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PubMed1980

[Variation in the number of nipples in Wistar-Imamichi rats (author's transl(].

In order to determine heritability of accessory nipples, variations in the number of nipples were investigated in 13-week old female Wistar-Imamichi rats, maintained as a closed colony in the Institute for Animal Reproduction. Most of the females examined (93.32%) had six pairs of nipples; three in the pectoral and three in the abdomino-inguinal regions. Whereas, 229 out of 3606 rats had one accessory nipple each, 9 animals had 2 accessories, and 3 females were deficient of the pectoral nipple. Most of the accessory nipples were found either in the caudal and cranial regions of the third pectoral nipples or in the regions between the second and third abdomino-inguinal nipples. The frequencies for appearance of the accessory nipples were higher in the pectoral regions than those in the abdomino-inguinal ones, and also in the left side than in the right (p < 0.01), respectively. In 208 out of 791 litters examined, 177 litters had only one sister-mate with accessory nipple, 29 litters had 2 sister-mates with accessories, and 2 litters had 3 sister-mates with accessories, respectively. The localization of accessory nipples of the sister mates within the litter was similar in most of the cases. Heritability of the appearance of accessory nipples was estimated to be 0.8074 by using the formula described by Falconer.

Animals↗
PubMed2006

Light on the moth-eye corneal nipple array of butterflies.

The outer surface of the facet lenses in the compound eyes of moths consists of an array of excessive cuticular protuberances, termed corneal nipples. We have investigated the moth-eye corneal nipple array of the facet lenses of 19 diurnal butterfly species by scanning electron microscopy, transmission electron microscopy and atomic force microscope, as well as by optical modelling. The nipples appeared to be arranged in domains with almost crystalline, hexagonal packing. The nipple distances were found to vary only slightly, ranging from about 180 to 240 nm, but the nipple heights varied between 0 (papilionids) and 230 nm (a nymphalid), in good agreement with previous work. The nipples create an interface with a gradient refractive index between that of air and the facet lens material, because their distance is distinctly smaller than the wavelength of light. The gradient in the refractive index was deduced from effective medium theory. By dividing the height of the nipple layer into 100 thin slices, an optical multilayer model could be applied to calculate the reflectance of the facet lenses as a function of height, polarization and angle of incidence. The reflectance progressively diminished with increased nipple height. Nipples with a paraboloid shape and height 250 nm, touching each other at the base, virtually completely reduced the reflectance for normally incident light. The calculated dependence of the reflectance on polarization and angle of incidence agreed well with experimental data, underscoring the validity of the modelling. The corneal nipples presumably mainly function to reduce the eye glare of moths that are inactive during the day, so to make them less visible for predators. Moths are probably ancestral to the diurnal butterflies, suggesting that the reduced size of the nipples of most butterfly species indicates a vanishing trait. This effect is extreme in papilionids, which have virtually absent nipples, in line with their highly developed status. A similar evolutionary development can be noticed for the tapetum of the ommatidia of lepidopteran eyes. It is most elaborate in moth-eyes, but strongly reduced in most diurnal butterflies and absent in papilionids.

Animals↗
PubMedDate not supplied

A new surgical procedure for the very severe inverted nipple.

Severe cases of inverted nipple usually cannot be corrected by a simple procedure, especially if the nipple cannot be pulled out above the areolar level by manipulation. We describe a new method for these cases and we classify the inverted nipple into 3 grades following the choice of their required operative procedure. Our classification for inverted nipple is as follows. Grade I: The inversion is corrected simply by manipulation; the nipple protrusion is long-lasting. Grade II: The inversion can be corrected by manipulation, but recurrence of the inversion is frequent. Grade III: The inversion cannot be corrected without a surgical procedure. Cases of Grades I and II can be corrected by conventional simple surgical procedures. But some cases of Grade II and almost all of Grade III cannot be corrected by conventional methods, in spite of the high frequency of relapse. Cutting of the lactiferous duct, such as the Pitanguy and Broadbent methods, can correct the very severely inverted nipple. But if we want to maintain the lactiferous function after correction, we had better not cut the lactiferous ducts. Our new procedure for correcting very severe cases can keep the lactiferous function after correction without any relapse. In order to avoid the recurrence of nipple retraction and to maintain the lactiferous function, the new surgical procedure that we performed makes an incision deeply and vertically on the nipple to free the lactiferous ducts from the contracted tissues surrounding them. After extension or resection of the restricting tissues, the nipple is raised easily. This procedure will preserve the feeding function and prevent the recurrence of nipple inversion. For very severe cases, using a dermal flap inserted into the base of the nipple may be necessary due to its role of interposing tissue to prevent reverting to inversion.

