Nipple hypersensitivty-An unusual symptom of duct ectasia.

Mammary duct ectasia (MDE) is a benign and often troublesome breast condition. The usual presentation includes colored nipple discharge and mastalgia. Nipple hypersensitivity has never before been described as a presenting complaint for MDE. This case report looks into such an unusual case.

Measurement tools and intensity of nipple pain among women with or without damaged nipples: A quantitative systematic review.

AIMS: To describe and evaluate pain scales used to measure nipple pain in breastfeeding women and to identify nipple pain intensity in women with or without nipple damage. BACKGROUND: Nipple pain is one of the most common reasons given for premature cessation of breastfeeding. However, there are no agreed tools to measure pain and no previous reviews have provided summary estimates of pain scores. DESIGN: Systematic review. DATA SOURCES: Medline, CINAHL, Scopus, Web of Science, SciELO, and LILACS. REVIEW METHODS: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The guiding question was: How is nipple pain in breastfeeding women measured and how severe is it? We analysed articles published up to February 2018, excluded review articles and those that did not present the level of nipple pain or tools to estimate pain severity. RESULTS: A total of 1,023 articles were identified and 25 were included in the review after applying the exclusion criteria. The Numeric Rating Scale (nine studies) and Visual Analogue Scale (seven studies) were the most prevalent tools for measuring pain. Using a pain score between 0-10, women with nipple damage reported a weighted mean of 6.2 in the first week and 5.8 after that period; women without damage reported a weighted mean of 2.7. CONCLUSION: Women with nipple damage consistently reported a higher level of pain than women without damage. To prevent premature cessation of breastfeeding, it is important to help new mothers avoid nipple damage.

Implications of nipple discharge in Hong Kong Chinese women.

INTRODUCTION: There are no recent data on nipple discharge and its association with malignancy in Hong Kong Chinese women. This study reported our 5-year experience in the management of patients with nipple discharge, and our experience of mammography, ultrasonography, ductography, and nipple discharge cytology in an attempt to determine their role in the management of nipple discharge. METHODS: Women who attended our Breast Clinic in a university-affiliated hospital in Hong Kong were identified by retrospective review of clinical data from January 2007 to December 2011. They were divided into benign and malignant subgroups. Background clinical variables and investigative results were compared between the two subgroups. We also reported the sensitivity, specificity, and positive and negative predictive values of the investigations that included mammography, ultrasonography, ductography, and cytology. RESULTS: We identified 71 and 31 patients in the benign and malignant subgroups, respectively. The median age at presentation for the benign subgroup was younger than that of the malignant subgroup (48 vs 59 years; P=0.003). A higher proportion of patients in the malignant subgroup than the benign subgroup presented with blood-stained nipple discharge (87.1% vs 47.9%; P=0.002). Mammography had a specificity of 98.4% and positive predictive value of 66.7%; ultrasonography had a specificity of 87.0% and negative predictive value of 75.0%. Cytology and ductography were sensitive but lacked specificity. Ductography had a negative predictive value of 100% but a low positive predictive value (14.0%). Clinical variables including age at presentation, duration of discharge, colour of discharge, presence of an associated breast mass, and abnormal sonographic findings were important in suggesting the underlying pathology of nipple discharge. Multiple logistic regression showed that blood-stained discharge and an associated breast mass were statistically significantly more common in the malignant subgroup. CONCLUSIONS: In patients with non-blood-stained nipple discharge, a negative clinical breast examination combined with negative imaging could reasonably infer a benign underlying pathology.

Breast Durometer (Mammometer): A Novel Device for Measuring Soft-Tissue Firmness and Its Application in Cosmetic Breast Surgery.

