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PubMed1991

The inverted nipple: to cut the ducts or not?

Much dilemma exists as whether to divide the lactiferous ducts or not when correcting an inverted nipple. We report a series of 26 cases (44 nipples), which have undergone correction with or without duct division. Eversion was maintained in 59% of nipples. Analysis of the failure groups revealed similar rates of failure for umbilicated nipples whether the ducts were divided (27%) or not (25%). Invaginated nipples showed an increased tendency to reinvert postoperatively if the ducts were not divided (80%) than if they were (42%) (not significant). Permanent loss of nipple sensation was noted in 20% of cases when the lactiferous ducts were divided. Postoperatively two women were able to breast feed despite complete division of their lactiferous ducts. Women with umbilicated nipples are usually able to breast feed. We believe that correction of the umbilicated nipple can usually be successfully performed, and function maintained without dividing the ducts. Correction of the invaginated nipple requires duct division. The underlying pathogenesis and varying methods of correction are reviewed.

Adolescent↗
PubMed1995

Nipple confusion: toward a formal definition.

The purposes of this article are to introduce a formal definition of nipple confusion and to propose various hypotheses concerning its cause. The term nipple confusion refers to an infant's difficulty in achieving the correct oral configuration, latching technique, and suckling pattern necessary for successful breast-feeding after bottle feeding or other exposure to an artificial nipple. Many early breast-feeding failures are attributed to nipple confusion, although scientific data are lacking to document its prevalence, the mechanisms involved, or various factors that predispose an infant to this phenomenon. Two classifications of nipple confusion are recommended to distinguish the impact of artificial nipples during the newborn period from their influence after breast-feeding is well established. Maternal and infant risk factors making an infant more susceptible to nipple confusion are discussed. Future studies are planned to help elucidate the nature of nipple confusion and identify the circumstances under which infants are most vulnerable to this phenomenon. Meanwhile, it would seem prudent for clinicians to identify newborns at risk for nipple confusion and to minimize the use of bottle feedings in such babies. Medically indicated supplements in the early days of life could be provided by alternative methods, such as cup, spoon, or dropper feeding, until breast-feeding can be established.

Bottle Feeding↗
PubMed2000

Breast conserving therapy in breast cancer patients presenting with nipple discharge.

PURPOSE: To retrospectively review the outcome of conservatively treated breast cancer patients who present with nipple discharge at initial diagnosis. METHODS AND MATERIALS: The charts of 1097 patients undergoing conservative surgery and radiation therapy between January 1970 and December 1990 were reviewed. All patient data, including clinical, pathologic, treatment, and outcome variables were entered onto a computerized database. For the current study, specific attention was directed to the initial presenting symptoms and patients were divided into two groups: those presenting at initial diagnosis with nipple discharge (D/C-YES, n = 17), and those presenting without nipple discharge (D/C-NO, n = 1080). RESULTS: As of August 1998, with a median follow-up of 12 years, the 10-year actuarial survival, distant metastasis-free survival, and breast relapse-free survival rates for the overall population were 73%, 78%, and 83%, respectively. Although the D/C-YES and D/C-NO groups were well balanced with respect to the majority of clinical factors, the D/C-YES patients had a higher percentage of DCIS histology (7.3% vs 1.2%, p < 0.01), were less likely to undergo reexcision (12% vs 35%), and were more frequently under age 40 (35% vs 12%) than the D/C-NO patients. Over the time span of this study, status of the final surgical margin was indeterminate in the majority of cases. Local relapses occurred in 6 of the 17 patients in the D/C-YES group, resulting in a 10-year actuarial breast relapse-free survival rate of 50%, which was signifcantly lower than the 10-year breast relapse-free survival rate of 86% in the D/C-NO population. Among the patients presenting with nipple discharge, those with sacrifice of the nipple areolar complex had a lower local relapse rate than those patients who had conservation of the nipple areolar complex (20% vs 42%), although this difference did not reach statistical significance. CONCLUSIONS: Although patients presenting with nipple discharge may be suitable candidates for radiation therapy, local relapse rates were higher than those presenting without nipple discharge. The limitations of the study and implications regarding breast conserving management in patients presenting with nipple discharge are discussed.

Adult↗
PubMed2005

[Erosive adenomatosis of the nipple].

