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At least 19 recordsLinked to original sources
PubMed1999

Nipple care, sore nipples, and breastfeeding: a randomized trial.

Sore and cracked nipples are common and may represent an obstacle to successful breastfeeding. In Italy, it is customary for health professionals to prescribe some type of ointment to prevent or treat sore and cracked nipples. The efficacy of these ointments is insufficiently documented. The incidence of sore and cracked nipples was compared between mothers given routine nipple care, including an ointment (control group), and mothers instructed to avoid the use of nipple creams and other products (intervention group). Breastfeeding duration was also compared between the two groups. Eligible mothers were randomly assigned, after informed consent, to one of the two groups. No difference was found between the control (n = 96) and the intervention group (n = 123) in the incidence of sore and cracked nipples and in breastfeeding duration. However, several factors were associated with sore nipples and with breastfeeding duration. The use of a pacifier and of a feeding bottle in the hospital were both associated with sore nipples at discharge (p = 0.02 and p = 0.03, respectively). Full breastfeeding up to 4 months postpartum was significantly associated with the following early practices: breastfeeding on demand, rooming-in at least 20 hours/day, non-use of formula and pacifier, no test-weighing at each breastfeed. The incidence of sore and cracked nipples and the duration of breastfeeding were not influenced by the use of a nipple ointment. Other interventions, such as providing the mother with guidance and support on positioning and latching, and modifications of hospital practices may be more effective in reducing nipple problems.

Adult↗
PubMed1996

Stabilization of the nipple base with titanium rings when reoperating patients with continent urostomies for nipple dysfunction.

Nipple dysfunction in Kock reservoirs used for continent urinary diversion is usually caused by a flattening out of the intestinal nipple due to a lateral tore at the base of the nipple when the reservoir expands. This study describes a new method to repair dysfunctioning nipples based on the use of titanium rings applied outside the reservoir around the base of the nipple. Experiments on dogs and rats have shown that rings and plates of titanium rapidly attach to the serosal surface of ileum exposed to urine with only minor signs of inflammation. Ten patients with Kock reservoirs for urinary diversion have been reoperated for nipple dysfunction due to nipple sliding with elongation of the nipple and fixation of the nipple base with titanium rings. The functional result is excellent in 9 out of the 10 patients. No signs of erosion of the rings into the reservoirs have been noted. With this new method for nipple repair the need for using more intestine to construct a new nipple is eliminated.

Adult↗
PubMed1990

Determinants of milk flow through nipple units. Role of hole size and nipple thickness.

The aim of the present study was to elucidate the role of hole size and thickness in determining milk flow through nipple units during bottle feeding. Commonly used standard nipple units (SMA single-hole, Enfamil single-hole, and Twist-on) for term and preterm infants, as well as Nuk-type nipple units (SMA Nuk, Enfamil Natural, and Nuk) were tested. The size of the nipple hole and wall thickness were determined for each nipple unit. Airflow was measured by forcing pressurized air through the feed hole. Simulated sucks were used to measure the milk flow. A marked variability in airflow and milk flow was observed within and among the various types of nipple units studied. Within each type of nipple unit, both milk flow and airflow measurements correlated well with hole size. The thickness of the nipple units contributed minimally to the observed variability. We conclude that differences in hole size primarily account for the observed variability in milk flow. This finding may be clinically important in that rapid milk flow can lead to apnea and bradycardia in some preterm infants. The above observations imply that design changes are necessary to reduce the variability of milk flow within each nipple type. Moreover, milk-flow measurements made using a simple mechanical system and airflow measurements used by the industry are equally sensitive to evaluate nipple flow.

Animals↗
PubMed2000

Comparison of nipple and areolar sensation after breast reduction by free nipple graft and inferior pedicle techniques.

Breast reduction with free nipple-areolar transplantation has traditionally been used for patients with gigantomastia. It is a widely held belief that there is little or no recovery of sensation in the nipple-areolar complex after this procedure. We set up a retrospective study to compare nipple-areolar sensation after free nipple grafting with that after breast reduction by the more commonly performed inferior pedicle technique. We reviewed 38 patients (17 free nipple grafts and 21 inferior pedicles) at least 1 year after breast reduction and measured the nipple and areolar pressure sensibility in each breast with Semmes-Weinstein monofilaments. We found some degree of recovery of sensation in all patients, with areolar sensation being similar in the two groups but nipple sensation being superior in the inferior pedicle group. In addition, we assessed the erectile function of the nipples in each group.