Adult↗
PubMed2002

Fading of nipple-areolar reconstructions: the last hurdle in breast reconstruction?

Fading of nipple-areolar reconstructions is commonly reported, but there are few formal studies of this phenomenon. The purpose of this study was to determine whether deficiencies in nipple-areolar reconstruction and pigmentation were perceived by patients, their partners and independent observers, and whether a technique could be developed to measure nipple-areolar colour reliably. A total of 57 patients, 32 partners and four independent observers completed questionnaires about the appearance of the patients' breast reconstructions in general and specifically about their nipple-areolar reconstructions. Scores for the general attributes of the breast reconstruction were used as internal controls for the scores of the nipple-areolar reconstruction. A computer software package was developed to analyse colour in photographs of the reconstructions. Independent observers thought that nipple-areolar reconstruction improved the appearance of a breast reconstruction 81% of the time. Considerably fewer patients were happy with their nipple-areolar colour than were happy with the more general attributes of the breast reconstruction (P < 0.005). Colour analysis objectively demonstrated measurable mismatch between normal and reconstructed nipple-areolar skin, which was positively correlated with time since surgery due to fading of the nipple-areolar reconstruction. In our patients, the quality of nipple-areolar reconstruction, in particular its pigmentation, is seen as inferior to that of the rest of the breast reconstruction in the eyes of patients, their partners and independent observers. The poor colour match and fading of reconstructed nipple-areolar skin are phenomena that can be measured using colour analysis.

Adult↗
PubMed2002

Threshold of tactile perception after nipple-sharing: a prospective study.

Reconstruction of the nipple-areola complex is the final procedure of a breast reconstruction. The method of choice in our department for nipple reconstruction is nipple-sharing and tattooing of the areola. Some patients are reluctant to use a part of the healthy nipple, as it is not fully known how the sensibility in the remaining donor nipple is affected by surgery. Twenty patients admitted to the hospital for nipple-sharing were invited to participate in the study. The tactile perception threshold of the donor nipple was assessed using von Frey monofilaments preoperatively, and 1, 6, and 12 months postoperatively. The patients' subjective impressions one year postoperatively were also evaluated. The donor nipple had regained sensibility to touch six months after nipple-sharing. All patients reported that the nipple felt the same as before surgery and could become erect. We therefore recommend the nipple-sharing technique for completion of a breast reconstruction.

Adult↗
PubMed1996

Anatomical parameters for nipple position and areolar diameter in males.

In this paper we present anatomic parameters for nipple position and areolar diameter in males. Larger forms of gynecomastia with significant ptosis pose a challenge to the plastic surgeon with respect to relocation of the nipples on the chest wall. Selection of the appropriate areolar size is also of concern in gynecomastia correction. There is a paucity of information in the current literature pertaining to this problem. In order to establish guidelines for the placement of the nipple in gynecomastia correction and for the selection of the appropriate areolar size, we set out to determine these anatomic parameters. We believe use of these parameters will enhance the aesthetic results of gynecomastia correction. One hundred males between the ages of 17 to 30 years were chosen for this study. The males selected were of ideal body weight and without evidence of gynecomastia. The distances from the sternal notch to the nipple, the midclavicular line to the nipple, and the nipple-to-nipple distance were recorded. The areolar diameter was also measured in each subject. The average distances were determined for each category. The validity of these values was confirmed with statistical analysis. Equations were then derived, using this analysis, to determine nipple position in males. We have determined the nipple position in males to be approximately 20 cm from the sternal notch and 18 cm from the midclavicular line. The ideal nipple-to-nipple distance is 21 cm. The average areolar diameter is 2.8 cm.