First rule out galactophoric carcinoma underlying all the erosions of the nipple or a breast tumor. A 52-year-old woman consulted for a right breast tumor that had developing for more than four years due to a serious nipple flow. Physical examination disclosed an ulcer tumor of the nipple and the superior quadrant of the areole. Mammography and mammary ultrasound found a mass texture suspected of malignity. Needle aspiration produced a white fluid. Wide tumor resection was performed. The histological analysis led to the diagnosis of erosive nipple adenomatosis. The patient had recovered at 34 months. Erosive adenomatosis of the nipple is a benign tumor which developing within the lactic nipple. Clinically, the differential diagnosis is breast carcinoma, Paget disease and galactophoric dilatation. Pathology is required for certain diagnosis. The treatment is usually surgical. Erosive adenomatosis of the nipple is very rare and should be suspected in patients with nipple erosions or a nipple tumor. The prognosis is excellent.

Adenoma↗
PubMed1996

Candida albicans: is it associated with nipple pain in lactating women?

Persistent nipple pain in lactating women, burning in nature, and associated with radiating breast pain, has been claimed by some authorities to be due to 'thrush' (candida) infection. Yet, scientific proof has been lacking. This study compared microbiological assessment of 61 women with nipple pain, 64 women without nipple pain, and 31 non-lactating women. Swabs of the nipple and baby's mouth, and expressed breast milk were collected for culture. Growth of Candida albicans (nipple and milk) was found more often in the women with nipple pain (19%) than in the control group (3%, p < 0.01). In addition, Staphylococcus aureus was also associated with nipple pain (p < 0.0001), and independently associated with nipple fissures (p < 0.0001). Neither C. albicans nor S. aureus was found on the nipples of the non-lactating group.

Adult↗
PubMedDate not supplied

Prevention of and therapies for nipple pain: a systematic review.

OBJECTIVE: To review the literature on nipple pain and to delineate effective strategies for the prevention and treatment of nipple pain in breastfeeding mothers. DATA SOURCES: Computerized searches on MEDLINE, Pre-MEDLINE, CINAHL, and the Cochrane Library. STUDY SELECTION: Articles from indexed journals relevant to the objective were reviewed from January 1983 to April 2004. Preference was given to research-based studies in English. DATA EXTRACTION: Data were extracted and organized under two headings: prevention of nipple pain or trauma and treatment of nipple pain or trauma. The Critical Appraisal Form by J. Briggs was used to extract the data from research-based articles. DATA SYNTHESIS: The health benefits of breastfeeding for mother and infant are well documented; however, nipple pain is a common reason reported by women for the early termination of breastfeeding. Several studies have compared various treatments for either the prevention of or treatment for nipple pain. These treatments include warm water compresses, tea bag compresses, heat, application of expressed mother's milk, lanolin, vitamin A, collagenase, dexpanthenol, hydrogel therapy, glycerin gel therapy, moist occlusive dressing, education regarding proper latch-on and positioning, and no treatment. CONCLUSIONS: No one topical agent showed superior results in the relief of nipple discomfort. The most important factor in decreasing the incidence of nipple pain is the provision of education in relation to proper breastfeeding technique and latch-on as well as anticipatory guidance regarding the high incidence of early postpartum nipple pain.

Administration, Cutaneous↗
PubMed2005

The effect of breast milk and lanolin on sore nipples.

OBJECTIVE: To compare the effect of rubbing breast milk versus lanolin in the treatment of symptoms of sore nipples. METHODS: We carried out this randomized clinical trial on 225 mothers with sore nipples in the Neonatal Intensive Care Unit of Imam Reza Hospital in Mashhad, Iran from April 2001 for 2 years. We randomly divided the patients into 3 groups. The first group rubbed the hind milk on their nipples at the end of each breast-feeding session, and the second group used lanolin locally on the nipple 3 times a day, and cleaned the nipple with a wet cloth before infant feeding. The third group did not use anything (control group). We corrected the breast-feeding technique of all mothers throughout the study. After the first visit, we reexamined the patient on the third, fifth, seventh and tenth days. We obtained information with interviewing and physical examination by using a questionnaire. We based the sore nipple improvement on absence of irritation according to mothers opinions. We analyzed the obtained information using the SPSS version 11.5 software, and the used tests were Chi-Square test, Mann-Whitney test, and Kruskal-Wallis test. RESULTS: The first group (breast milk users) included 78 patients, the second group (lanolin users) included 74 patients, and the third group (control group) included 73 patients. The 3 groups were similar in gravidity, delivery method, pre-delivery breast feeding education, the beginning time of the first breast feeding, prior success breast feeding experiences, detergent agents usage for nipples, use of formula, and pacifier. Clinical manifestations, such as appearance time of symptoms, irritation and breast wound were not significantly different. The healing time was different in these 3 groups (p=0.038) according to the mean ranking in the groups. The healing time in the lanolin group was longer than the breast milk group (p=0.029) and the control group (p=0.028). No side effects were noted during the study. CONCLUSION: This study suggests that, due to the better healing of the sore nipple with breast milk, its availability, without payment and side effect, breast milk is recommended for the treatment of sore nipples.