Adult↗
PubMed1999

Sustained attachment to the nipple in the newborn rat depends on experience with the nipple, milk, and the expression of oral grasping.

Newborn rats showed mouthing, licking, and oral grasping when presented with a surrogate nipple. These responses changed after the pup expressed an oral grasp response and experienced milk at the nipple. Newborn pups that ingested milk from the surrogate nipple showed brief oral grasp responses and, when tested 1 hr later, showed sustained attachment to an empty surrogate nipple. Contact with the nipple, oral grasping of the nipple, and experience with milk altered subsequent behavioral responses to the nipple. Classical and instrumental conditioning may play a role in transforming brief oral grasp responses into longer oral grasp responses and sustained attachment to the nipple.

Animals↗
PubMed1997

Nipple-areola reconstruction by tattooing and nipple sharing.

In a reconstructed breast the nipple-areola complex can be restored by various techniques, most of which are complicated and may leave residual scarring at the donor site. The primary intradermal tattooing and nipple sharing technique for nipple-areola reconstruction is simple and can be done under local anaesthesia. We present our experience of 31 patients who had 32 areolar reconstructions using intradermal tattooing (one patient had bilateral breast reconstruction). Seventeen patients had a nipple reconstruction by the nipple sharing technique. At follow-up of 2 months to 4 years, 4 patients have required further tattooing because of fading of the pigment and 1 patient has a gross areolar colour mismatch. There have been no nipple graft failures and the reconstructed nipples have adequate projection.

Adult↗
PubMed1997

Positive effects of an antenatal group teaching session on postnatal nipple pain, nipple trauma and breast feeding rates.

OBJECTIVE: To assess whether an antenatal teaching session on position and attachment of the baby on the breast had an effect on postnatal nipple pain, nipple trauma and breast feeding duration. The study was planned as a pilot study to allow an adequate sample size to be calculated for a larger study. DESIGN: An observer blind experimental design was used. Women were randomly assigned to either the experimental group teaching session or the control group. SETTING: One public hospital in Western Australia. PARTICIPANTS: 70 primiparae who intended to breast feed their baby were recruited from the antenatal clinic of the study hospital at 36 weeks' gestation. INTERVENTION: Antenatal group sessions on position and attachment of the baby on the breast were conducted by a lactation consultant. MEASUREMENTS AND FINDINGS: During the first four postnatal days, position and attachment was measured by LATCH (Latch on, Audible swallow, Type of nipple, Comfort and Help) (Jensen et al 1994), nipple pain was measured by the Visual Analogue Scale (VAS) and nipple trauma was measured by the Nipple Trauma Index (NTI). The analysis of variance (ANOVA) results indicated that the women in the experimental group were better able to attach the baby on the breast and had significantly less nipple pain and trauma than the control group. At six weeks postnatally, 31 of the 35 women in the experimental group were breast feeding compared to 10 of the 35 in the control group. CONCLUSIONS AND IMPLICATIONS: These initial findings suggest that midwives can make the best use of decreasing resources by using practical 'hands on' antenatal group teaching as an effective strategy to increase breast feeding rates.

Adult↗
PubMedDate not supplied

Evaluation of a dressing to reduce nipple pain and improve nipple skin condition in breast-feeding women.

This study was designed to evaluate whether maintenance of a moist environment on the nipple skin during the first week of breast-feeding would improve damaged nipple skin condition, as indicated by the presence of eschar, erythema, and fissures, and reduce pain. Fifty White women applied a polyethylene film dressing with a perimeter adhesive system to a randomly determined nipple. The dressing was present at all times except during feeding. Subjects were assessed every 48 hours (four times) over 7 days. Serial photographic slides were obtained and assessed for skin characteristics. Nipple pain was self-rated with a verbal descriptor scale. Use of an occlusive film dressing on nipple skin during the first week of breast-feeding appeared to have limited influence on improvement in damaged skin condition. Summary scores indicated significant reduction in the amount of eschar on the surface of the nipple. There were no differences in erythema intensity or fissure severity. Use of a dressing significantly reduced nipple pain during the study period.