Adolescent↗
PubMed1999

Long-term predictable nipple projection following reconstruction.

The creation of the nipple-areola complex is often the final step in the surgical treatment of breast cancer patients, and it consequently has important symbolic and aesthetic implications. Patient expectations and the need for symmetry make nipple projection a crucial aesthetic determinant of nipple reconstruction. We hypothesize that long-term nipple projection and shape can be achieved in a predictable fashion using the modified star dermal fat flap technique. Prospectively, 93 nipples were reconstructed by a single surgeon using a modified star dermal fat flap technique in 44 implant and 49 TRAM flap breast reconstructions. Flap dimensions (base diameter and flap length) were designed according to patient desire or to the base diameter and projection of the opposite breast nipple. A standardized, 3-month postoperative care regimen was observed in all patients. Nipple projection was assessed by the same observer at each follow-up examination. The average length of follow-up was 730 days (745 for TRAM reconstructions and 713 for implants). Consistently, an average of 41 percent of the intraoperative projection remained intact in both groups at final evaluation (SD 12 percent). The total flap length was strongly predictive of intraoperative and long-term projection (r = 0.64 and 0.86, p < 0.0001). Flap lengths ranged from 5.5 to 9.0 cm, and in a linear correlation, resulted in intraoperative projection of 1.0 to 2.1 cm, respectively, and long-term projection of 0.4 to 0.83 cm, respectively. Based on the linear relationship, every 1-cm increase in flap length could be expected to result in a 0.16-cm increase in projection. When controlled for flap length and intraoperative projection, there was no difference between TRAM and implant nipple reconstruction in predicting postoperative nipple projection. Intraoperative planning and execution are critical to achieve predictable nipple shape, size, and projection. The dimensions of the star dermal fat flap can be strategically modified to allow the surgeon predictable projection with a consistent 41-percent preservation of intraoperative nipple projection in both TRAM and implant patients at 2 years.

Adult↗
PubMed2001

Configuration and localization of the nipple-areola complex in men.

The causes of bilateral absence of the nipple-areola complex in men are seldom congenital, but attributable rather to destruction as a result of trauma, or after mastectomy in female-to-male transsexuals and in male breast cancer, or after the correction of extreme bilateral gynecomastia. Such a bilateral loss becomes a major reconstructive challenge with respect to the configuration and localization of a new nipple-areola complex. Because there is very little information available in the literature, we carried out a cross-sectional study on the configuration and localization of the nipple-areola complex in men.A total of 100 healthy men aged 20 to 36 years were examined under standardized conditions. The first part of the study dealt with the configuration of the nipple-areola complex (dimensions, round or oval shape). The second part concentrated on the localization of the complex on the thoracic wall with respect to anatomic landmarks and in correlation to various parameters such as weight and height of the body, circumference of the thorax, length of sternum, and position in the intercostal space. Of the 100 subjects examined, 91 had oval and seven had a round nipple-areola complex. An asymmetry between the right and the left side was found in two cases. The mean ratio of the horizontal/vertical diameter of an oval nipple-areola complex was 27:20 mm and the mean diameter for a round nipple-areola complex was 23 mm. The center of the nipple-areola complex was in the fourth intercostal space in 75 percent and in the fifth intercostal space in 23 percent of the subjects. To localize the nipple-areola complex on the thoracic wall de novo, at least two reproducible measurements proved to be necessary, composed of a horizontal line (distance from the midsternal line to the nipple = A) and a vertical line (distance from the sternal notch to the intersection of line A, = B). The closest correlation for the horizontal distance A was given by the circumference of the thorax: A = 2.4 cm + [0.09 x circumference of thorax (cm)], (r = 0.68). The best correlation to calculate the vertical distance B was found using the distance A and the length of the sternum: B = 1.2 cm + [0.28 x length of sternum (cm)] + [0.1 x circumference of thorax (cm)], (R = 0.50). In cases of bilateral absence, we recommend creating an oval nipple-areola complex in men. The appropriate localization can be calculated by means of two simple equations derived from the circumference of the thorax and the length of the sternum.

Adult↗
PubMed2003

Autologous fat graft in nipple reconstruction.

