Nipple Diameter Research Articles

The hyperplasia of the mammary gland effect of the Mongolian Remedy RuXian-I in rats reduced by estrogen and progesterone via inhibition of MAPK and NF-κB pathways

Background: The aim of the present study was to evaluate whether the HMG (Hyperplasia of the Mammary Gland) effect of RuXian-I in estrogen- and progestogen- induced HMG rats is mediated through the activation of MAPK (Mitogen activated protein kinase) and NF-κB signaling pathways. Materials and methods: Fifty virgin female Wistar rats were randomly divided into in control and HMG, RuXian-I (0.75 g·kg−1, 1.5 g·kg−1, 3 g·kg−1, respectively) groups, 10 in each. Injections of estrogen and progestogen were given to establish rat models of HMG and RuXian-I at the same time. Changes in nipple heights were measured; pathologic changes of HMG in rats were also observed under a light microscope; the phosphorylation levels of MAPK and NF κB and the expression levels of TNF-α and IL-1β were measured. Results: Compared with the control group, the nipple diameters and height were increased significantly, the numbers of MG lobules were increased, there were changes in breast histopathology, the levels of TNF-α and IL-1β increased significantly, and MAPK and NF-κB were activated in HMG rats. Compared with the HMG model group, the increased nipple height was decreased, the numbers of MG lobules were reduced, the degree of HMG in rats was alleviated obviously, and the phosphorylation level of MAPK and NF-κB and cytokines TNF- α and IL-1β levels in serum were decreased by RuXian-I treatment. Conclusion: Those results suggest RuXian-I has protective and therapeutic effects on HMG rats induced by estrogen and progestogen and is likely to activate MAPK and NF-κB signaling pathways.

Successful reconstruction using a de-epithelialized rectangular flap on a nipple necrosis site after DIEP flap-based breast reconstruction: a case report

Postmastectomy nipple necrosis is a factor that leads to a poor aesthetic outcome in breast reconstruction because of the unique projective structure of the nipple. We present a case of successful nipple reconstruction using a de-epithelialized rectangular flap. A 45-year-old woman was diagnosed with left breast cancer. She had a vertical scar below the nipple-areolar complex due to previous reduction mammoplasty. She underwent nipple-sparing mastectomy, breast reconstruction with a deep inferior epigastric artery perforator (DIEP) flap, and contralateral reduction. After the operation, the nipple gradually necrotized, and full-thickness nipple necrosis was observed on postoperative day 12. For nipple reconstruction, we designed a 38×23 mm rectangular flap from the DIEP flap considering the contralateral nipple diameter (12 mm), protrusion (2 mm), and ipsilateral mastectomy skin flap thickness (15 mm). The area in contact with the mastectomy skin flap was placed in the defect area after de-epithelialization. The reconstruction was successful and the nipple survived with a slight loss of projection. When unexpected nipple necrosis occurs after DIEP-based breast reconstruction, designing a de-epithelialized rectangular flap using the DIEP flap tissue is a feasible reconstructive method to consider.

Flange Sizing Recommendations for Frequent Breast Pump Use

IntroductionGuidance to assist in establishing a precise breast flange fit can be found in previously published nipple diameter research, case observations of pumping subjects, and in manufacturer’s flange-fit recommendations.MethodsThe nipple diameters of 11 exclusively pumping individuals were measured with either a standard ruler, ruler with a circular diameter, or coins, and variations were observed that required reconsideration of the flange size.ConclusionsGLactation professionals in practice need to consider variations in nipple diameter and systematic ways to measure nipples should be explored with exclusively or near-exclusively pumping individuals.

Nipple/Areola Dimensions in Early Breastfeeding.

