-
Women's Health (London, England) 2022Nipple pain is a common reason for premature cessation of breastfeeding. Despite the benefits of breastfeeding for both infant and mother, clinical support for problems... (Review)
Review
Nipple pain is a common reason for premature cessation of breastfeeding. Despite the benefits of breastfeeding for both infant and mother, clinical support for problems such as maternal nipple pain remains a research frontier. Maternal pharmaceutical treatments, and infant surgery and bodywork interventions are commonly recommended for lactation-related nipple pain without evidence of benefit. The pain is frequently attributed to mammary dysbiosis, candidiasis, or infant anatomic anomaly (including to diagnoses of posterior or upper lip-tie, high palate, retrognathia, or subtle cranial nerve abnormalities). Although clinical protocols universally state that improved fit and hold is the mainstay of treatment of nipple pain and wounds, the biomechanical parameters of pain-free fit and hold remain an omitted variable bias in almost all clinical breastfeeding research. This article reviews the research literature concerning aetiology, classification, prevention, and management of lactation-related nipple-areolar complex (NAC) pain and damage. Evolutionary and complex systems perspectives are applied to develop a narrative synthesis of the heterogeneous and interdisciplinary evidence elucidating nipple pain in breastfeeding women. Lactation-related nipple pain is most commonly a symptom of inflammation due to repetitive application of excessive mechanical stretching and deformational forces to nipple epidermis, dermis and stroma during milk removal. Keratinocytes lock together when mechanical forces exceed desmosome yield points, but if mechanical loads continue to increase, desmosomes may rupture, resulting in inflammation and epithelial fracture. Mechanical stretching and deformation forces may cause stromal micro-haemorrhage and inflammation. Although the environment of the skin of the nipple-areolar complex is uniquely conducive to wound healing, it is also uniquely exposed to environmental risks. The two key factors that both prevent and treat nipple pain and inflammation are, first, elimination of conflicting vectors of force during suckling or mechanical milk removal, and second, elimination of overhydration of the epithelium which risks moisture-associated skin damage. There is urgent need for evaluation of evidence-based interventions for the elimination of conflicting intra-oral vectors of force during suckling.
Topics: Breast Feeding; Female; Humans; Infant; Lactation; Mothers; Nipples; Pain
PubMed: 35343816
DOI: 10.1177/17455057221087865 -
American Family Physician Sep 2018All major health organizations recommend breastfeeding as the optimal source of infant nutrition, with exclusive breastfeeding recommended for the first six months of...
All major health organizations recommend breastfeeding as the optimal source of infant nutrition, with exclusive breastfeeding recommended for the first six months of life. After six months, complementary foods may be introduced. Most organizations recommend breastfeeding for at least one year, and the World Health Organization recommends a minimum of two years. Maternal benefits of breastfeeding include decreased risk of breast cancer, ovarian cancer, postpartum depression, hypertension, cardiovascular disease, and type 2 diabetes mellitus. Infants who are breastfed have a decreased risk of atopic dermatitis and gastroenteritis, and have a higher IQ later in life. Additional benefits in infants have been noted in observational studies. Clinicians can support postdischarge breastfeeding by assessing milk production and milk transfer; evaluating an infant's latch to the breast; identifying maternal and infant anatomic variations that can lead to pain and poor infant weight gain; knowing the indications for frenotomy; and treating common breastfeeding-related infections, dermatologic conditions, engorgement, and vasospasm. The best way to assess milk supply is by monitoring infant weight and stool output during wellness visits. Proper positioning improves latch and reduces nipple pain. Frenotomy is controversial but may reduce pain in the short term. The U.S. Preventive Services Task Force recommends primary care interventions to support breastfeeding and improve breastfeeding rates and duration.
Topics: Adolescent; Adult; Breast Feeding; Child Development; Female; Humans; Infant; Infant, Newborn; Nipples; Social Support; Time Factors
PubMed: 30215910
DOI: No ID Found -
Annals of the Academy of Medicine,... Mar 2021
Topics: Humans; Keratosis; Nipples
PubMed: 33855333
DOI: 10.47102/annals-acadmedsg.2020412 -
Medicina (Kaunas, Lithuania) Jun 2020The reconstruction of the nipple-areola complex is the last step in the breast reconstruction process. Several techniques have been described over the years. The aim of... (Review)
Review
The reconstruction of the nipple-areola complex is the last step in the breast reconstruction process. Several techniques have been described over the years. The aim of this review is to provide clarity on the currently available reconstructive options.