Reconstruction of the nipple is the penultimate step in breast reconstruction after mastectomy. A number of reconstructive techniques have been described for nipple reconstruction including skin grafts, composite grafts, and various local flaps. The authors' preferred reconstructive technique is the local C-V or modified star flap. This flap produces an excellent reconstruction, but it is dependent on underlying subcutaneous fat to provide bulk to the reconstructed nipple. In most instances, the subcutaneous tissue is adequate. However, under certain circumstances, the subcutaneous fat may be insufficient to produce a nipple of adequate projection. Two cases of bilateral nipple reconstruction after soft-tissue expansion and implant placement and subsequent nipple reconstruction with local flaps provided inadequate nipple projection. These instances, as well as a retrospective review of reconstructed nipples after mound restoration using a variety of techniques, led the authors to conclude that a more predictable alternative to sustain nipple projection was necessary. The authors identified two broad categories of breast reconstruction patients in whom this new technique would be beneficial. In the first category of patients, breast mounds are reconstructed with tissue expansion and implant insertion, and in the second category, breast mounds are reconstructed by any technique in which the nipple reconstruction subsequently flattens. This article describes the indications, techniques, and experience in 13 patients treated over a 10-month period with fat grafting for nipple reconstruction.

Adipose Tissue↗
PubMed2005

Improving long-term projection in nipple reconstruction using human acellular dermal matrix: an animal model.

Reconstructed nipples rapidly lose projection. We describe the use of human acellular dermal matrix (ADM) to improve long-term projection of nipple flaps. Athymic rats were randomized to 3 groups; each received 2 nipples: bell flap (control, n = 16 nipples), bell flap with a cylinder of implanted ADM (n = 24), or bell flap with intraflap injection of micronized ADM (MADM) (n = 10). Seven of 24 ADM nipples extruded (30%). By 12 weeks, the control nipples maintained 44% of initial projection compared with 70% for ADM nipples (P = 0.000025). The MADM nipples maintained 49% of initial projection after 12 weeks (P = 0.55 compared with control). No MADM nipples extruded. ADM grafts maintain long-term projection better than local tissue flaps alone. We hypothesize that MADM may limit extrusion and allow for serial injection of nipples. Based on the promising results of this study, clinical trials are warranted using human ADM and/or human MADM for nipple reconstruction.

Animals↗
PubMed2001

A possible function of the preference for hind nipples in prairie voles (Microtus ochrogaster).

Prairie vole pups (Microtus ochrogaster) in laboratory cages prefer hind nipples. In this research, the author observed 8 litters of prairie voles in a seminatural environment to confirm the preference for hind nipples and to determine if young on hind nipples were groomed more frequently or dislodged less frequently than were young on other nipples. Prairie vole pups in seminatural environments preferred hind nipples; this preference was illustrated by the progressive use of more anterior nipples only as litter size increased and by the reluctance of pups to voluntarily release their hold on hind nipples. Maternal grooming of young did not vary with suckling location. Prairie vole young on hind nipples, however, were dislodged less frequently than were young on other nipples. Less frequent dislodgment from hind nipples during maternal movements may play a role in the preference for hind nipples in prairie voles.

Animals↗
PubMed2003

[Correction of nipple depression by using rhomboid de-epithelialized subcutaneous flaps].

OBJECTIVE: To evaluate a new technique by using rhomboid de-epithelialized subcutaneous flaps for correction of congenital nipple depression. METHODS: Two de-epithelialized subcutaneous flaps were formed in the areola and placed into the base of the nipple after the nipple was elevated by releasing the fibrous tissue between depressed nipple and its base. The base was then tightened to reinforce the protrusion of the nipple and prevent the withdrawal of the nipple. RESULTS: Nine patients with 17 nipples were successfully treated with above technique between 1993 and 2001. Six patients were followed up for a period from 6 to 18 months. The results were satisfactory regarding to the shape and projection of the nipple. There was no visible scar and decreasing sensation of the nipple. One woman had children after the operation and fed well. CONCLUSION: The above mentioned technique may be an effective surgical procedure for correction of nipple depression with the advantages of preserving the lactiferous ducts, no visible scar and obtaining the sufficient protrusion and size of the nipple.