Background: Nipple dimensions may be an important factor in breastfeeding (BF) initiation success. Objective: To establish standards of nipple/areola dimensions in early BF and to determine whether maternal age, gestational age (GA), parity, cup size, previous BF experience, and early (<2 hours) BF affect nipple dimensions (assessed on the second day of BF). Design/Methods: A total of 205 consecutive BF women were enrolled. They were all Caucasians, and had uncomplicated pregnancies, labors, and vertex vaginal deliveries. Measurements (immediately before and after BF) of nipple length and diameter and of prefeeding areolas were by sliding calipers. Results: In average, there were no significant differences between right (R) and left (L) side dimensions, except for post-BF nipple length, and post-BF horizontal nipple diameter (significantly higher on the L side). Both R and L nipple length correlated positively with maternal age, gravidity, parity, number of previously breastfed infants, and cumulative number of BF months. Early (<2 hours) first BF did not correlate with increased nipple length. Pre-BF nipple length correlated significantly with post-BF nipple length on both sides. There were significant differences between pre- and post- BF values in terms of nipple length (longer length post-BF), but not in terms of nipple diameter. In stepwise regression analysis, where pre-BF nipple length was the dependent variable, and parity (or maternal age, or previous BF), early first BF, and GA were independent variables, parity, maternal age, gravidity, or previous BF experience were positively and significantly associated with nipple length (p < 0.001). The correlation maternal age-nipple length remained significant in primigravida mothers. Conclusions: This study provided a set of standards for nipple and areola dimensions on day 2 of BF in Caucasian women. The only areola/nipple dimension significantly affected by BF is the nipple length. Increasing parity, maternal age, or previous BF experience is significantly associated with increased nipple length.

Impact of Nipple Properties on Coordination of Respiration and Swallowing in Infant Pigs

Coordination of respiration and swallowing in mammalian feeding is a tightly regulated process necessary for survival. It is particularly critical in infants owing to their immature development and associated elevation aspiration risk. Infant swallowing disorders are associated with abnormal swallow‐breathe patterns. Commercial nipples are often marketed as being able to regulate swallow‐respiration coordination to manage infant swallowing problems, however, a systematic analysis of what aspects of nipple design affect aerodigestive coordination has not been undertaken. We tested the impact of varying two parameters of nipple design, stiffness and nipple opening diameter, on the coordination of respiration and swallowing. We hypothesized that parameters associated with easier feeding (lower stiffness, larger hole diameter), would lead to more variable swallow respiration coordination as a result of increased frequency of swallowing. We designed and manufactured four test nipples representing all combinations of two stiffnesses and two diameters. Six infant pigs were trained to drink milk replacement formula mixed with barium on a nipple of intermediate stiffness and diameter to the experimental nipples. At six days of age, pigs were recorded using high speed (100 fps) videofluoroscopy suckling from each of the experimental nipples. We randomized the order in which the pigs drank from the nipples. We measured respiration using a plethysmograph placed around the thorax to record thoracic expansion and contraction, synchronized with the fluoroscope recording. We collected twenty swallows per nipple for each pig. We identified the time of each swallow from the videofluoroscopy, and the onset of each inspiration and expiration cycle from the plethysmograph trace. For each swallow, we calculated the delay between the swallow and the closest onset of inspiration. For each breath cycle, we calculated length of the breath cycle as well as the number of swallows occurring the cycle. We used linear mixed models, with individual as a random factor, for all analyses. We tested the effect of stiffness, diameter, and their interaction on swallow‐inspiration delay, and the effect of nipple type and number of swallows during a respiration cycle on duration of respiratory phases. Swallow inspiration delay was lower for large diameter nipples than small diameter nipples regardless of stiffness (diameter F(1,351)=7.6, p=0.006). Both nipple type (F(3,644.02)=4.8, p=0.003) and swallow number (F(3,656.31)=19.5, p&lt;0.001) had a significant effect on respiratory duration length. Larger diameter nipples resulted in shorter respiratory cycle lengths, but the more swallows in a respiratory cycle, the longer that cycle was. Both coordination of individual swallows with respiration, and overall respiratory patterns during feeding, changed in response to changing nipple diameter, but not stiffness. However, this was strongly linked to the number of swallows occurring in a respiratory cycle, suggesting that understanding how nipple properties affect frequency and distribution of swallows in the feeding sequence may be key to understanding how milk delivery affects aerodigestive coordination in infant feeding.

Effect of vitamin D3 on hyperplasia of mammary glands in experimental rats.

