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At least 145 records · Page 8Linked to original sources
PubMed2006

Necrotic complications after nipple- and areola-sparing mastectomy.

OBJECTIVE: The objective was to analyze the frequency and factors influencing necrotic complication in female patients undergoing nipple- and areola-sparing mastectomy. Nipple- and areola-sparing mastectomy has recently been shown to yield satisfactory results in a carefully selected group of breast cancer patients. The technique includes extensive undermining of the nipple-areola complex, which may result in an increased rate of necrotic complications. We report our early experience with necrotic changes after nipple- and areola-sparing mastectomy. METHODS: The medical records of 38 patients undergoing nipple- and areola-sparing mastectomy were analyzed retrospectively. RESULTS: Mean age of the patient was 44.5 years (range 26-65). Necrotic complications occurred in 15.8% of patients and included: skin flap necrosis (1 case), partial nipple-areola complex necrosis (2 cases), and complete nipple-areola complex necrosis (3 cases). Two cases of capsular contraction were also recorded. Statistical analysis showed age below 45 years to be associated with a lower risk of necrotic complications (OR 4.51, P<0.05). CONCLUSIONS: The nipple- and areola-sparing mastectomy, although resulting in a relatively high frequency of necrotic complications, is a valuable surgical option for patients with small, peripheral tumors and for women undergoing prophylactic mastectomy. The procedure seems to be safer for women under 45 years of age.

Adult↗
PubMed2006

Nipple-sparing mastectomy for breast cancer and risk reduction: oncologic or technical problem?

BACKGROUND: We evaluated the risks and benefits of nipple-sparing mastectomy in a multiinstitutional experience in the settings of risk-reducing surgery and breast cancer treatment. STUDY DESIGN: We analyzed data on 123 patients who had undergone nipple-sparing mastectomy with breast reconstruction for prophylaxis (n=55), treatment of breast cancer (n=41), or both (n=27) at four large centers. RESULTS: Median patient age was 45 years (range 22 to 70 years). There were 192 procedures (69 bilateral, 54 unilateral). Forty-four patients had invasive cancer; 20 had ductal carcinoma in situ (DCIS); 4 had phyllodes tumor. In all of these patients, the nipple tissue was cancer free on pathologic review. Median followup was 24.6 months (range 2.0 to 570.4 months). Local recurrence developed in two patients: one had DCIS in the upper-outer quadrant, with 71.8 months of followup; the other's cancer was invasive, in the upper-outer quadrant, with 6 months of followup. Distant metastasis developed in a third patient, who died 50 months after the procedure. Breast cancer developed in two patients after prophylactic mastectomy: one in the upper-outer quadrant at 61.8 months; one in the axillary tail at 24.4 months. No patients had recurrences in the nipple-areolar complex. Necrosis of the nipple was reported in 22 of 192 patients (11%) and it was judged minimal (less than one-third total skin of nipple) in 13 of 22 patients (59%). Overall cosmesis was judged by the patient and surgeon as good to excellent in the majority of patients. Level of satisfaction with cosmetic results was similar between prophylactic and treatment patients. CONCLUSIONS: The risk of local relapse was very low in our series of nipple-sparing mastectomies performed for DCIS or invasive cancer. Nipple-sparing mastectomy in the risk-reducing and breast cancer-treatment settings may be feasible in selected patients and should be the subject of additional prospective clinical trials.

Adult↗
PubMed2003

Surgical decision making and factors determining a diagnosis of breast carcinoma in women presenting with nipple discharge.

BACKGROUND: There is no consensus about the use of the various diagnostic tests and surgical procedures available to confirm or rule out breast cancer in patients presenting with nipple discharge. This study was designed to identify patient and nipple-discharge characteristics associated with the diagnosis of breast cancer and to determine the utility of mammography, sonography, ductography, and cytology in surgical decision making in patients presenting with pathologic nipple discharge. STUDY DESIGN: We reviewed the medical records of all patients who presented with nipple discharge at our institution between August 1993 and September 2000. Patient and nipple-discharge characteristics and findings on imaging studies and cytologic examination were analyzed. RESULTS: A total of 146 patients presented at our institution with nipple discharge during the study period. Of these, 52 had clinically benign discharge and were managed without surgical intervention; 94 patients had pathologic discharge and underwent a biopsy procedure for histologic diagnosis, treatment, or both. Logistic regression analysis identified mammographic (relative risk [RR] = 10.47, 95% confidence interval [CI] 2.36 to 46.39, p = 0.0002) and sonographic (RR = 5.54, 95% CI 1.27 to 25.40, p = 0.028) abnormalities as independent factors associated with a malignant diagnosis. Nineteen cancers, 62 papillomas, and 13 other benign lesions were identified among the patients with pathologic discharge. In 3 patients with cancer (15.8%) and 30 patients with a papilloma (48.4%), ductography was the only means of identifying lesions to be resected. Patients who underwent ductography-guided operation (n = 42, 50%) or any surgical procedure including a localization study (n = 66, 78.6%) were significantly more likely than patients who underwent central duct excision alone to have a specific underlying lesion identified (p = 0.045 and p = 0.033, respectively). CONCLUSIONS: Abnormalities on mammography and sonography in patients with nipple discharge should alert physicians to the possibility of a breast cancer diagnosis. In patients with pathologic discharge with normal findings on physical examination and other imaging studies, ductography might be the only means of localizing and resecting breast lesions associated with nipple discharge.