Breast Feeding↗
PubMed2006

[A kind of improved operative correction of severe inverted nipples].

OBJECTIVE: To introduce a kind of improved operative method for correction of severe inverted nipples. METHODS: Sixteen patients (aged 28-38 years) with 31 inborn inverted nipples were operated with the improved method from January 2002 to March 2005. The nipple was incised horizontally through the middle, the fibrotic band was released, and the tissue below the nipple was contracted. Then the defective space with mammary gland flap. Finally, a Z-shaped suture was employed at each base of nipple. RESULTS: The shapes of these nipples were satisfactory. No infection and necrosis of the nipples occurred. The follow-up showed that the results were perfect in the sensory and elective functions of nipples. All the corrected nipples did not have recurrence except one nipple. The scars in the local site were limited and inconspicuous. CONCLUSION: Severe inverted nipples can be corrected effectively by the combined improved incisions and Z-shaped sutures. This method is suitable for the female patients with no requirement for feeding.

Adult↗
PubMed1996

Staphylococcus aureus and sore nipples.

OBJECTIVE: To correlate clinical symptoms and signs of sore nipples with the presence of Staphylococcus aureus and to determine the probability of mothers having S aureus-infected nipples when these local symptoms and signs are found. DESIGN: Two cohorts of consecutive patients were enrolled regardless of presenting complaint. A questionnaire was administered to determine the presence and severity of sore nipples. Objective findings on breast examination were documented. A nipple swab was taken for culture and sensitivity. SETTING: Breastfeeding clinic serving patients referred by family physicians, pediatricians, and community health nurses. PATIENTS: A sample of 227 breastfeeding mothers was collected in two cohorts. MAIN OUTCOME MEASURES: Answers to questions about sore nipples, objective findings from physical examination, and results from nipple swabs. RESULTS: Most subjects (51%) had sore nipples, and 45% of subjects had objective findings on examination; 23% of subjects had a positive nipple swab culture; 15% grew S aureus on culture. The risk of having S aureus colonization was 4.8 times greater if nipple pain was moderate or severe rather than mild. A break in nipple integument associated with cracks, fissures, ulcers, or pus gave a 35% chance of having S aureus colonization, five times greater than when the integument was intact. CONCLUSIONS: The study showed that mothers with infants younger than 1 month who complained of moderate to severe nipple pain and who had cracks, fissures, ulcers, or exudates had a 64% chance of having positive skin cultures and a 54% chance of having S aureus colonization.

Adolescent↗
PubMed1997

The prevalence of nipple disease among breast feeding mothers of HIV seropositive infants.

OBJECTIVE: To determine the prevalence of nipple disease among breast feeding mothers of symptomatic HIV seropositive infants and factors associated with nipple disease. DESIGN: Cross sectional survey. SETTING: Harare Central Hospital general paediatric wards. SUBJECTS: One hundred and four symptomatic, HIV seropositive breast feeding infants and their mothers. MAIN OUTCOME MEASURES: Prevalence of nipple disease. RESULTS: The majority of the hospital admissions (90%) were for pneumonia. The prevalence of nipple disease was high (30.8%). Nipple eczema was seen in 22.1%, cracked nipples in 10.6% and sore nipples in 10.6% of these breast feeding mothers. The odds of developing nipple disease in the mother if the infant had oral disease were 11.47 (95% CI 5.28 to 25.39). There was no significant association between nipple disease and mother's age, infant's age, nutrition status or mode of feeding. Malnutrition was a major problem. CONCLUSION: Nipple disease was highly prevalent and oral disease was the major risk factor for the development of nipple disease in breast feeding HIV seropositive mothers.

Adult↗
PubMedDate not supplied

Nipple feeding for preterm infants with bronchopulmonary dysplasia.