1,25(OH)2D3/vitamin D3 receptor (VD3/VDR) signaling pathway can inhibit the occurrence of breast cancer in many ways. We used vitamin D3 to interfere with Hyperplasia of mammary glands (HMG) model rats, and to explore the intervention effect of vitamin D3 on HMG. We divided 42 female rats into six groups randomly: blank control group, hyperplasia model group, negative control group, and vitamin D3 (VD3) groups of low-dose (LVD, 5 µg/kg), medium-dose (MVD, 10 µg/kg), and high-dose (HVD, 20 µg/kg). We established HMG model in all groups except for the blank control group, then different dose of VD3 was intraperitoneal injected for VD3 groups and normal saline (NS) was given to the negative control group. After the experiment, the body weights, heights and diameters of nipples, and the thickness of the mammary gland of rats were measured. The serum content of sex hormone and VD3 were detected by enzyme-linked immunosorbent assay (ELISA). The tissues of mammary glands were analyzed by hematoxylin and eosin (HE) stain, and the expression of estrogen receptor α (ERα), progesterone receptor (PR), and VDR were detected by immunohistochemical (IHC) stain. Similarly, the total protein expression of ERα, PR, and VDR were measured by western blot. Compared with the hyperplasia group, rats in the VD3 groups displayed a marked decrease of the thickness of the mammary glands and the height and diameter of the nipples. The serum estrogen (E2), testosterone (T), luteinizing hormone (LH), and VD3 was markedly decreased in all VD3 groups (P<0.05). The IHC results showed that ERα and PR was decreased in all three VD3 groups; however, VDR was increased. Western blot demonstrated that both ERα and PR were reduced in VD3 groups, while the VDR level was significantly enhanced. Overall, the findings suggested that VD3 could be used in HMG treatment. Supplementation of VD3 could markedly decrease the mammary gland thickness, nipple diameter, and nipple height of rats, accompanied by the decrease of serum E2, T, and LH. Intervention with VD3 can lead to decreased expression of ERa and PR, in conjunction with the increase of VDR.

Comparative study on the pharmacodynamic difference of oral administration of Xiaojin Pills accompanied with Chinese Baijiu and water

Ethnopharmacological relevanceXiaojin Pills is a classic prescription for the treatment of mammary glands hyperplasia with a history of nearly 300 years, and is also the first choice of Chinese patent medicine for the clinical treatment of mammary glands hyperplasia in contemporary traditional Chinese medicine clinic. Clinical and animal studies have shown that Xiaojin Pills has the effects of anti-mammary glands hyperplasia, promoting blood circulation, anti-inflammation and analgesia. However, its initial administration method was “taking orally after soaked with Chinese Baijiu”, the modern method was changed to “taking orally with water” in recent 20 years. Whether there is any difference in the efficacy of the two administration methods is still unknown. Aim of the studyTo reveal the difference in efficacy and metabolic mechanism of anti-mammary gland hyperplasia between the oral administration of Xiaojin Pills accompanied with Chinese Baijiu (XJP&B) and water (XJP&W). Materials and methodsCOX-2 inhibition rate test and anti-platelet aggregation activity test were used to investigate the efficacy difference between the 40 vol% Chinese Baijiu and water extracts of Xiaojin Pills on anti-inflammatory and blood-activating in vitro. Kunming male mice (20 ± 5 g) and SD female rats (200–220 g) were orally treated with XJP&B and XJP&W, respectively. Then the difference in anti-inflammatory and analgesic effects between XJP&B and XJP&W were evaluated via xylene-induced ear swelling test, formaldehyde-induced pain test, and acetic acid-induced writhing test in mice. Determination of nipple diameter, pathological examination of mammary gland tissue, determination of serum E2, P and FSH content and hemorheological parameters of rats with mammary gland hyperplasia were performed to explore the efficacy difference in anti-mammary gland hyperplasia between XJP&B and XJP&W. Metabolomics was used to study the difference of anti-mammary gland hyperplasia mechanism between XJP&B and XJP&W. ResultsThe results showed that the effect of XJP&B was superior to that of XJP&W in anti-platelet aggregation, inhibition of inflammation and pain, and anti-mammary gland hyperplasia. Interestingly, the advantages were more significant under low-dose condition. In addition, the mechanism of the two combinations against mammary gland hyperplasia was indeed different. Their common metabolic pathways include tryptophan metabolism and alanine, aspartic acid and glutamic acid metabolism. However, Chinese Baijiu and XJP&B also have additional regulatory effects on linoleic acid metabolic pathway. ConclusionIn brief, this research demonstrated that the efficacy of XJP&B was better than that of XJP&W in activating the blood, anti-inflammation, analgesia and anti-mammary gland hyperplasia, which means that XJP&B has synergistic and superior effects. The special dose-effect relationship under the condition of XJP&B was also found, laying the foundation for clinical treatment to reduce the dosage and shorten the medication cycle, which is beneficial to reduce the economic burden of patients.