The measurement of soft-tissue firmness has many potential applications in medical practice. This study reports a user-friendly, novel device that is capable of measuring changes in soft-tissue firmness in a reproducible manner. The study reports the development of the equipment and how it has been applied to breast implant surgery. The device was tested for both intra- and inter-observer variability on an in vitro model, using a breast implant. Once reproducibility was confirmed, breast firmness was measured on a series of patients who underwent sub-fascial breast augmentation (n = 50) to examine how it varied post-operatively. Firmness in the upper half of the breast increased to a maximum level two weeks post-surgery (0.44-0.61 Pa), reducing to pre-operative levels by 6 weeks (0.37-0.54 Pa). There was no further significant change at 12 weeks. Firmness in the nipple areolar complex (NAC) and at the lower outer quadrant (LOQ) followed a similar pattern, but remained firmer at 12 weeks. We interpret these patterns as implying that measurements taken at the upper half of the breast are indicative of post-operative oedema, whereas those at the NAC and LOQ represent changes in firmness produced by the breast implant composite. We consider the potential for this novel device in the measurement of soft-tissue firmness in aesthetic breast surgery and would encourage other researchers to explore novel applications. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Factors Associated with Nipple Lesions in Puerperae.

This retrospective cross-sectional study aimed to evaluate the factors associated with nipple lesion development in puerperae. Analyses were performed using the Poisson regression with robust variance. The level of significance was set at 5% (p < 0.05). We evaluated 1270 puerperae, among whom 193 (15.4%) presented with nipple lesions. The condition was more prevalent among the mothers who did not receive information about breastfeeding [PR, 1.69; 95% confidence interval (CI), 1.19-2.42], those who underwent cesarean delivery (PR, 1.48; 95% CI, 1.02-2.16), those who used a pacifier (prevalence ratios (PR), 2.04; 95% CI, 1.05-3.95), those who used baby formula only (PR, 1.61; 95% CI, 4.82-5.36) and those who used baby formula combined with breastfeeding (PR, 1.61; 95% CI, 1.06-2.45). A lower incidence of nipple lesions was observed among those who did not receive information on hand expression of breast milk (PR, 0.65; 95% CI, 0.46-0.93) and those who did not breastfeed in the first hour of life (PR, 0.61; 95% CI, 0.38-0.97).

Retrospective analysis of pathologic nipple discharge.

The cause of pathologic nipple discharge is mainly benign lesions, but there is still a possibility of malignancy. Pathologic nipple discharge may be the only or the first symptom of breast cancer. This study aimed to investigate the clinical factors associated with lesions in patients with pathologic nipple discharge using a retrospective analysis of clinical data in 207 cases. The univariate analysis showed that age >50 years, breast lumps, or breast calcifications were risk factors associated with breast cancer in nipple discharge patients (P < 0.05). Discharge characteristics, duration of disease, and identification of lesions had no clear clinical significance (P > 0.05). The multivariate analysis also showed that age >50 years, breast lumps, and breast calcifications were risk factors associated with breast cancer in nipple discharge patients (P < 0.05). Age, breast lumps, and breast calcifications had important clinical significance in identification of benign and malignant nipple discharge.

Raynaud's Phenomenon of the Nipple: Epidemiological, Clinical, Pathophysiological, and Therapeutic Characterization.

Raynaud's phenomenon of the nipple is a possible cause of pain and breastfeeding cessation in lactating women. However, there are still few studies on the characterization of this manifestation. Thus, we aim to develop a systematic review of the literature carried out between January 1992 and January 2024 in PubMed, Scopus, Web of Science, Virtual Health Library (VHL), and Portal de Periódicos da CAPES. Of the 438 articles, 19 met the eligibility criteria. The findings were divided by heuristic questions into two groups: "Epidemiological, pathophysiological, and clinical characterization of Raynaud's Phenomenon of the nipple" and "Treatment of Raynaud's Phenomenon of the nipple". Raynaud's phenomenon of the nipple is commonly primary, being more prevalent in the postpartum period, in women with a mean age of 32 years. The main triggers appear to be stress and temperature change. Generally, it is associated with a change in color and pain during breastfeeding. A calcium channel blocker was the most used medication with or without non-pharmacological measures.

Is chronic nipple piercing associated with hyperprolactinemia?

