How does breastfeeding work?
Wendy Jones in Breastfeeding and Medication, 2018
The areola is a circular pigmented area around the nipple. It turns darker, reddish brown during pregnancy and retains the colour subsequently. However, the colour varies with the general complexion. Montgomery tubercules are small sebaceous glands present in the areola. They become enlarged in pregnancy and appear as small pimples. They are believed to secrete a lubricating substance during pregnancy and lactation to protect the nipple from bacterial infection. Too frequent washing may remove this protection and make the skin drier with the nipple and areola becoming more prone to soreness and cracking.
The breast
Kevin G Burnand, John Black, Steven A Corbett, William EG Thomas, Norman L Browse in Browse’s Introduction to the Symptoms & Signs of Surgical Disease, 2014
Stand or sit directly in front of the patient, and look for the following (Revision panel 13.1). Size There is enormous variation, with individual sensitivity at each extreme. Symmetry It is quite normal for there to be a difference between the sides. However, any marked size difference of recent onset is likely to be caused by significant pathology. Skin The skin may be pulled in or puckered by an underlying cancer. There may be oedema caused by obstruction of skin lymphatics by cancer cells, which is commonly referred to as peau d’orange, an accurate description. Other skin changes include visible tumour nodules or a malignant ulcer caused by direct invasion of the skin by a cancer. The colour of the nipples and areolae changes with age, and there is darkening during pregnancy. The areolar skin is naturally corrugated with small nodules known as Montgomery’s tubercles. The nipple may be inverted. Is this bilateral, is it of recent origin or long-standing, and does it display the transverse slit pattern seen in duct ectasia? There may be evidence of fluid leaking from the nipple, or there may be eczema-like skin changes as in Paget’s disease. Duplication There may be accessory nipples along the mammary line from axilla to groin (Fig. 13.2), or visible ectopic breast tissue in the anterior axillary fold (Fig. 13.3). Ask the patient to raise her arms slowly above her head. Skin changes may then become more apparent, particularly tethering to a carcinoma. Exposure of the underside of the breasts in an obese patient with large breasts may reveal intertrigo. Ask the patient to press her hands against her hips to tense the pectoral muscles. This may reveal a previously invisible swelling.
Nipple-areola complex reconstruction
Steven J. Kronowitz, John R. Benson, Maurizio B. Nava in Oncoplastic and Reconstructive Management of the Breast, 2020
Tattooing is either used by itself or in conjunction with skin grafting and can provide excellent areolar color match with limited morbidity. Tattooing uses intradermal sterile pigments on the needle of the tattoo machine. Rotating the cap of the needle assembly can regulate the depth of pigment placement. Pigment deposited too superficially will result in pigment extrusion and sloughing, while deeper placement leads to macrophage processing and removal, both resulting in early pigment fading. The selected color is typically one or two shades darker than the native areola due to a tendency for color fading over time. The tattooed area will usually undergo sloughing and crusting for 3–5 days. The area should be kept moist with bacitracin or some other type of petroleum jelly. After this period, slight de-pigmentation may occur and many patients will require touch-ups over the next few months.
Bilateral hyperkeratosis of the nipples and areolae with linear nevus: a rare case report and review of the literature
Published in Postgraduate Medicine, 2018
Mei-fang Wang, Li Wang, Lin-feng Li
Hyperkeratosis of the nipple and areola is an uncommon dermatosis without well-defined etiology, which occurs mostly in young women and may only be a cosmetic problem. In 1938, Levy-Frankel classified this disease into three variants; type I involves hyperkeratosis with an epidermal nevus, and has rarely been reported. We report a case of a 23-year-old woman with long-term bilateral pigmentation and thickening of the nipples and areolae, accompanied with dark brown, flat lesions with a linear distribution on her left forearm. The verrucous plaques were asymptomatic and could be scratched off by the patient herself. Consequently, she did not seek medical care for more than ten years. The prevalence of this condition is likely underestimated because many affected individuals are not sufficiently motivated to seek medical attention.
Effects of laser-assisted lipolysis on nipple-areola complex
Published in Journal of Cosmetic and Laser Therapy, 2017
Selma Sönmez Ergün, Reşit Burak Kayan, Mustafa Ekrem Güleş, İsmail Melih Kuzu
Background: Gynecomastia, as a most common benign condition, represents itself as the enlargement of the male breast and also nipple-areola complex as the severity of the condition increases. With this study, we aimed to clarify the effects of 980-nm diode laser on nipple-areola complex (NAC). Objectives: Although numerous open techniques have been described to correct gynecomastia, nowadays trends have shifted to minimally invasive techniques such as laser-assisted lipolysis (LAL). Methods: A total of 25 patients with bilateral gynecomastia treated with LAL by using a 980-nm diode laser. Results: The resultant contour and reduced size of the complex were satisfactory. Conclusions: LAL leads to significant reduction of the size of NAC.
Management of a Benign Phyllodes Tumor in a 13-Year-Old Girl with Transposition of the Nipple Areola Complex and Breast Reconstruction
Published in Acta Chirurgica Belgica, 2015
B. Erginel, B. Celet Ozden, S. Yesil Onder, S. Yuksel, F. Gun Soysal, A. Celik, T. Salman
Phyllodes tumor is a rare primary tumor of the breast. In children and adolescents, it is even rarer with only 20 cases, treatment of which vary in the literature. Herein we report the case of a 13-year-old female patient with a giant benign phyllodes tumor eroding the bottom of the breast skin and causing nipple retraction. We performed breast conservative surgery by mobilizing the areola, using skin flaps and inserting an implant. Breast malignancy, including phyllodes tumor (PT), is very rare in adolescents. PT, previously called cystosarcoma phylloides, consists of leaf-like fronds, from which the tumor gets its name (1, 2). Although PT is most often seen in the fourth decade of life, almost 20 cases have been reported in the adolescent period, most of which are benign. The histologic types are benign, borderline, and malignant, depending on the mitotic rate of the tumor (3, 4).