Correlation of udder shape, size and udder size of Bushuev breed of cows with milk yield

This article examines the relationship between the shape, size and size of the udder and udder of Bushuev cows on different categories of farms and their milk yield. It was determined that the milk yield of cows belonging to the form of bowl-shaped udder in all farms was higher from 720.9 kg to 641.8 kg than their peers belonging to the form of round udder. In comparison, the udder of cows with a cup-shaped udder was 3.3 cm to 2.2 cm wider, the udder length was 9.1 cm to 7.8 cm longer, and the udder circumference was 6.3 to 8.7 cm bigger, the udder depth was 1.6 cm to 2.7 cm longer, and the nipple diameter was higher 0.06 cm to 0.35 cm, than the udder of cow belonging to a round udder. It was found that the daily milk yield in bowl-shaped udder cows was 29.3% to 25.4% higher than in their round udder-like counterparts.

PSVII-20 Heat stress alters reproductive phenotypic impacts of Zearalenone in pre-pubertal gilts

Abstract Zearalenone (ZEA) is an estrogenic mycotoxin produced by strains of Fusarium and is often inadvertently consumed via feed contamination. Heat stress (HS) occurs when heat accumulation exceeds heat dissipation resulting in increased body temperature. Independently, HS and ZEA cause swine reproductive dysfunction such as delayed puberty onset, altered circulating steroid hormones and irregular estrous cycles. During HS, gilts become hyperinsulinemic and insulin regulates hepatic and ovarian chemical metabolism. We hypothesized that during HS, ZEA-induced alterations to reproductive parameters are heightened such that HS is additive to ZEA-induced reproductive toxicity. Prepubertal crossbred gilts (n = 38) were randomly assigned to six treatment groups: thermal neutral (TN) ad libitum fed controls (TNCT; n = 6); TN + ZEA (2 ppm; TNZ; n = 6); pair-fed (PF) control (PFCT; n = 6); PF + ZEA (2 ppm; PFZ; n = 6); cyclical HS control (HSCT; n = 7); and HS + ZEA (2 ppm; HSZ; n = 7) for 7 d. Ovarian and uterine weights (g) were measured, and nipple and vulva diameters (l × w; mm2) were assessed by digital calipers. Ovarian weight was decreased (P = 0.04) in the PFZ relative to PFCT, but ZEA did not affect ovarian weight in the other groups (P &amp;gt; 0.73). There was no impact of ZEA exposure on uterine weight (P &amp;gt; 0.22) or nipple diameter (P &amp;gt; 0.51) in any treatment groups, respectively. There was no effect of ZEA on vulva size in either of the TN groups; however, vulva diameter increased (P = 0.04) in the HSZ relative to HSCT. These data suggest that HS exaggerates some ZEA-induced phenotypic effects in prepubertal gilts. This project was supported by the Iowa Pork Producers Association.

Nipple Dimensions After Augmentation Mammoplasty, Mastopexy and Reduction Mammoplasty: A Comparative Clinical Study.

Nipple hypertrophy is a rare aesthetic problem. Ideal nipple dimensions are 6-8mm, while nipples larger than 10mm are considered hypertrophic. A total of 24 female patients, aged between 22 and 53years, with a nipple diameter or height greater than 10mm, underwent augmentation mammoplasty (AM), augmentation mastopexy (AUM) and reduction mammoplasty (RM) operations. The patients were divided into three groups according to the type of surgery containing equal numbers of patients. Group I underwent AM, Group II underwent AUM and Group III underwent RM surgery. Preoperative and 1-year post-operative nipple dimension measurements were performed, and the results were compared. There was no significant difference between the preoperative nipple volumes among the groups (p > 0.05). There was no significant difference between preoperative and post-operative nipple volumes in Group I (p > 0.05). The difference between preoperative and post-operative nipple volumes in Group II and Group III was significant (p < 0.05). When post-operative dimension comparisons were taken into consideration, there was a significant difference between Group I compared to Group II and Group III (p < 0.05); however, the difference between Group II and Group III was not significant (p > 0.05). Since there will be no reduction in nipple size during the post-operative period in AM patients, hypertrophic nipple can be reduced in the same session. However, in patients with AUM or RM, if the reduction in nipple size is not sufficient, it is more convenient to perform the nipple reduction operation 1-year post-surgery. 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 .