Topics: Adult; Breast Neoplasms; Female; Humans; Mastectomy; Middle Aged; Nipples; Plastic Surgery Procedures; Surgical Flaps
PubMed: 32560062
DOI: 10.3390/medicina56060296 -
Ugeskrift For Laeger Oct 2016Inverted nipples is an anatomical variation which can be uni- or bilateral, congenital or acquired. The degree of inversion can vary from slight to severe. Treatment can... (Review)
Review
Inverted nipples is an anatomical variation which can be uni- or bilateral, congenital or acquired. The degree of inversion can vary from slight to severe. Treatment can be surgical or non-surgical and should depend on the degree of functional problems. Non-surgical treatment can be beneficial, does not risk affecting sensibility, spares the lactiferous ducts, and therefore does not risk any interference with breast-feeding. Surgical options should only be considered when non-surgical treatment is insufficient.
Topics: Female; Humans; Nipples
PubMed: 27745579
DOI: No ID Found -
The New England Journal of Medicine Jun 2017
Topics: Breast Diseases; Humans; Male; Middle Aged; Nipples; Thrombophlebitis
PubMed: 28591532
DOI: 10.1056/NEJMicm1611550 -
Korean Journal of Radiology Aug 2020Ultrasound (US) is an attractive diagnostic approach to identify both common and uncommon nipple pathologies, such as duct ectasia, nipple abscess, nipple leiomyoma,... (Review)
Review
Ultrasound (US) is an attractive diagnostic approach to identify both common and uncommon nipple pathologies, such as duct ectasia, nipple abscess, nipple leiomyoma, nipple adenoma, fibroepithelial polyp, ductal carcinoma (restricted to nipple), invasive carcinoma, and Paget's disease. US is the reliable first-line imaging technique to assess nipple pathologies. It is useful to identify and characterize nipple lesions. Additionally, we have presented the mammography and MRI outcomes correlated with histopathologic features for the relevant cases.
Topics: Adenoma; Adult; Aged; Breast Neoplasms; Carcinoma, Intraductal, Noninfiltrating; Female; Humans; Magnetic Resonance Imaging; Mammography; Middle Aged; Nipples; Paget's Disease, Mammary; Papilloma; Ultrasonography
PubMed: 32677380
DOI: 10.3348/kjr.2019.0831 -
CMAJ : Canadian Medical Association... May 2015
Topics: Breast Diseases; Female; Humans; Nipples
PubMed: 25733736
DOI: 10.1503/cmaj.140633 -
Anais Brasileiros de Dermatologia Jun 2018
Topics: Adult; Biopsy; Humans; Male; Nipples; Sweat Gland Neoplasms; Tubular Sweat Gland Adenomas
PubMed: 29924236
DOI: 10.1590/abd1806-4841.20187572 -
Journal of Dairy Science Aug 2021Transiently increased teat wall thickness in response to machine milking has been documented by various methods, including ultrasound. However, correlative...
Transiently increased teat wall thickness in response to machine milking has been documented by various methods, including ultrasound. However, correlative ultrasonography and histology to detect the origin of this phenomenon is lacking. The first goal of the present study was to evaluate and compare milking-related changes of the teat tissue in 2 breeds of dairy cows (11 Simmental and 3 Holstein) using B-mode ultrasonography. Additionally, the observed changes were compared with ultrasonographic findings in a Holstein cow with periparturient udder edema. Finally, corresponding histological sections of the Simmental teats were analyzed and compared with those from a lactating nonmilked Angus cow. We hypothesized that the mechanical load of both stretching by the vacuum during phases of open teat cup liner and compression by the closed liner during machine milking results in a transient congestion of blood vessels in the teat wall. The barrel of 1 front teat of each cow was scanned immediately before and after machine milking (system vacuum: 42 kPa; pulsation rate: 60 cycles/min; pulsation ratio: 65:35). Shortly after milking (33 ± 6 min), the Simmentals were slaughtered, and their scanned teat was immediately removed and processed for investigation by light microscopy. Ultrasonography after milking revealed anechoic tubular structures mainly in the inner half of the teat wall. Histological examination revealed these structures to be thick-walled veins. The left front and hind teats of the nonmilked lactating cow, collected and prepared identically to those from the Simmental cows, showed the same histological features. Ultrasonographic measurements showed that the diameter of these veins significantly increased after milking compared with matching images before milking. This effect was most pronounced in the Holstein cows. Similarly, these veins were very prominent in the periparturient cow. However, neither the milked cows, including the periparturient cow, nor the lactating nonmilked cow provided any evidence of edematous extravasation on ultrasonography or histology. These findings corroborated our hypothesis that the increase in size of thick-walled veins in the teat tissue is the main reason for the thickening of the teat walls in response to machine milking.
Topics: Animals; Cattle; Dairying; Female; Lactation; Mammary Glands, Animal; Milk; Nipples
PubMed: 34024610
DOI: 10.3168/jds.2021-20294