Professional Documents
Culture Documents
Nipple Knowledge
Nipple Knowledge
NIPPLE
Knipple Knowledge
cxxxw u
Diana West, BA, IBCLC
dwestIBCLC@gmail.com
NIPPLE
PURPOSE
SirAstleyCooper(1840)
Almost infinite
nipple variations
(Montagna, 1974)
Genetic
expression
Nipple = Mammal
Characteristic
Handle infant
to grasp breast
Point of
interaction
between breast
and infant
Conduit through
which milk passes
Look cute
Nipple = Mammal
Characteristic
Characterized by
(Eastwood, 2007)
Reduced hair/feathers/scales
Specific patterns of cell differentiation
Adaptation to changing states
Distinctive keratins to
withstand mechanical strain
Knipple Knowledge
Fetal
Nipple/Areola Pigment
Contains melanin
Protection from ultraviolet rays
Resists abrasion
Fetal
2-3 months
gestation: Breast
glandular tissue
forms near 4th and
5th ribs, ectodermal
lines recede
This is when
malformations
(supernumerary
nipples/polythelia)
occur
Nipple/Areola Pigment
Melanin increases (darkens) during
pregnancy to increase resistance to
UV rays and abrasion
Knipple Knowledge
Nipple/Areola
Pigment and Pain
Nipple Tips
(Delaney, 2010)
Drupelet:
Nipple Sides
Sides have
intersecting
grooves for
expansion when
not erect
Hoover,K.Proposinganewterm:drupelet.
ClinicalLactation 2013:4(1);36.
Nipple Muscles
Nipple Muscles
Knipple Knowledge
Nipple Muscles
Erection of nipples NOT due to erectile
tissue
Due to contraction of smooth
muscle under control of autonomic
nervous system
Like hair follicle standing on end
NOT like sexual erection
Nipple
Nerves
20 of 140
Nipple Ducts
Most ducts
branch at 2mm
below surface
(Ramsay, 2005)
Closer than
previously
thought
Nipple Ducts
Number of ducts IN
the nipple is greater
than number of
ducts ON the nipple
(Going and Moffat, 2004)
Converge
# greater than
0.5mm
(sonogram limit)
5-9 (Love and Barsky, 2004)
4-18, avg 9 (Ramsay, 2005)
Knipple Knowledge
Flat Nipples
Nipple
Variations
Problematic
for Latching
or Milk
Removal
Short shank
NOT retracted,
but no or very
little protrusion
Incidence (Dewey, 2003)
9% Day 1 pp
7% Day 7 pp
Edema
Flat Nipples
Preeclampsia
Renal (kidney) clearance impaired
Breast pump
Pulls fluids into areola
Flat Nipples
Knipple Knowledge
Inverted Nipples
AKA: tied, invaginated, tethered,
non-protractile
Inverted Nipples
50% congenital
50% from trauma, disease,
surgery
Inverted Nipples
Han & Hong Inverted Nipple Classification System
Grade 1
protrusion
Grade 3
Other Causes of
Inverted Nipples
FLN
Funny Looking Nipple
Other Causes of
Inverted Nipples
Cancer
Timing is
very important
If it happened
recently and
spontaneously:
Could be from
scar tissue in or around lesion or duct
Other Causes of
Inverted Nipples
Fat necrosis
Benign
inflammatory
condition
Secondary to:
Breast injury or
trauma
Surgery or
biopsy
Radiation
Common in
very large
breasts
Knipple Knowledge
Other Causes of
Inverted Nipples
Breast abscess
Duct ectasia
Plug and
inflammation
when NOT
lactating
Benign
Knipple Knowledge
Knipple Knowledge
Lansinoh LatchAssist
Breast shells
No permanent effect
(Alexander,1991)
Knipple Knowledge
Nipple Tags
Bulbous Areola
May
indicate
hypoplasia
(insufficient
glandular
tissue)
Supernumerary Nipples
Polythelia
Accessory nipple
Supernumerary Nipples
Can appear on areola (Abramson, 1975;
Arranz Lpez, 2005; Onesti, 2010)
Supernumerary Nipples
Can form
anywhere
along milk
lines
10
Knipple Knowledge
Classification
1
Polymastia
nipple,areola,glandulartissue
