Abstract
Background
The anatomy of the nipple has become clinically relevant. Diagnostic techniques access the breast through nipple ducts and surgeons offer nipple-sparing mastectomy. There is variation in the number of ducts reported and little is known about the spatial location of ducts, their size, and their relationship to orifices on the surface.
Methods
Nipple specimens were taken from 129 consecutive mastectomies. Each was sectioned coronally into 3 mm blocks and one section was prepared from each block. The number of ducts and cross-sectional areas of nipple and duct ‘bundle’ were recorded. Three nipples were sectioned at 50 μm intervals and digitally reconstructed in three dimensions.
Results
The median number of ducts was 23 (interquartile range 19–28). Reconstructions and summary data from 25 nipples show a central duct bundle narrowing to form a ‘waist’ as the ducts enter breast parenchyma. A three-dimensional reconstruction focusing on one nipple tip demonstrated 29 ducts arising from 15 orifices. Beneath the skin, most ducts are very narrow, gradually becoming larger deeper within the nipple.
Conclusions
This work demonstrates that many ducts share a few common openings onto the surface of the nipple, explaining the observed discrepancy between number of ducts and of orifices. Neither duct diameter nor position predicts whether a duct system will terminate close to the nipple or pass deeper into the breast. These new insights into nipple anatomy will be of use in considering the reliability of a ductal approach to diagnosis and in planning nipple-sparing mastectomy.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Cooper SAP (1840) On the anatomy of the breast. Longman, Orme, Green, Brown, Longmans, London
Taneri F, Kurukahvecioglu O, Akyurek N et al (2006) Microanatomy of milk ducts in the nipple. Eur Surg Res 38(6):545–9
Going JJ, Moffat DF (2004) Escaping from Flatland: clinical and biological aspects of human mammary duct anatomy in three dimensions. J Pathol 203(1):538–44
Love SM, Barsky SH (2004) Anatomy of the nipple and breast ducts revisited. Cancer 101(9):1947–57
Dooley WC (2000) Endoscopic visualization of breast tumors. JAMA 284(12):1518
Mokbel K, Escobar PF, Matsunaga T (2005) Mammary ductoscopy: current status and future prospects. Eur J Surg Oncol 31(1):3–8
Khan SA, Wiley EL, Rodriguez N et al (2004) Ductal lavage findings in women with known breast cancer undergoing mastectomy. J Natl Cancer Inst 96(20):1510–7
Brogi E, Robson M, Panageas KS et al (2003) Ductal lavage in patients undergoing mastectomy for mammary carcinoma: a correlative study. Cancer 98(10):2170–6
Slavin SA, Schnitt SJ, Duda RB et al (1998) Skin-sparing mastectomy and immediate reconstruction: oncologic risks and aesthetic results in patients with early-stage breast cancer. Plast Reconstr Surg 102(1):49–62
Ho CM, Mak CK, Lau Y et al (2003) Skin involvement in invasive breast carcinoma: safety of skin-sparing mastectomy. Ann Surg Oncol 10(2):102–7
Fersis N, Hoenig A, Relakis K et al (2004) Skin-sparing mastectomy and immediate breast reconstruction: incidence of recurrence in patients with invasive breast cancer. Breast 13(6):488–93
Cense HA, Rutgers EJ, Lopes Cardozo M et al (2001) Nipple-sparing mastectomy in breast cancer: a viable option? Eur J Surg Oncol 27(6):521–6
Petit JY, Veronesi U, Orecchia R et al (2003) The nipple-sparing mastectomy: early results of a feasibility study of a new application of perioperative radiotherapy (ELIOT) in the treatment of breast cancer when mastectomy is indicated. Tumori 89(3):288–91
Crowe JP, Jr. Kim JA, Yetman R et al (2004) Nipple-sparing mastectomy: technique and results of 54 procedures. Arch Surg 139(2):148–50
Petit JY, Veronesi U, Luini A et al (2005) When mastectomy becomes inevitable: the nipple-sparing approach. Breast 14(6):527–31
Going JJ (2006) Ductal-lobar organisation of human breast tissue, its relevance in disease and a research objective: vector mapping of parenchyma in complete breasts (the Astley Cooper project). Breast Cancer Res 8(4):107
Fiala JC (2005) Reconstruct: a free editor for serial section microscopy. J. Microsc 218(Pt 1):52–61
Lagios MD, Westdahl PR, Margolin FR et al (1982) Duct carcinoma in situ. Relationship of extent of noninvasive disease to the frequency of occult invasion, multicentricity, lymph node metastases, and short-term treatment failures. Cancer 50(7):1309–1314
Rosen PP, Tench W (1985) Lobules in the nipple. Frequency and significance for breast cancer treatment. Pathology annual 2(20 Pt):317–322
Ramsay DT, Kent JC, Hartmann RA et al (2005) Anatomy of the lactating human breast redefined with ultrasound imaging. J Anat 206(6):525–34
Going JJ, Mohun TJ (2006) Human breast duct anatomy, the ‘sick lobe’ hypothesis and intraductal approaches to breast cancer. Breast Cancer Res Treat 97(3):285–91
Acknowledgements
The authors would like to thank Patricia Della Pelle for her technical assistance.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Rusby, J.E., Brachtel, E.F., Michaelson, J.S. et al. Breast duct anatomy in the human nipple: three-dimensional patterns and clinical implications. Breast Cancer Res Treat 106, 171–179 (2007). https://doi.org/10.1007/s10549-006-9487-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10549-006-9487-2