected and analyzed. In breast cancer patients, no differences in protein expression were identified between the breast with the intact primary carcinoma and the contralateral noncancerous breast. Seventeen peaks were overexpressed in cancer-bearing breasts compared to breasts of healthy volunteers (p < 0.0005). When spectra from the nontumor-bearing breasts of breast cancer patients were compared with spectra from breasts of healthy volunteers, two peaks that were overexpressed in breast cancer patients and one peak that was underexpressed in breast cancer patients were detected (p < 0.0027). SELDI-MS was able to identify differences in the phenotypic proteomic profile of NAF samples obtained from patients with early-stage breast cancer and healthy women. Proteomic screening techniques such as SELDI-MS analysis of NAF may be useful for breast cancer screening and diagnosis.

Biopsy, Needle↗
PubMed2005

Nutritional predictors for cellular nipple aspirate fluid: Nutrition and Breast Health Study.

The presence of epithelial cells in breast nipple aspirate fluid (NAF), irrespective of abnormality, has been associated with increased risk of breast cancer in previous studies. We sought to investigate whether the presence of epithelial cells in NAF is associated with nutritional parameters among 71 healthy premenopausal women who participated in the Nutrition and Breast Health Study and provided any samples of NAF during the study. Total of 142 samples which were obtained over a 1-year period of intervention with low-fat and/or high vegetable-fruit diets were available for cytological evaluation. The odds ratios (ORs) and 95% confidence intervals (CIs) for the detection of epithelial cells in NAF were estimated by fitting generalized estimating equations models by quartile level of nutritional parameters. The probability of yielding epithelial cell-positive NAF progressively increased with increasing total fat intake (p=0.001). The OR for the highest quartile level of fat intake, compared with lowest, was 7.22 (95% CI 1.14-45.82). On the other hand, there were a marginally significant inverse association with total fiber intake as well as an weak inverse association with the number of servings of fruit and vegetables. Furthermore, the probability of detecting epithelial cells in NAF decreased with increasing plasma levels of lutein and alpha-carotene (p-values for linear trend; 0.001 and 0.049, respectively). The ORs for the highest versus lowest quartile levels are 0.17 (95% CI 0.04-0.65) and 0.19 (95% CI 0.04-0.91), respectively. These results are generally in support of roles of nutritional factors in breast cancer and thus further studies are warranted.

Adult↗
PubMed2005

Non-steroidal anti-inflammatory drug (NSAID) use and levels of a lipid oxidation marker in plasma and nipple aspirate fluids.

Non-steroidal anti-inflammatory drugs (NSAIDs) are thought to reduce cancer risk by inhibiting cyclo-oxygenases, resulting in deceased formation of inflammatory mediators and oxidative stress. We examined whether the level of one oxidative stress marker, 15-F(2t)-isoprostane, was affected by NSAID use in plasma and breast nipple aspirate fluids (NAF) of pre-menopausal women who were participating in a dietary intervention trial (n=121). Baseline levels of 15-F(2t)-isoprostane were lower in NSAID users than non-users in both NAF and plasma, although the differences did not persist after intervention. Over the duration of the study, information on NSAID use was collected five times, and average 15-F(2t)-isoprostane levels in both NAF and plasma exhibited a statistically significant trend for decreases with increased frequency of NSAID use. These results indicate that NSAID use can result in lower levels of 15-F(2t)-isoprostane, which may have implications for the effects of NSAID use on breast cancer risk.

Adult↗
PubMed1989

A comparison of perinatal outcome in patients undergoing contraction stress testing performed by nipple stimulation versus spontaneously occurring contractions.

Perinatal outcomes were analyzed in 848 high-risk pregnancies managed with a prospective weekly contraction stress testing protocol. In 615 patients the last test was performed by a nipple stimulation protocol whereas 233 patients had sufficient spontaneous contractions for performance of the test. All patients were either delivered of their infants or admitted for delivery within 7 days of the last test. The results of the last test were compared to various perinatal outcome parameters. There was no significant difference in perinatal outcomes between the two groups.

Breast↗
PubMed1994

The "Niplette": an instrument for the non-surgical correction of inverted nipples.

Inverted and non-protractile nipples are a common problem which cause psychological distress and interfere with a woman's ability to breast feed. A new instrument, the "Niplette", readily corrects the defect without the need for surgery. It is cheap and all patients found it comfortable and easy to use. Breast feeding is possible after treatment. The device should replace surgery in medical practice for this common condition.

Adult↗
PubMed1993

Nipple discharge and abnormal galactogram. Results of a long-term study (1964-1990).

In case of abnormal nipple discharge of the female breast, galactography can detect variations of ductal calibre, intraductal alterations and ductal discontinuities. Between 1964 and 1990 we examined 2588 women by galactography and performed 826 duct excisions. In one out of 8 patients (13.4%) we diagnosed invasive carcinoma or ductal carcinoma in situ. In more than 40% a solitary ductal papilloma was detected. 13.7% of the patients were found to have extensive intraductal solid papillary or adenomatous epithelial proliferations. Comparison with collected statistical data reveals that other investigators are able to detect malignant changes in 1-23% of cases. We have managed the largest number of cases and have diagnosed pathologic ductal secretion in more than 3% of women we screened by physical inspection, mammography and sonography. The colour of the ductal discharge is of minor importance, as histologic analysis is mandated by the presence of ductal system alterations.

Breast Neoplasms↗