Adult↗
PubMed1999

[The nipple in MR mammography--the normal findings and the signs of disease].

PURPOSE: To differentiate between patterns of contrast enhancement in normal and pathologic nipples. MATERIALS AND METHODS: The examinations were performed on a 1.0 T imager, using a dynamic FLASH-3D-Sequence (9/3/50 degrees). The enhancement of nipples and normal breast parenchyma was evaluated retrospectively in 156 patients. In total, 277 nipples and the parenchyma of 101 patients could be evaluated. In 5 cases histologically confirmed pathologies were found. RESULTS: The 272 normal nipples were characterized by a slow and continuous increase of enhancement from 80% in the first minute to 300% in minute 10. The mean values of the normal parenchyma ranged from 20% in the first minute to 90% in minute 10. The five pathologic nipples showed a high initial signal increase reaching a maximum in the third minute (mean 400%) followed by a plateau. The enhancement of the normal nipples was of fine-linear morphology in the corium, while it was nodular for the pathologic nipples. CONCLUSION: Normal nipples show a slowly increasing fine-linear enhancement, higher than the enhancement of normal parenchyma. Nodular enhancement with a plateau or wash-out should be considered suspicious and a further work-up is necessary.

Adolescent↗
PubMed1998

Correction of recurrent nipple inversion with cartilage graft.

Of the many techniques advocated to correct nipples, all demonstrate a failure rate with a recurrence of the inversion. We report a technique to correct the recurrent nipple inversion in a simple and permanent fashion. This technique consists of releasing all scar tissue and any lactiferous ducts deep to the nipple and inserting a cartilage graft (rib or auricular) under the nipple. This cartilage graft serves to fill in any soft tissue defect and prevent recurrent contraction and nipple inversion. Although generally used for correction of recurrent nipple inversion, we have also used this technique successfully as an initial modality in patients with inverted nipples. We have found this technique to be simple, nondeforming, cosmetically acceptable, and permanent in the treatment of both inverted and recurrent inverted nipples.

Adult↗
PubMed1982

Nipple discharge from the breast.

Abnormal nipple discharge is rare, constituting only 3-5% of mammary consultation. In the present paper 267 patients with primary nipple discharge operated on at Institut Gustave-Roussay (IGR) in Villejuif, France, between January 1, 1960 and December, 1974 were evaluated. In all cases, the nipple discharge was symptomatic, spontaneous, and represented the primary reason for the patient's consultation. During the same period 1,145 cases of nipple discharge were treated at IGR. Of the 1,145 cases with symptomatic nipple discharge, 267 patients (23%) required surgical intervention. Among these, fibrocystic disease and duct ectasia were the leading causes of nipple discharge occurring in 42% of surgical specimens. Twenty one per cent of the patients had carcinoma and 35% were found to have intraductal papilloma. The overall incidence of malignancy, however, was 4.8% among the 1,145 women with nipple discharge. On the average, patients with nipple discharge due to malignancy were ten years older than those with benign lesions (Table 2). Approximately 25% of patients with malignant discharge and 5% with benign discharge have associated tumor. Over 60% of the patients with both discharge and a mass had malignancy.

Adolescent↗
PubMed1990

A direct surgical approach to correct the inverted nipple.

Inverted nipples are cosmetically unpleasing to the patient and can become inflamed due to mechanical difficulty with cleaning the nipple-areola complex. A surgical technique for the permanent repair of inverted nipples is described. The rationale for the surgical approach is that the major pathophysiologic basis for nipple inversion is shortened lactiferous ducts. Briefly outlined, under local anesthesia, the nipple is everted with a skin hook and held in gentle traction while a small incision is made on each side at the nipple-areola junction. Breast ducts are then divided by sharp dissection, and a drain is inserted through the tunnel under the nipple. The drain is removed in 7 to 10 days. The patient must be informed before the procedure that breast-feeding will not be possible afterward because breast ducts will be permanently divided. Advantages to the procedure are (1) no scars on the areola, (2) no stricture from sutures, (3) adequate blood and nerve supply to the nipple, and (4) decreased risk of hematoma.