OBJECTIVE: To examine the influence of an infant's physical condition on nipple-feeding practices and the contribution of the infant's age at complete nipple feeding to dietary intake and somatic growth outcomes. DESIGN: A retrospective, correlational study. SETTING: Two Level III nurseries. PARTICIPANTS: Records of 55 preterm infants with bronchopulmonary dysplasia. MAIN OUTCOME MEASURES: The infant's intake of kcal/kg on Day 1 of complete nipple feeding and the weight gain per day between complete nipple feeding and discharge. RESULTS: Gestational age and days on mechanical ventilation, continuous positive airway pressure, or supplementary oxygen influenced age at start and at completion of nipple feeding (p < .05). The infant's weight when nipple feeding was introduced was the primary determinant of age at introduction of nipple feeding (B = .50, p < .001). The physical condition variables did not influence the transition time from introduction of nipple feeding to complete nipple feeding. Neither the physical condition variables nor the feeding practice variables contributed to caloric intake. Weight gain between the time of complete nipple feeding and hospital discharge was less for infants who were on supplementary oxygen longer and who were older when completely nipple fed (p < .01).

Age Factors↗
PubMed2005

Water intake and wastage at nipple drinkers by growing-finishing pigs.

Three experiments were conducted to assess water intake, water wastage, and a means to decrease water wastage by growing-finishing pigs from nipple drinkers. In Exp. 1, 48 pigs were studied during two periods (average BW = 53 and 72 kg for Period 1 and 2, respectively). Water disappearance and wastage were determined for 4 d, while nipple drinkers were set at 50 mm above the shoulder height of the smallest pig in the pen (recommended heights), with flow rates at 700 mL/min during Period 1, and 1,000 mL/min during Period 2. Water intake rate was assessed at two nipple flow rates, approximately 650 and 1,300 mL/min during the Period 1, and 1,000 and 2,000 mL/min during the Period 2. The average water intake was 4.01 and 5.38 +/- 0.19 L.pig(-1).d(-1) during Periods 1 and 2, respectively (P < 0.01). Water wastage as a percentage of water disappearance was similar between the two periods (25.8 and 27.0 +/- 1.9% for Periods 1 and 2, respectively). Water intake rate was 467 and 795 mL/min (+/-34.2; P < 0.01) during Period 1, and 722 and 1,422 mL/min (+/-80.0; P < 0.01) during Period 2, at the lower and higher flow rates, respectively. In Exp. 2, 32 pigs were used in a 2 x 2 factorial design to determine effects of nipple heights (recommended vs. unadjusted = 330 mm) and flow rates (500 vs. 1,000 mL/min) on water intake and wastage. Water wastage was increased (P < 0.01) on the unadjusted vs. recommended nipple height, and the higher flow rate also resulted in greater wastage (P = 0.03) compared with the lower rate. In Exp. 3, water disappearance and manure output in 16 pens of 18 pigs per pen were monitored for 12 wk (average initial BW = 32 kg) using four drinker treatments (bowl drinker, nipple drinker at recommended heights, an unadjusted nipple set at 480 mm, and high nipple drinker height of 730 mm with a step underneath). For pigs on the high nipple drinker, the average water disappearance and manure output did not differ from those of the pigs on the recommended nipple heights and bowl drinker, but these measurements were 15 and 12% lower, respectively, than for the pigs on the low nipple drinker. The results indicate that growing-finishing pigs can maintain adequate water intake from a variety of drinker types and management. Water wastage can be controlled through drinker management.

Animal Husbandry↗
PubMed1988

Nipple units for newborn infants: a functional comparison.

Milk flow characteristics of nipple units commonly used in the neonatal period were compared in the laboratory using a mechanical system. The number of simulated sucks required to empty 120 mL of formula was determined for each nipple unit. In general, the number of simulated sucks required to empty the bottle decreased when the applied negative pressure was increased from -60 to -120 cm of H2O except for SMA nipple units for premature infants. The Nuk type required less sucks (ie, higher flow) than standard nipple units. Among the Nuk-type nipple units, the SMA nipple had the highest mean flow and Enfamil Natural the lowest mean flow; among the standard nipple units, SMA single-hole had the highest flow and Ross Twist-on had the lowest flow. However, wide variability in performance was observed not only between different types of nipple units but also within the same type. Flow characteristics of nipple units for preterm infants overlapped markedly, with that for term neonates with Enfamil nipples exhibiting the highest flow. Clinical relevance of these differences in flow characteristics among the nipple units is discussed.

Bottle Feeding↗