Literature on hyperprolactinemia in the setting of a nipple piercing is limited to individuals with concomitant breast/chest wall infection. It is unclear if chronic nipple stimulation from a piercing alone can cause sustained elevations of serum prolactin. Nipple piercing is emerging as a more mainstream societal form of body art, and the answer to this clinical question would potentially alter patient management. Our aim was to assess serum prolactin levels in subjects with nipple piercing. Inclusion criteria were as follows: men and women ≥ 18 years old with nipple piercing(s) present > 6 months. Exclusion criteria included: women who are pregnant, lactating or < 6 months postpartum; subjects on medications known to increase prolactin levels; chest wall/breast infection at the time of phlebotomy or conditions known to be associated with hyperprolactinemia. Three men and eight women were enrolled. Median (range) ages for men and women were 33 (24-42) and 27 years (23-42), respectively. All except one subject had bilateral piercings. The median interval from nipple piercing to blood draw was 4.0 (2.0-12.0) years. None of the subjects had hyperprolactinemia. Median (range) prolactin levels for men and women were 5.6 ng/mL (3.8-7.4) and 8.0 ng/mL (2.8-10.9), respectively. Our results suggest that in the absence of any concomitant infection, chronic nipple piercing is not associated with hyperprolactinemia.

Nipple-sparing mastectomy in modern breast practice.

Breast cancer management has evolved from the conventional radical Halsted to a fully integrated multidisciplinary approach. Nipple sparing mastectomy (NSM) is an innovative technique that preserves native breast envelope without mutilation of nipple-areola complex (NAC), thus providing a reasonable alternative for early cancers without NAC involvement and prophylactic high risk patients and avoids multiple surgical procedures required for reconstruction. This article aims to critically review indications, intra-operative protocols, radiotherapy planning and limitations of NSM. Patient selection should be based on study of breast duct anatomy by Magnetic Resonance Imaging, mammographic tumor-nipple distance and obligatory intra-operative frozen section from retro-areolar tissue. Tumor size, axillary lymph node status, lymphovascular invasion and/or degree of intraductal component are factors used to include NSM candidates based on institutional practice. Given the heterogeneity of patients and lack of standardization of preoperative investigations, surgical technique and pathologic sampling of retro-areola tissue so far, mandates a multi-institutional prospective study to define and validate a role for NSM in invasive breast cancer and DCIS. Nipple necrosis is an important NSM complication which can be greatly reduced using alternative skin incisions. Even if the nipple survives, an insensate nipple and lack of sexual function is common and requires preoperative counseling and discussion. Finally the relation and timing of intra-operative versus adjuvant breast radiation and tailoring of dosage and delivery methods has not been fully explored. Although NSM reduces psychological trauma associated with nipple loss, the oncologic safety as well as functional and aesthetic outcomes needs additional investigation.

[Diagnostic imaging and histologic background of nipple discharge -- our experience with 40 patients]. / A váladékozó emlo képalkotó diagnosztikája és szövettani háttere -- tapasztalataink 40 betegünk kapcsán.

The authors present the diverse etiology of nipple discharge, which background may be a tumor. They discuss the checkup ways of nipple discharge and review in detail the galactographic technique and evaluation. The examination of pathologic nipple discharge is essentially based on contact cytology, x-ray-, and ultrasound mammography. Consequently, galactography is applied by filling the ducts with contrast material. The final diagnosis is rendered by histologic examination, following the operation. The authors demonstrate the application and role of galactography through various cases.

Positive effect of HPA lanolin versus expressed breastmilk on painful and damaged nipples during lactation.

Painful and/or damaged nipples associated with breastfeeding are common and represent a challenge for both the persons experiencing nipple pain and/or trauma and for those providing treatment. However, evidence-based data has been insufficient to demonstrably minimize these common reasons for failure to initiate or continue successful breastfeeding. The aim of this study was to evaluate the efficacy of specific-grade highly purified anhydrous (HPA) lanolin versus expressed breastmilk (EBM) for the treatment of painful and damaged nipples associated with breastfeeding in a prospective controlled clinical trial evaluating 84 lactating mothers. Nipple trauma and healing rates were rated by the Nipple Trauma Score. Nipple pain intensity was assessed on a visual analog scale. Outcome parameters were in favor of the HPA lanolin group, reaching statistical significance for healing rates, nipple trauma and nipple pain. In our study, we found HPA lanolin more effective than EBM, inducing faster healing of nipple trauma (absolute risk reduction of 0.43) and reducing nipple pain (absolute risk reduction of 0.61 on day 3). We concluded that HPA lanolin, combined with breastfeeding education, was more effective than EBM, combined with breastfeeding education, in reducing nipple pain and promoting healing of nipple trauma.