Adult↗
PubMed1991

Correction of inverted nipple with periductal fibrous flaps.

I devised a method to correct the inverted nipple considering the preservation of the lactiferous ducts, sensory fibers to the nipple, and the contracting function of the areolar muscle. Excision of the excess skin at the base of the nipple was done in three diamonds fashion, and they were located at 2, 6, and 10 o'clock positions not to jeopardize the sensory fibers to the nipple. To release the fastened nipple, the periductal fibrous tissue was thoroughly dissected and made into three flaps pedicled inferiorly. These three flaps were sutured to the dermis of the periareolar skin to pull up the nipple base by means of traction in three directions. The purse-string suture, the dermal stitch on the shorter diagonals of the diamond-shaped defects, anchors the skin-muscle bridges caught at the base of the ductal column, makes the nipple base narrower, obtains stable anchoring, helps the areolar muscle contraction to resume, and prevents the recurrence of the inversion. The use of the periductal tissue as flaps to bring in areolar skin for easier anchoring and for more prominent eversion of the nipple has not been described in the literature.

Female↗
PubMed2003

Modified technique for nipple-areolar reconstruction: a case series.

SUMMARY: Thousands of women undergo postmastectomy breast reconstruction each year. Part of the reconstruction of an aesthetically pleasing breast is a high-quality nipple-areolar reconstruction. The goals for this reconstruction include appropriate nipple projection, areolar color, and areolar texture. Presented in this article is a novel technique that achieves these goals without the need for harvesting a distant skin graft. The nipple-areolar reconstruction is performed under local anesthesia. A skate flap is designed to achieve the nipple reconstruction. The skate flap donor sites are closed primarily, and the outline of the areola is then defined with a round template. The skin is then incised at the border of the areola, and a full-thickness graft is elevated to the base of the reconstructed nipple. After hemostasis is achieved, the skin graft is placed back down in its original position and a bolster dressing is applied. Tattooing is performed 4 months postoperatively to achieve a color match. Twenty-four consecutive patients underwent 31 nipple-areolar reconstructions using this novel technique. All patients achieved excellent results without complications. One patient did experience a partial skate flap loss; however, the wound healed secondarily without the need for revision. The technique described herein can achieve the goals of nipple-areolar reconstruction, including appropriate nipple projection, areolar color, and areolar texture, without the need for a distant skin graft.

Adult↗
PubMed2007

The double opposing periareola flap: a novel concept for nipple-areola reconstruction.

BACKGROUND: This report describes the authors' currently favored method of nipple reconstruction that has been developed and used by the senior author over the past 26 months. METHODS: A pull-out flap is derived as the lead edge of one of two opposing skin flaps contained in a circular design approximating the areola complex of the opposite breast. The larger flap gives rise to the nipple construct, a derivative of the skate flap design. The flap donor areas are closed by suture approximation centrally and peripherally within the areolar margins. The donor area resulting from elevating the central flaps that give rise to the nipple is closed by direct suturing; the opposing subcutaneous dermal pedicle flaps are advanced or "slid" toward each other centrally, and the peripheral area is closed by a purse-string suture placed in the periareolar incision. The only undermined area is the nipple flap itself. There is no undermining of the larger flaps or peripheral breast skin. The dissection is straightforward and the technique is rapid. RESULTS: The procedure was used 47 times in 36 patients (unilateral reconstruction, 25 patients; bilateral reconstruction, 11 patients), with no flap losses or wound separations. In one case of redo bilateral nipple reconstruction, ischemia noted at the most anterior aspect (distal portion) of both flaps healed with the application of topical ointment. CONCLUSIONS: This novel design for nipple-areola complex reconstruction can be used in either primary or secondary nipple reconstruction. Of particular advantage, all of the scars are contained within the peripheral periareolar incision and thus can be completely camouflaged by an intradermal tattoo. Nipple projection has been consistently maintained and appears similar to that of a skate flap.

Female↗
PubMedDate not supplied

A pilot study of maternal and term infant outcomes associated with ultrathin nipple shield use.