Associations Between Variations in Breast Anatomy and Early Breastfeeding Challenges.

Mothers with anatomic variability (e.g., shorter, wider nipples; denser areolas) may experience breastfeeding challenges disproportionately. To examine whether variations in breast anatomy are associated with risk for early breastfeeding challenges. Participants included mothers < 6 weeks postpartum. Nipple base width, nipple length, and areolar density were measured on the right and left breast separately. Experiences with early breastfeeding challenges were determined through a combination of maternal report and clinical assessment. Participants (N = 119) had an average nipple diameter of 23.4 (SD = 3.0) mm for left nipples and 23.5 (SD = 3.0) mm for right nipples (range = 10-34 mm). Average nipple length was 8.5 (SD = 3.2) mm for left breasts and 9.1 (SD = 3.2) mm for right breasts (range = 5-20 mm); 35% of participants had dense areolas on the left breast and 36% had dense areolas on the right breast. The combination of wider and longer nipples was associated with greater risk for difficulties with latch; the combination of wider nipples and denser areolas was associated with greater risk for sore nipples. For participants with more dense areolas, shorter and wider nipples were associated with greater risk for low milk supply and slow infant weight gain. For participants with less dense areolas, longer and wider nipples were associated with greater risk for low milk supply and slow infant weight gain. Further research is needed to understand how measures of breast anatomy can be used to guide targeted intervention efforts.

Therapeutic Effect of Mongolian Medicine RuXian-I on Hyperplasia of Mammary Gland Induced by Estrogen/Progesterone through CRYAB-Promoted Apoptosis.

The traditional Mongolian medicine (TMM) RuXian-I is an empirical formula specifically used for treating the hyperplasia of mammary gland (HMG) in clinic based on the principles of traditional Mongolian medicine, but the treatment mechanism is not completely clear. In this paper, we elaborated the mechanism of RuXian-I in the treatment of HMG induced by estrogen and progestogen from its toxicity and activity. Firstly, RuXian-I exhibited no toxic effect on HMG rats through no changes of body weight and food intake measurement and no pathologic changes of the organs (heart, liver, spleen, lung, and kidney) detected. Secondly, RuXian-I could decrease the increased nipple height and diameter and remarkably relieve the pathologic changes of HMG rats and also alleviate serum sex hormone levels (estradiol (E2), luteinizing hormone (LH), progesterone (P), and testosterone (T)) of HMG rats. Finally, RuXian-I could obviously inhibit the upregulation level of antiapoptotic protein CRYAB of HMG rats and promote mammary gland cell apoptosis of HMG rats via increases of promoting apoptosis protein caspases-3, 8, and 9 and Bax and tumor suppressor protein p53, decreases of antiapoptosis protein Bcl-2, and release of cytochrome c. These results suggested that RuXian-I has protective and therapeutic effects on HMG rats induced by estrogen and progestogen possibly via promoting apoptotic pathway regulated by CRYAB and is a promising agent for treating HMG.

Влияние конструкционных параметров на тепловые процессы в дутьевом канале воздушной фурмы доменной печи

Ansys Fluent 18.2 software was used to simulate PAO NLMK air tuyere functioning. It was established that 5 degrees hot air feed angle and 22 mm inner nipple diameter for natural gas feeding are rational. It was recom-mended to increase coal dust fuel feed angle till 20 degrees, to decrease dis-tance between natural gas nipple and flange till 30 mm.