Crusted nipple and areola: A new aetiology of secondary hyperkeratosis of the nipple and areola.

Hyperkeratosis of the nipple and areola is a rare condition first described by Tauber in 1923. Less than 100 cases have been reported in the literature. Hyperkeratosis of the nipple and areola presents as hyperkeratotic, hyperpigmented plaques on the nipple and areola. It is more common in females. An 18-year-old female patient presented with hyperkeratotic, plaque-like, hard crusts on both nipples and areolas. The examining physician could successfully remove this crust using his finger. The crust had accumulated as a result of the patient's reluctance to touch or clean the breast area due to psychological issues. A crusted nipple and areola may occur as a secondary condition due to a patient's reluctance to touch or clean their breasts.

Breastfeeding success with the use of the inverted syringe technique for management of inverted nipples in lactating women: a study protocol for a randomized controlled trial.

BACKGROUND: Breastfeeding provides ideal infant nutrition, conferring several health benefits to children and their mothers. Women with inverted nipples, however, face difficulties that force them to prematurely terminate breastfeeding. Whereas available conservative measures for the correction of inverted nipples are of limited success, the use of an inverted syringe may be effective in achieving high rates of infant latching and exclusive breastfeeding. This technique, however, has not been investigated in a clinical trial. METHODS/DESIGN: This open-label randomized controlled trial aims to investigate whether, in women with inverted nipples, the use of an inverted syringe increases the rate of exclusive breastfeeding at one month compared to standard care. One-hundred healthy women with grade 1 or 2 inverted nipples will be recruited as of 37 weeks of gestation. They will be randomly allocated to standard care (control group) or to an intervention group. The intervention consists of using an inverted syringe to evert the nipple before every breastfeed, starting with the first feed after delivery. The primary outcome measure is the rate of exclusive breastfeeding at 1 month. Secondary outcome measures include exclusive breastfeeding rates at 3 and 6 months, nipple eversion rate, successful latching rate, rates of any breastfeeding at 1, 3, and 6 months, breastfeeding-associated complications, maternal satisfaction with breastfeeding, maternal quality of life, and adverse events. Descriptive and regression analysis will be conducted under the intention to treat basis. DISCUSSION: The use of the inverted syringe to evert inverted nipples is a simple, inexpensive, and safe technique that can be performed by mothers with inverted nipples. Findings of this trial, if positive, will provide much needed evidence for a safe, affordable, readily available, and simple intervention to treat inverted nipples, and improve breastfeeding practice among affected women. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03529630. Registered May 8, 2018.

Frenotomy for tongue-tie in newborn infants.

BACKGROUND: Tongue-tie (ankylglossia) occurs when there is an anterior attachment near the tip of the tongue resulting in restricted tongue movement. It is reported to be a cause of poor breastfeeding in infants and nipple pain in breastfeeding mothers. OBJECTIVES: The objectives of the study were to determine whether frenotomy is safe and effective in improving ability to feed orally among infants. INTERVENTION/METHODS: Frenotomy may correct the restriction of tongue movement and allow improved breast feeding and reduced maternal nipple pain. Randomised, quasi-randomised cluster-randomised controlled trials that compared frenotomy verses no frenotomy or frenotomy verses sham procedure were included in the review. Participants were infants with tongue-tie experiencing feeding problems, or whose breast feeding mothers were experiencing nipple pain. RESULTS: Five studies (N = 302) met the inclusion criteria. Pooled analysis of two studies showed no change following frenotomy (mean difference (MD) -0.1, 95% confidence interval (CI) -0.6 to 0.5 units on a 10-point feeding scale). A third study showed objective improvement on a 12-point feeding scale (MD 3.5, 95% CI 3.1 to 4.0 units of a 12-point feeding scale). Pooled analysis of three studies (n = 212) showed a reduction in maternal pain scores following frenotomy (MD -0.7, 95% CI -1.4 to -0.1 units on a 10-point pain scale). These studies had serious methodological shortcomings. CONCLUSION: Investigators did not find a consistent positive effect on infant breastfeeding following frenotomy. A short-term reduction in breast pain was found among breastfeeding mothers. Small trial numbers and methodological issues meant no definitive benefit for frenotomy in infants with tongue-tie could be proved.