OBJECTIVE: To examine maternal satisfaction with nipple shield use and maternal and infant physiological outcomes of breastfeeding with and without nipple shields. DESIGN: A descriptive study using a structured telephone survey to examine maternal satisfaction of nipple shield use and a within-subject design to compare maternal and infant physiological outcomes for a subset of mother-infant dyads. SETTING: Breastfeeding sessions were conducted in Pacific Northwest hospitals. PARTICIPANTS: 32 lactating women with experience using nipple shields; a subset of 5 maternal-infant dyads participated in the physiological part of the study. MAIN OUTCOME MEASURES: Maternal response to survey explored maternal satisfaction with nipple shield use. To examine maternal and infant physiological outcomes, two measures were used: infant test weighing to evaluate breast milk intake and maternal prolactin and cortisol levels to evaluate breast milk production. RESULTS: Maternal survey response indicated that use of nipple shields may prevent premature breastfeeding termination. Physiological results demonstrated no significant difference in maternal hormonal levels and infant breast milk intake for breastfeeding sessions with and without nipple shields. CONCLUSION: Use of nipple shields may be considered in face of potential abandonment of breastfeeding.

Adult↗
PubMed2005

Sections of the nipple and quadrants in mastectomy specimens for carcinoma are of limited value.

AIM: To assess the value of nipple and quadrant sections in mastectomy specimens for carcinoma in detecting Paget's disease and multifocal carcinoma. METHODS: Two hundred and forty eight consecutive mastectomies performed for carcinoma were reviewed. The presence of Paget's disease of the nipple and mode of identification of any multifocal carcinoma was recorded. RESULTS: Nipple sections showed Paget's disease in eight specimens: in five the diagnosis had been made on previous biopsy and in three (1%) this was a new diagnosis. In the 220 specimens in which all four quadrants were sampled, multifocal disease was identified more often in specimens with invasive carcinoma (39 of 186; 21%) than in those with only ductal carcinoma in situ (0 of 34). In specimens with invasive carcinoma, multifocality was identified macroscopically in 20: on microscopy of tumour sections in four, on microscopic examination of quadrant sections in 11, in the nipple in three, and in both quadrant and nipple sections in one. Overall, multifocality was found on microscopic examination of quadrant or nipple sections in 15 of 220 specimens (7%). CONCLUSIONS: The low frequency of detection of multifocality or Paget's disease in nipple and quadrant sections from mastectomy specimens, combined with the fact that such findings do not affect patient management, suggest that nipple and quadrant sections should only be taken if resources permit.

Breast↗
PubMed1992

Control of nipple and body contact by mothers and infants in rhesus macaques.

While 3-month-old infant rhesus macaques (Macaca mulatta) were awake and active in social interactions away from their mothers, body and nipple contacts with their mothers were nevertheless made from time to time. In each dyad the proportions of contacts made by the mother nearly equalled those broken by her, suggesting a meshed interaction in which each partner accepted most of the other's contact initiations and terminations. Passive prevention of nipple contact by a mother reduced the frequency of nipple contact by her infant in the first 5 s after the infant had made body contact. Passive prevention occurred after fewer than 1 in 6 body contacts initiated by infants, and--even without its occurrence--most infants were less ready to take the nipple after their own initiatives than after maternal initiatives. Once nipple contact had been made, the probability of breaking body contact was reduced. The role of maternal rejection both in the control of nipple contact in the short term and in determining (through its effect on the sucking pattern) whether the mother gives birth in the next birth season or later is discussed. We suggest that, by the age of 3 months, the infants had already learned when and how often nipple contact with their mothers would be acceptable during their awake and active periods, and we suggest that subsequent decreases in the frequency of nipple contact were partly the results of maternal rejections which were accepted by the infants.

Animal Communication↗
PubMed1983

Nipple and areola reconstruction. A study in 79 mastectomized women.

Seventy-nine patients of 100 desired a nipple-areola reconstruction. In nipple-areola reconstruction, skin from the upper inner thigh gives the best results as areola replacement, except perhaps in women with very large contralateral areola. Nipple-sharing was the most favourable method for reconstruction of the nipple. Mushroom nipple plasty could give satisfactory results when nipple sharing was not feasible. There were no early complications of nipple-areola reconstruction, which often can be done on an out-patient basis. Most of a series of women who underwent breast reconstruction thought that nipple-areola reconstruction was important and were satisfied with the result.

Adult↗
PubMedDate not supplied

Local control by breast-conserving surgery with nipple resection.