The rule of thirds: Determining the ideal areolar proportions

BackgroundBreast surgery often requires changing the diameter of the areola. Recommended areolar size is commonly based on population averages, or surgical judgement. An ideal areola size has not been previously been described. We hypothesized that the ideal areolar diameter would be proportional to two breast measurements not commonly altered during breast surgery: the nipple diameter and breast base width. Methods‘The Sun’ newspaper (London, UK) publishes photographs of topless models which are selected based on the aesthetic appeal of their non-operated breasts. The publication's archive, from March 2014 to January 2017, was independently reviewed by three authors to identify photographs that presented a clear anterior view of the breast. The base width, nipple diameter and areolar diameter were measured independently by each reviewer. Measurements were pooled, and the mean was included for analysis. Ratios of the areolar diameter to the base width and the nipple diameter were calculated. ResultsThe photographs of 58 models were eligible for inclusion. The average areolar diameter to base width was 0.29 (SD = 0.05). The average nipple to areolar diameter was 0.29 (SD = 0.06). ConclusionsIn aesthetically pleasing breasts, the areolar diameter is proportional to both the breast base width and nipple diameter. Breast base width is commonly measured preoperatively in aesthetic breast procedures, and is not typically modified. Breast base width can therefore be used to determine the ideal areolar size using the ratio of areola:base width ratio of 0.29 identified in this study.

Breastfeeding Difficulties, Breastfeeding Duration, Maternal Body Mass Index, and Breast Anatomy: Are They Related?

Objective: We examined the influence of maternal body mass index (BMI), and of breast and nipple anatomic variations, on breastfeeding difficulties and duration. Methods: In this prospective observational study, we collected demographic and anthropometric data from 109 mothers of full-term newborns. Women were classified as underweight, normal weight, overweight, and obese using the World Health Organization definitions and were otherwise healthy. Breast anthropometrics assessments were recorded after delivery and during hospitalization. Latching difficulties were collected as reported by the mothers. Breastfeeding duration was assessed by phone interview at 3, 6, 1 year, or more postdelivery. Results: The four prepregnancy BMI groups included 12 underweight, 59 normal weight, 20 overweight, and 18 obese women. The higher the BMI group, the larger the breast was (p = 0.005). In univariate regression, nipple diameter, nipple length, and areola diameter correlated significantly with breast size. The overall rate of latching difficulties was 15.5%, without significant differences among all four BMI groups. In multivariate analysis, the higher the BMI group the lower was the likelihood of breastfeeding at 6 months of age (odds ratio [OR] = 0.88, 95% confidence interval [CI]: 0.79-0.99), and the higher the birth order the higher was the likelihood of breastfeeding at 6 months of age (OR = 3.36, 95% CI: 1.44-7.83). Early latching difficulties predicted shorter breastfeeding duration. Conclusion: We conclude that high prepregnancy BMI has a negative impact on breastfeeding initiation and duration.

Efficacy of moxibustion by stimulating acupoints of Danzhong (CV 17) and Ganshu (BL 18) on hyperplasia of mammary gland in rats

OBJECTIVETo evaluate the efficacy of moxibustion, through stimulating acupoints of Danzhong (CV 17) and Ganshu (BL 18) in rats with hyperplasia of mammary gland (HMG) which induced by estrogen and progestogen. METHODSThirty female Sprague-Dawley rats were randomly divided into saline control group, HMG model group, and HMG moxibustion group with 10 in each group. Saline control was the group injected by saline. HMG model were created by injection of estrogen and progestogen. Moxibustion group was also injected of estrogen and progestogen with moxibustion at the same time. The Changes of nipple diameter and height were measured. The rats’ skin temperature was recorded by an infrared thermal camera at the nipples, mammary areas, Danzhong (CV 17) and Ganshu (BL 18). Pathological changes of mammary gland in rats were also observed under light microscope. RESULTSThe diameter and height of the nipples in model group were prominently bigger and higher than that in control group (P < 0.01). The diameter and height in moxibustion group were prominently smaller and lower than that in model group (P < 0.01), and there was no significant difference between moxibustion group and control group. Compared with control group, skin temperature of the nipples, mammary area, and acupoints Danzhong (CV 17) and Ganshu (BL 18) decreased prominently in model group (P < 0.01-0.05). Compared with model group, skin temperature of that in moxibustion group increased prominently (P < 0.05). CONCLUSIONTreatment with moxibustion can effectively decrease the HMG rats’ nipple diameter and height, and increase the skin temperature in HMG model rats at the nipples, mammary areas, Danzhong (CV 17) and Ganshu (BL 18). This study convinces the therapeutic effect of moxibustion on mammary gland hyperplasia.

Modified S-Flap for Nipple Reconstruction.