Breast Feeding↗
PubMed1985

Lobules in the nipple. Frequency and significance for breast cancer treatment.

Subcutaneous mastectomy with nipple preservation has been advocated for the treatment of in situ lobular carcinoma. The rationale for not removing the nipple in these cases is the perception that lobules do not occur in the nipple. This study was undertaken to assess the frequency with which lobules occur in the nipple, exclusive of the areola. A routine vertical section of the nipple was reviewed in each of 101 consecutive mastectomies performed for breast carcinoma. One or more lobules was found in 17 percent of specimens. An additional independent observation of note was the presence of carcinoma in 13 percent of nipples, largely noninvasive. Coexistence of lobules and carcinoma was found in two cases. These data indicate that nipple preservation is not appropriate if mastectomy is performed to remove tissue at risk in the treatment of breast cancer. A procedure which removes the central part of the nipple or nipple reconstruction should be employed.

Adult↗
PubMed1996

Reduction mammaplasty: the results of avoiding nipple-areolar amputation in cases of extreme hypertrophy.

In extreme cases of breast hypertrophy, amputation of the nipple-areolar complex and transplantation during reduction mammaplasty has been advocated to avoid nipple necrosis. We report our experience with 172 patients having inferior breast pedicle reduction without amputation of the nipple-areolar complex. Mean total weight of resected tissue was 1,946 g (548 to 5,100 g), with a mean nipple-areolar transposition of 10 cm (0.5 to 23 cm). Dividing patients into four groups by weight of resection, we compared complication rates. In this series, where nipple-areola amputation was avoided, there was a 99.6% survival rate of the nipple-areolar complex with 97.1% retention of nipple sensibility. Patients with extreme breast hypertrophy (3,000 g resected tissue) experienced no increase in complications when compared to smaller reductions. In most cases of gigantomastia, amputation of the nipple can be avoided using the inferior breast pedicle technique. Size of breast resection alone should not determine the fate of the nipple.

Adolescent↗
PubMed1997

Experimental study of the first suckling episode: rat pups ingest fluids through a surrogate nipple.

The present study reported a new technique in which pups ingested fluids from a surrogate nipple. Cesarean-delivered pups tested before suckling experience showed oral grasp responses and ingested milk from the surrogate nipple. Pups ingested equal amounts of distilled water and milk and rejected saline. After ingesting milk from the surrogate nipple, pups remained attached to an empty surrogate nipple, while pups exposed to distilled water or saline did not show sustained attachment. Brief experience with milk from an oral cannula or from a surrogate nipple elicited sustained attachment to an empty nipple. Pups ingesting milk from a surrogate nipple showed increased intake of water and saline from the nipple when tested subsequently. The surrogate nipple provides a new technique for experimental study of early suckling behavior. The results suggest that initial experiences with milk may reinforce components of early suckling behavior.

Age Factors↗
PubMed1998

A Case of Breast Cancer Coexisting with Florid Papillomatosis of the Nipple.

We report a 47 year-old woman with a unique breast cancer coexisting with florid papillomatosis (FP) of the left nipple. The diseased nipple was enlarged and reddened. There was an area of erosion on the surface. Incisional biopsy revealed FP of the nipple. Under the nipple, there was an elastic hard tumor with an unclear border and irregular surface. Aspiration biopsy cytology of the tumor revealed carcinoma. Modified radical mastectomy was performed. Histological examination showed that the superior portion of the tumor was FP, and most of the tumor in and under the nipple was breast cancer. To the best of our knowledge, only 16 cases of FP of the nipple have been reported in the Japanese literature. FP of the nipple coexisting with carcinoma in the same nipple has never been reported. This is thought to be the first case in Japan of mammary carcinoma coexisting with FP in the same nipple.

Journal Article↗
PubMed1982

Estimation of volatile N-nitrosamines in rubber nipples for babies' bottles.