nipple,glandulartissue
areola
glandular tissue,areola
nipple
glandulartissueonly
nipple,areola,adipose tissue
glandulartissue
6
Polythelia
nippleonly(mostcommontype)
7
Polythelia areolaris
areolaonly
8
Polythelia pilosa
hairpatchonly
Population
Prevalence
0.22%
0.6%
1.6%
2.5%
4.7%
5%
0.22-6%
population
Ethnic,
geographic
variance
Distribution of
Supernumerary Nipples
Among Selected Populations
CaucasianEuropeans
Caucasian Americans
AfricanAmericans
Israelis
Arabs
Japanese
Supernumerary Nipples
Citation
Mathes,2006
Kenny,1997
Rahbar,1982
Mimouni, 1983
Jaber,1988
Johnson,1986
Supernumerary Nipples
14.5% have kidney and urinary tract
malformations (Varsano, 1984; Kenney, 1987; Mimouni,
1988; Ferrara, 2009)
Incidence of kidney
and urinary tract
malformations 30%
(Casey, 1996)
Supernumerary Nipples
Held magical powers
Sign of virility and
divine powers in men
Sign of a witch in women
To suckle the devil
IntraAreolar
Polythelia
May or may
not be fused
together
Each nipple
has own
duct system
(Onesti, 2008)
11
Knipple Knowledge
Usually
hereditary
(Abramson, 1975)
Often
unilateral
Affected
breast may
have larger
areola
(Lopez, 2006)
Nipple Reduction
12
Knipple Knowledge
Nipple and
Areola
Conditions
Problematic
for Latching
or Milk
Removal
Eczema on Nipple
Usually have a prior history of
allergies (Barankin, 2004)
Can include erythema (redness),
fluid-filled blisters, crusts, fissures,
scaling, friable skin
(Rago, 1988, Ward, 1997)
Nipple Galactocele
Eczema on Nipple
Can occur after introduction of solids
Inflammation creates opportunity for
staph infection
Common
Not contagious
NO FLAKING
13
Knipple Knowledge
Pagets Disease
medicalpicturesinfo.com/breastcancerpagets/
Psoriasis on Nipple
Thick, red skin
with flaky, silverwhite patches
(scales)
(Islam, 2000)
Itchy
Not contagious
Can cause
impetigo
vulgaris
Daily water and soap cleansing helps
destroy biofilm (staphs protective
barrier) (Ryan, 2007)
Story of
my client
14
Knipple Knowledge
Nipple Vasospasm
Nipple Squeeze
for Vasospasm
YELLOW
Bacteria
BRIGHTRED
Eczema/
Dermatitis
WHITE
Vasospasm
Nipple Bleb
Blocked nipple pore
Leading edge of plugged duct
Pinpoint pain, may radiate deep in
breast
TX:
Lancing with sterile needle
Hydrocortisone cream with occlusive
dressing (plastic wrap)
Massage
15
Knipple Knowledge
Congenital Polands
Syndrome
Absent nipple on one side
Absent chest muscle
Congenital Polands
Syndrome
Usually webbed fingers
(cutaneous syndactyly)
on same side hand
Severity varies
Congenital Polands
Syndrome
Incidence 1:10,000 - 1:100,000
births
3x more common in boys than
girls
Affects right side twice as often
as left
Nipple Warts
Nevoid hyperkeratosis of the nipple
and areola (NHNA)
Unilateral or bilateral
Asymptomatic
Unknown etiology, may be related to
estogen levels
(Verma, 2011)
16
Knipple Knowledge
Neurofibromatosis
Type I
(Verma, 2011)
Nipple Procedures
Problematic for Latching
or Milk Removal
Nipple Piercings
Recommended by doctors in
Victorian England to improve
breastfeeding
Pregnancy does not affect
(Armstrong, 2006)
Nipple Piercings
Milk may leak
through openings
No muscle to
close
Potential for
nerve damage
Areola Piercings
HIGH
Potential
for nerve
damage
(Garbin, 2009)
Reduced milk
ejection
reduced milk
production
17
Knipple Knowledge
Breast Tattoos
Nipple/Areola Injuries
THE END
Questions?
Thoughts?
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