Adult↗
PubMedDate not supplied

Nummular nipple hypertrophy and repair as part of an aesthetic nipple-areola unit.

The author suggests that an aesthetically pleasing ratio between nipple and areola diameter exists which should always be taken in consideration during nipple and areola reconstruction. In a study of 40 nipple-areola complexes of 20 healthy, nulliparous, Caucasian female volunteers with a mean age of 25.5 years, the average nipple diameter measured 28% of the areola diameter, that is, a ratio of 1:3.6. A hitherto undescribed form of macrothelia is presented in which the nipple width rather than the projection (length) is increased. A successful technique for reconstruction is described, based on the new method of assessing the aesthetic relations within the nipple-areola complex and known anatomy.

Adult↗
PubMed1994

Nipple placement in simple mastectomy with free nipple grafting for severe gynecomastia.

Severe gynecomastia with excessive skin is difficult to treat by only periareolar excision or suction-assisted lipectomy or both. In these patients, total mastectomy and free nipple grafting may be the best option. Placement of the nipple, however, has been arbitrary. With use of 20 "aesthetically perfect" men as models, standard nipple distances were identified. The average sternal notch-to-nipple measurement was 21 cm. In addition, two consistent ratios were identified. The nipple plane was located 0.33 times the distance from the sternal notch to the pubis, and the internipple distance was 0.23 times the chest circumference. With use of preoperatively obtained measurements of the sternal notch to pubis and chest circumference, accurate nipple placement can be accomplished.

Adult↗
PubMed1997

Inverted nipple with fatty plaques on areola and nipple.

A client who presented for a prenatal consultation for inverted nipples was treated and followed up. The right areola and nipple were characterized by amorphous fatty plaques which initially made identification of nipple diameter difficult. Both nipples were successfully everted at the first consultation with an inverted hypodermic syringe, which was cut off and the plunger reversed to draw out rather than push. The mother continued the treatment and there was good nipple protrusion at postnatal follow-up.

Breast Feeding↗
PubMed2004

Nipple core biopsy for the deformed or scaling nipple.

The key to diagnosis for deformed or scaling nipple is cytology or histology. While scrape cytology and punch biopsy do not provide underlying breast tissue for histology wedge excision requires more time and resource. We present the technique of nipple core biopsy (NCB) in 40 patients with deformed or scaling nipple done as a part of triple assessment yielding both skin and breast tissue for histological examination. Histological diagnosis confirmed eczema in 24, Paget's disease of nipple in 9 and chronic inflammation in 2. Among 5 remaining patients with normal skin histology, underlying breast invasive ductal carcinoma was seen in 3, ductal carcinoma in situ (DCIS) in 1 and adenoma in 1. NCB identified 5(55%) significant breast pathologies in Paget's disease and detected a further 2 invasive cancers in the absence of a palpable mass. The technique also provides additional information in the form of oestrogen receptor, which can have direct impact on patient management.

Aged↗
PubMed2003

New technique for nipple areola reconstruction: arrow flap and rib cartilage graft for long-lasting nipple projection.

The nipple-areola complex is an integral part of breast reconstruction. It serves as an important landmark for the new breast and many techniques have been described for its reconstruction. Historically, nipple projection has been most difficult to achieve and maintain. The authors found that techniques that use isolated soft tissue flaps eventually fail secondary to scar contraction with loss of projection. Since 1994, the authors have used a local skin fat flap shaped as an arrow for the reconstruction of the nipple on 454 breasts. The arrow shape is advantageous because it allows the scar to be broken on closure, minimizing postoperative wound contracture. Within the flap, the authors routinely use a rib cartilage graft, which provides additional support and projection for the skin-soft-tissue envelope. The graft is harvested during the initial breast flap transfer for the purpose of exposing the internal mammary vessels and has been obtained without any additional morbidity. By combining a skin fat flap and rib cartilage graft, the authors have achieved excellent long-term projection and a more esthetically pleasing nipple reconstruction.

Cartilage↗
PubMed2005

The use of calcium hydroxylapatite for nipple projection after failed nipple-areolar reconstruction: early results.