A method is described for the estimation of volatile N-nitrosamines in the rubber nipples of babies' bottles. In a study of rubber nipples from one manufacturer, N-nitrosodimethylamine, N-nitrosodiethylamine and N-nitrosopiperidine were determined by gas chromatography, using a thermal energy analyser, and their presence was confirmed by mass spectrometry with average levels of individual nitrosamines ranging from 22 to 281 ppb. When the nipples were sterilized in a conventional sterilizer together with milk or infant formula the three nitrosamines migrated into the milk or formula. Storing a bottle of milk with a rubber nipple inverted in it for 2 hr at room temperature or overnight in a refrigerator after sterilization resulted in an 8-13% average increase in the nitrosamine levels migrating into the milk. On repeated sterilization of a single nipple, the quantities of nitrosamines migrating into milk from rubber nipples declined steadily, but after seven sterilizations, nitrosamines were still readily detectable in the milk. Nitrosamine levels were higher in rubber nipples after sterilization, indicating the presence of nitrosamine precursors in the nipples. No nitrosamines were found in raw, uncured rubber. Chemical accelerators and stabilizers added during the vulcanization process are the source of the amine precursors in rubber nipples.

Bottle Feeding↗
PubMed1997

Mechanics and energetics of nutritive sucking: a functional comparison of commercially available nipples.

The purpose of this study was to compare the mechanics of sucking for 48 term infants with four different nipple units: Gerber Newborn (Gerber Products Company, Fremont, Mich.), Playtex (Playtex Products, Westport, Conn.), Evenflo (Evenflo Products Co., Canton, Ga.), and Gerber NUK. At 24 hours after birth, infants were assigned randomly to one of the nipple units and were studied twice with that nipple unit. A customized data acquisition system was used to measure and record the following variables: intraoral suction, sucking frequency, work, power, milk flow, milk volume per suck, and oxygen saturation. Although no statistically significant differences among the nipple units were noted for intraoral suction, sucking frequency, power, and oxygen saturation, the data revealed that the Playtex nipple unit was accompanied by higher peak milk flow and greater volume of milk per suck (p < 0.05). Infants fed differently with the Playtex nipple than they did with the other nipples. Our findings indicate that the Playtex nipple permits a greater milk flow in response to similar amounts of suction, work, and power when compared with others. The mean total work per such was significantly lower in the Gerber NUK group compared with the Playtex group. In addition, the total number of sucks per volume ingested was higher, and the total time to ingest a specific quantity of milk was longer for the Gerber NUK nipple.

Biomechanical Phenomena↗
PubMed2000

Milk delivery schedules and stomach preloading alter patterns of suckling behavior by newborn rats on a surrogate nipple.

Newborn rat pups tested before suckling experience attached to and ingested milk from the surrogate nipple. Time attached to the nipple and amount of milk ingested depended on the schedule of milk infusion through the nipple. More frequent milk infusions resulted in more frequent disengagements from the nipple during the test, less time attached to the nipple, and less body weight gain. The initial patterns of attachment behavior--continuous or intermittent--were reproduced later when rats were tested on the surrogate nipple. Preloading of the stomach with milk effectively altered both attachment and ingestion from the nipple, whereas preloading with the same amount of water had no effect on suckling behavior. The data suggest that newborn rats flexibly adjust their attachment behavior to peculiarities of milk delivery through the surrogate nipple and reproduce the initial attachment pattern when reexposed to the surrogate nipple.

Animals↗
PubMed1992

Sucking patterns of neonates during bottle feeding: comparison of different nipple units.

The present study was designed to compare the sucking pattern of term and preterm infants during bottle feeding with different types of nipple units (Enfamil single-hole nipple units for term and preterm infants and SMA Nuk nipple units). In addition, the sucking pattern of term neonates during a feeding regimen commonly used in many feeding studies was evaluated (reservoir nipple system). In this system milk flows from a reservoir through a tube and depends on the sucking pressure generated by the infant. Only the Enfamil single-hole nipple units for term and preterm infants were compared in preterm infants. No significant difference in sucking frequency was observed in term neonates with different types of nipple units. Although the mean sucking pressures generated tended to be less among nipple units with higher flow, these differences were not statistically significant. Similarly, no significant difference in total sucking or feeding time was observed among the three nipple units tested. Sucking pressures generated by term infants were significantly less when milk flow was increased markedly utilizing the reservoir system. In preterm infants no differences in sucking frequency, sucking pressure, mean flow, or total feeding time were observed when sucking patterns with term and preterm nipple units were compared. Implications of these findings in feeding neonates are discussed.