Local control was compared between patients who had undergone breast-conserving therapy with and without nipple resection. We explored whether there was any difference in local control between the two treatment methods for patients with early breast cancer. A total of 333 women with breast cancer, who had undergone breast-conserving therapy between 1991 and 2002, were included in this study. Surgery consisted of a wide local excision of the primary tumor with a 2-cm free margin as the minimum distance. When the tumor was located under the nipple or close to the nipple, breast-conserving surgery with nipple resection was selected. A total of 320 patients received breast-conserving surgery without nipple resection and radiation therapy (BCT) and 13 patients breast-conserving surgery with nipple resection and radiation therapy (BCT-NR). There were no significant differences in age, tumor size, nodal status, clinical stage, ER status, histological type or surgical margin status between the two groups. The surgical margin was positive in 55 (17.2%) out of 320 patients in the BCT group and in one (7.7%) out of 13 patients in the BCT-NR group. There was no significant difference in the breast-free survival between the two groups. In conclusion, breast-conserving surgery with nipple resection and radiation therapy may be the treatment of choice for early breast cancer patients with the tumor located under the nipple or very close to the areola.

Breast Neoplasms↗
PubMed2003

Oral compression activity on a surrogate nipple in the newborn rat: nutritive and nonnutritive sucking.

Newborn rats, 3 hr after birth and before any experience in suckling, were exposed for 10 min to a surrogate nipple providing milk. One hour later, they were exposed to an empty nipple for another 10-min period. The basic characteristics of oral behavior (oral compression activity, OCA) were assessed by recording intranipple pressure during the pups' first attachment to a nipple. The peculiarities of milk-induced changes of OCA were examined with three modes of milk delivery (milk infusions, and intermittent and continuous milk deliveries). The pattern of OCA exerted by the newborn pups on a surrogate nipple consisted of rhythmic oscillations within a frequency range of 0.4 to 1.0 Hz superimposed on slow (frequency < 0.2 Hz), irregular intranipple pressure fluctuations. Oral behavior during the first minute after oral capture of the nipple differed significantly from that during any subsequent 1-min interval in terms of frequency content of OCA. The pattern of OCA changes induced by milk infusions or intermittent milk delivery included an abrupt rise in intranipple pressure, accompanied or followed by a burst of fast nipple compressions (bites). Our data suggest that newborn rats attached to a surrogate nipple demonstrate patterns of oral behavior that simulate, in terms of basic frequency characteristics, patterns of nutritive and nonnutritive suckling observed in more mature pups on the maternal nipple.

Animals↗
PubMed1987

The Kock continent ileostomy: influence of a defunctioning ileostomy and nipple valve stapling on early and late morbidity.

Early and late morbidity was studied in 45 consecutive patients submitted to the Kock continent ileostomy reservoir procedure protected by a temporary loop ileostomy. In 24 patients the nipple valve was made by simple intussusception of the ileal segment after stripping of its mesenteric peritoneum and fat, whereas in 21 patients the nipple valve was stapled in addition. The early complication rate was low with necrosis of the nipple valve occurring in 3 patients and a nipple valve fistula in 1. These complications were easily dealt with and revision was done subsequently on an elective basis. The overall revision rate for late nipple valve dysfunction, mainly caused by sliding of the nipple valve was 29%. The majority of these complications occurred within the first postoperative year. Stapling of the nipple valve did not significantly reduce the rate of sliding. The overall complication rate was significantly less compared with a historical series of 21 patients not provided with a loop ileostomy. A temporary defunctioning ileostomy may reduce early complications and their consequences. Whether it may also lessen the risk of later nipple valve sliding is, however, not clear from this study. The observation that sliding was as common in both unstapled and stapled patients could imply either that the loop ileostomy is beneficial in preventing this complication or that the stapling procedure is in this respect unimportant. Which step or steps among all the measures employed are important in increasing the success rate of this operation remains unclear. Randomised controlled studies are needed for a true evaluation of this issue.

Adult↗
PubMed1995

Development of responses to an artificial nipple in the rat fetus: involvement of mu and kappa opioid systems.

Presentation of an artificial nipple to the rat fetus on E19, E20, or E21 of gestation promotes the expression of organized behavioral responses. Fetal responses include mouthing, licking, head-turning, and oral grasping of the nipple. Fetuses on E21 were more successful at grasping the nipple. Because all subjects were naive at the time of testing, this improved performance occurred in the absence of explicit experience with the nipple or specific practice (grasping the nipple). Manipulation of kappa and mu opioid activity with selective agonist drugs (U50,488 and DAMGO, respectively) altered fetal responsiveness to the nipple. U50,488 generally disrupted appetitive responses and promoted aversive reactions to the artificial nipple, whereas DAMGO increased responsiveness (licking and oral grasping), especially on E21. These findings suggest that both the mu and kappa systems may play functional roles in regulating neonatal behavior at the nipple by initiating and terminating a suckling bout.

Animals↗