Numerous studies have shown that the final stage in breast reconstruction, creation of the nipple-areolar complex, correlates highly with patient satisfaction and acceptance of body image. There are many different techniques, including nipple sharing, free-composite grafts, and local "pull-out" flaps, all of which are vulnerable to an unpredictable degree of loss of projection and possible need for reoperation. This leads to problems with symmetry and overbuilding the initial reconstruction with wider-based, larger flaps, which may cause breast-contour changes. We have used calcium hydroxylapatite (Radiesse, Bioform Inc., Franksville, WI) following nipple-areolar reconstruction to maintain or restore projection in selected breast-reconstruction patients. Approximately 0.4-1 mL of calcium hydroxylapatite was injected subdermally using a 27-gauge needle in 6 selected patients. All patients tolerated the office procedure well without the need for local anesthesia. We report initial short-term success, with 100% patient satisfaction, minimal loss of projection, and no complications. Semipermanent injectable soft-tissue fillers such as calcium hydroxylapatite may be useful in selected patients as a simple solution to the difficult problem of the lack of nipple projection following reconstruction.

Biocompatible Materials↗
PubMed1984

[Preservation of the nipple and areola for breast cancer--histopathological study on cancerous involvement of the nipple and areola].

In 141 mastectomy specimens, performed for invasive or non-invasive carcinomas, histopathologic study was performed to assess the extent of nipple-areola involvement by the tumor. In this study, patients were excluded when 1) the tumor was located beneath the areola, 2) nipple and/or areola abnormalities were clinically present. Tumor involvement of the nipple and/or areola was found in 44 of 141 specimens (31%), with intraductal growth in 36 (82%) of 44, stromal invasion in 3 (7%) and ductal & stromal invasion in 5 (11%). Analysis of nipple-areolar involvement with consideration of the different variables indicates that it occurred in association with tumor size, tumor-areola distance and histological type. Such information provides clinically relevant guide lines in decision making for limited breast surgery.

Breast Neoplasms↗
PubMed1989

Evaluation of dot-immunobinding assay for carcinoembryonic antigen determination in nipple discharge as an adjunct in the diagnosis of early breast cancer. Research Group for Carcinoembryonic Antigen in Nipple Discharge.

We have previously reported carcinoembryonic antigen (CEA) measurement in nipple discharge to be a useful adjunct in the diagnosis of non-palpable breast cancer. As an extension, a dot-immunobinding assay was developed to screen a large number of patients with nipple discharge for non-palpable breast cancer. The principle is as follows. CEA bound to a solid phase monoclonal anti-CEA antibody is detected by a second monoclonal anti-CEA antibody conjugated with horseradish peroxidase. The use of tetramethylbenzidine as a chromogen results in a stable color reaction that can be semiquantitively analyzed by the naked eye. The CEA levels determined by this dot assay correlated well with CEA levels determined using the former Elmotec assay. To determine whether or not the method could also be feasible in the detection of non-palpable breast cancer, a collaborative study from 12 Japanese institutes was organized. The CEA levels in nipple discharges from 155 patients were assayed. Thirteen of 30 patients with palpable breast cancer and 22 of 30 patients with non-palpable breast cancer exhibited CEA values higher than 400 ng/ml, a cut-off value determined using 89 benign controls. The specificity (91%) and sensitivity (73%) of this test were higher than those of mammography or cytology. The incidence of elevated CEA levels in nipple discharge correlated significantly with the incidence of intratumoral antigen expression. Thus, the system could prove useful in screening for early breast cancer.

Body Fluids↗
PubMed2002

Erosive adenomatosis of the nipple: Conservation of nipple by Mohs micrographic surgery.

Erosive adenomatosis of the nipple (EAN) is a rare, benign tumor that resembles Paget's disease and well-differentiated adenocarcinoma. Total excision of the nipple has been the usual treatment modality because of the high incidence of recurrence when removal is incomplete, and complete excision generally mandates a reconstructive procedure. We report a case of a 56-year-old woman with EAN treated with Mohs micrographic surgery (MMS). We suggest that MMS is the first choice of treatment for EAN because it can be effectively used to remove the tumor completely and at the same time preserve the nipple, if performed early enough, before the tumor is widely spread.

Adenoma↗
PubMed1976

Benign inverted nipple: trans-nipple-areolar correction.

It is not expected that patients who have this correction for inverted nipples can nurse, but neither could they preoperatively. Their hygiene problems are solved. The deformity, their prime concern, has been corrected through a direct trans-nipple-areolar incision with nipple augmentation by flaps of breast tissue.

Breast↗