Bottle Feeding↗
PubMed1996

Clinical implications of the white nipple sign and its role in the diagnosis of esophageal variceal hemorrhage.

OBJECTIVE: Differentiation of esophageal variceal hemorrhage from other sources of the GI tract is often difficult. This is a prospective investigation of the significance of the white nipple sign in patients with recent esophageal variceal hemorrhage. METHODS: One hundred sixty-six patients with recent variceal hemorrhage were prospectively studied with respect to presence or absence of the white nipple sign and other stigmata of hemorrhage and compared with 100 patients with known varices but without a clinical history of bleeding. RESULTS: The white nipple sign correlated positively with severity of bleeding (patients required more blood transfusion), hematemesis, and signs of shock. Patients with the white nipple sign also tended to undergo emergency endoscopy and have active bleeding at the time of endoscopy. There was no correlation between rebleeding rate after endoscopic therapy and presence of the white nipple sign. Appearance of the white nipple sign was closely related to the timing of endoscopy (p < 0.0001). The sensitivity and specificity of the white nipple sign in the diagnosis of esophageal variceal hemorrhage were 21 and 100%, respectively, compared with 100 and 54% for the red color sign. Furthermore, the sensitivity of the white nipple sign increased with shorter times between bleeding and endoscopy. CONCLUSIONS: In patients with upper GI bleeding, the white nipple sign suggests that the varices bled recently and that the bleeding was severe. However, it has no predictive value for rebleeding after endoscopic therapy. Earlier endoscopy (i.e., within 24 h of bleeding) is suggested to improve the diagnostic rate of esophageal variceal hemorrhage.

Case-Control Studies↗
PubMed1998

Preoperative galactography increases the diagnostic yield of major duct excision for nipple discharge.

BACKGROUND: Although most nipple discharge is due to a benign etiology, approximately 10-15% is due to breast carcinoma. The standard management of nipple discharge includes major duct excision, and although this procedure may eliminate future nipple discharge, a specific etiology is not always found. This study investigates the utility of preoperative galactography in targeting the causative lesion. METHODS: During 1994-1996, 46 cases of major duct excision were identified from operating room records. All patients presented with spontaneous nipple discharge from a single duct. In 16 patients both a diagnostic galactogram and a preoperative galactogram with methylene blue were performed to localize the causative lesion and to enable intraoperative identification. Data were obtained by retrospective chart review. Statistical significance was determined by Fisher's exact test. RESULTS: Preoperative galactography was obtained in 7 of 31 patients (23%) with bloody nipple discharge and 9 of 15 patients (60%) with guaiac negative discharge. All patients undergoing preoperative galactography were found to have either a filling defect and/or duct cutoff (n = 13) or duct ectasia (n = 3). All patients with a filling defect and/or duct cutoff on galactogram were found to have a carcinoma or papilloma at surgery. In the three patients with duct ectasia observed on galactogram, the diagnosis was confirmed at surgery. All patients who underwent preoperative galactography were found to have specific pathology that accounted for the nipple discharge versus 20 of 30 patients (67%) who did not undergo preoperative galactography (P = 0.009). CONCLUSIONS: Although major duct excision for nipple discharge may eliminate the presenting symptomatology, a pathologic correlate is not always found. The data from the current study show that localizing the causative lesion by preoperative galactography increases the likelihood that specific pathology will be found at surgery, and suggests that preoperative galactography may be helpful in the evaluation and management of patients presenting with spontaneous nipple discharge. Cancer 1998;82:1874-80. 1998 American Cancer Society.

Adult↗
PubMed2006

Left versus right nipple preference in free-ranging infant rhesus macaques (Macaca mulatta).

The examination of nonhuman primate (NHP) lateralized behaviors may provide insight into the evolution of hemispheric specialization. This study examined nipple preference in 64 infant macaques in order to consider the ontogeny of lateralized behavior. We used a focal animal sampling method to record nipple contact during 15, 30-min observation sessions collected across each infant's first year of life. Using a lateralized behavior index (LBI) we calculated individual and population preferences (LBI=(R-L)/(R+L); "R"=mean right nipple contact, "L"=mean left nipple contact). Strength of preference was calculated as the absolute value of this score. Infants exhibited no population preference for a particular nipple, but showed a significant strength of preference that developed after 48 hr. Interestingly, successive siblings preferred the nipple not used by the previous infant. These findings suggest that nipple preference is guided by external stimuli, and that nipple preference during infancy may not be a behavioral representation of hemispheric specialization.

Age Factors↗