Nipple reconstruction is an important last step in the process of autologous or implant-based breast reconstruction. A multitude of techniques have been described, among others the S-flap. To prevent nipple retraction after surgery, we modified the originally described method by Cronin. By adding an S-shaped incision line, the flap can be transposed with less tension and sutured on top of the new nipple along a curved line. Furthermore, two small triangular flaps were inserted at the base for reinforcement and reduced linear contraction. Assessment was completed by measuring nipple diameter and projection with a caliper. A total of 16 patients underwent the technique, of whom 11 could be followed after 3 and 6months. Overall patient satisfaction with the aesthetic result was high, and we observed no infection or necrosis. Nipples were stable in size and shape at 6months. Although reduction of 68% in projection and 31% in diameter was observed, the nipples remained pleasantly similar to the contralateral non-operated side. The modified S-flap is a simple and reliable technique for moderate-sized nipple reconstruction. By providing more tissue at the base, size and projection remain stable and durable. Moreover, by a modified linear incision line at the base, tension and subsequent scar contraction is minimal. 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 .

The 4-flap Jester's Hat Technique for Nipple Reduction.

Macrothelia, or nipple hypertrophy, is a condition that may cause severe psychological distress to those who suffer from it. Although effective in their primary goal of reducing nipple diameter and projection, previously reported techniques in nipple reduction suffer from imperfect aesthetic outcomes with noticeable scarring patterns, anatomically anomalous shape, and a smoothing of the natural ruffles of the nipple. We propose a simple technique to nipple reduction that improves upon previous techniques and creates a more naturally appearing nipple. A 4-flap technique resembling a jester's hat is described whereby suture lines are concealed within the central nipple to recreate the naturally ruffled appearance of a native nipple. Four patients have undergone this technique at a single institution with 100% patient satisfaction and no postoperative complications. Nipple sensation was maintained in all patients postoperatively. A 4-flap nipple reduction technique is a viable alternative to previously described techniques, which may offer more anatomically congruent results.

Persistent Nipple Pain in Breastfeeding Mothers Associated with Abnormal Infant Tongue Movement.

Background: Infants of breastfeeding mothers with persistent nipple pain have been shown to apply stronger vacuums to the breast and transfer less milk during one monitored feed. This may be associated with differences in the movement of the tongue. The aim was to analyse the intra-oral nipple shape and movement of the tongue of infants of mothers with and without nipple pain. Methods: Breastfeeding infants of mothers with or without nipple pain were monitored using ultrasound and intra-oral vacuum during one breastfeed. From cine clips of the ultrasound scans measurements were made of the depth of the intra-oral space between the hard-soft palate junction (HSPJ) and the mid-tongue; the distance of the tip of the nipple to the HSPJ; and nipple diameters from the tip to the base. Results: During nutritive sucking, tongue movements of infants of mothers with nipple pain resulted in a smaller intra-oral space (p = 0.040) and restricted nipple expansion compared to controls (p < 0.012). Stronger baseline and peak vacuums compared to controls were confirmed (p = 0.002). Conclusion: In these mothers, nipple pain was associated with restricted infant tongue movement. Ultrasound may complement measurement of intra-oral vacuum in monitoring treatment strategies in breastfeeding women experiencing nipple pain.

Male Nipple Reduction With a Simple Circular-Flap Technique

Nipple shape is crucial to the aesthetic appearance of the entire breast. Nipple hypertrophy, caused by congenital or acquired factors, affects the overall shape of the breast, which may lead to a severe lack of self-confidence.1 Although it is relatively rare, male nipple hypertrophy has a serious psychological impact on patients. In most cases, male nipples are usually smaller in both diameter and projection than female. The purpose of nipple reduction is to reduce the diameter and height of the nipple by removing part of the tissue. Quite a few nipple reduction techniques have been reported for nipple hypertrophy.2-5 Marshall et al6 treated nipple hypertrophy by excision of central nipple tissue, Basile and Chang7 removed the core nipple tissue by forming a complex triangular flap, and Jin and Lee8 reduced the nipple diameter by wedge resection of the nipple tissue and by reducing the height using loop excision of the base skin. These surgical methods undoubtedly offer excellent outcomes. However, one problem is the relatively complex surgical design.3 Flaps were used in these techniques. It is more difficult to perform such complex surgical operations on a male nipple with a relatively small size. As reported below, an ideal surgical outcome was achieved in the treatment of male nipple hypertrophy in our center with the use of a simple circular-flap technique. Reducing the height of the nipple is also …