Nipple Pain Incidence, the Predisposing Factors, the Recovery Period After Care Management, and the Exclusive Breastfeeding Outcome.

BACKGROUND: Nipple pain is the most common complaint of breastfeeding mothers during the immediate postpartum period. Persistent nipple pain is associated with low breastfeeding rate at 6 months postpartum. OBJECTIVE: To further explore the incidence of nipple pain, associated predisposing factors, time for recovery after management, and the impact on exclusive breastfeeding rates. MATERIALS AND METHODS: Included in this study were 1,649 singleton, pregnant women who delivered and had their 1-week follow-up at the breastfeeding clinic during the period of January 2013 to December 2015. The mothers who experienced nipple pain were analyzed for the incidence, the predisposing factors, and the recovery period after care management. The breastfeeding outcome comparison of both, mothers with and without pain, was measured by the exclusive breastfeeding rate at the sixth week postpartum. RESULTS: The incidence of nipple pain was at 9.6% by day 7. A predisposing factor of nipple pain was primiparity (relative risk = 1.8, 95% confidence interval 1.3-2.5). The reasons for nipple pain were inappropriate positioning and latching (72.3%), tongue-tie (23.2%), and oversupply (4.4%). The recovery period after care management was 1-2 weeks. There were no statistically significant differences between the 6-week exclusive breastfeeding rates of the mothers with nipple pain with treatment and the mothers without nipple pain. CONCLUSION: Persistent nipple pain was a common problem. The active management, including early detection and treatment, would help the mothers recover within a 2-week period and there was no significant difference of exclusive breastfeeding rates between the mothers who had early care management and the mothers without nipple pain.

ABM Clinical Protocol #26: Persistent Pain with Breastfeeding.

A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.

"Seeing Is Believing": Dermatoscope Facilitated Breast Examination of the Breastfeeding Woman with Nipple Pain.

BACKGROUND: It is well recognized that breastmilk provides optimal nutrition and immunological protection for infants. Many women, however, experience nipple pain while breastfeeding, leading to premature cessation of nursing. To overcome these difficulties, timely diagnosis is crucial to effectively treat the underlying pathology and permit resumption of breastfeeding. Examination of the superficial breast plays a key role in accurate diagnosis. Traditional direct inspection is clearly inadequate for this task. MATERIALS AND METHODS: The dermatoscope is a useful tool, enlarging and illuminating an area of epidermis to obtain an optimal image. Improvements in dermoscopy involving polarization obviate the need for full contact with the examined surface, thereby providing anatomical detail in three dimensions. RESULTS: A novel practice presented in this article features clinical cases introducing this technique as it is applied to the lactating breast, conclusively distinguishing normal from abnormal and illustrating the efficacy and added diagnostic value of this approach. The dermoscope is shown to facilitate identification of the causes of nipple pain ranging from asymptomatic candidal infection to exquisitely painful, minute traumatic erosions, aiding, thereby, in diagnosis of the underlying causes of nursing difficulties. Improved wound surveillance and standardization for purposes of research documentation are additional benefits anticipated with the use of breast dermoscopy. CONCLUSIONS: We conclude that real-time, high-quality, magnified imaging of the lactating breast represents a recognizable advance in pursuit of a rapid and accurate technique that aids in the identification of the factors responsible for lesions affecting nursing women. Moreover, it features an already existing technology requiring little training at a reasonable cost.