Skip to main content

Nipples: A Sensitive Topic

  • Chapter
  • First Online:

Abstract

Nipples are specialized structures through which milk, that is produced in the breast, is delivered to breastfeeding mammals. Both males and females have nipples, however in males nipples are vestigial structures. Since women’s nipples are sexualized, and therefore censored, their important role in breastfeeding is neglected by medical textbooks and relegated to Nursing and Lactation Consultants literature

This chapter aims to familiarise medical practitioners with pathology of the nipple and the various conditions that may cause discomfort during breastfeeding. Effective treatment often involves cooperation between medical practitioners, lactation consultants, and other health professionals.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   219.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   279.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   379.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Montagna W, Macpherson EE. Some neglected aspects of the anatomy of human breasts. J Investig Dermatol. 1974;63(1):10–6.

    Article  CAS  PubMed  Google Scholar 

  2. Lawrence RA, Lawrence RM. Breastfeeding: a guide for the medical professional. Philadelphia: Elsevier; 2010.

    Google Scholar 

  3. Schlenz I, Kuzbari R, Gruber H, Holle J. The sensitivity of the nipple-areola complex: an anatomic study. Plast Reconstr Surg. 2000;105(3):905–9.

    Article  CAS  PubMed  Google Scholar 

  4. Standring S, Ellis H, Healy J, Johnson D, Williams A, Collins P, et al. Gray’s anatomy: the anatomical basis of clinical practice. Am J Neuroradiol. 2005;26(10):2703.

    Google Scholar 

  5. Mortazavi SN, Geddes D, Hassiotou F, Hassanipour F. Mathematical analysis of mammary ducts in lactating human breast. In: 2014 36th annual international conference of the ieee engineering in medicine and biology society (EMBC). IEEE; 2014.

    Google Scholar 

  6. Geddes DT. Inside the lactating breast: the latest anatomy research. J Midwifery Womens Health. 2007;52(6):556–63.

    Article  PubMed  Google Scholar 

  7. Rusby JE, Brachtel EF, Michaelson JS, Koerner FC, Smith BL. Breast duct anatomy in the human nipple: three-dimensional patterns and clinical implications. Breast Cancer Res Treat. 2007;106(2):171–9.

    Article  PubMed  Google Scholar 

  8. Walker M. Breastfeeding management for the clinician. 4th ed. Burlington: Jones & Bartlett Learning; 2017.

    Google Scholar 

  9. Tezer M, Ozluk Y, Sanli O, Asoglu O, Kadioglu A. Nitric oxide may mediate nipple erection. J Androl. 2012;33(5):805–10.

    Article  CAS  PubMed  Google Scholar 

  10. Koyama S, Wu HJ, Easwaran T, Thopady S, Foley J. The nipple: a simple intersection of mammary gland and integument, but focal point of organ function. J Mammary Gland Biol Neoplasia. 2013;18(2):121–31.

    Article  PubMed  Google Scholar 

  11. Komisaruk BR, Wise N, Frangos E, Liu WC, Allen K, Brody S. Women’s clitoris, vagina, and cervix mapped on the sensory cortex: fMRI evidence. J Sex Med. 2011;8(10):2822–30.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Masters WH, Johnson VE. Human sexual response. Bronx, NY: Ishi Press; 2010. xiii, 366pp.

    Google Scholar 

  13. Lawrence RA, Lawrence RM. Breastfeeding e-book: a guide for the medical professional. Philadelphia: Elsevier; 2015.

    Google Scholar 

  14. Beer T. Social construction of the body: the nipple. Sociology toolbox. 2016. https://thesocietypages.org/toolbox/social-construction-of-the-body/.

  15. Battersby S. Not in public please: breastfeeding as dirty work in the UK. In: Exploring the dirty side of women’s health. London: Routledge; 2007. p. 101–14.

    Google Scholar 

  16. Henderson L, McMillan B, Green JM, Renfrew MJ. Men and infant feeding: perceptions of embarrassment, sexuality, and social conduct in white low-income British men. Birth. 2011;38(1):61–70.

    Article  PubMed  Google Scholar 

  17. Wilson MG, Hall EB, Ebbin AJ. Dominant inheritance of absence of the breast. Humangenetik. 1972;15(3):268–70.

    CAS  PubMed  Google Scholar 

  18. Finlay A, Marks R. An hereditary syndrome of lumpy scalp, odd ears, and rudimentary nipples. Br J Dermatol. 1978;99(4):423–30.

    Article  CAS  PubMed  Google Scholar 

  19. Pellegrino JE, Schnur RE, Boghosian-Sell L, Strathdee G, Overhauser J, Spinner NB, et al. Ablepharon macrostomia syndrome with associated cutis laxa: possible localization to 18q. Hum Genet. 1996;97(4):532–6.

    Article  CAS  PubMed  Google Scholar 

  20. Evers ME, Steijlen PM, Hamel BC. Aplasia cutis congenita and associated disorders: an update. Clin Genet. 1995;47(6):295–301.

    Article  CAS  PubMed  Google Scholar 

  21. Martı́nez-Chéquer JC, Carranza-Lira S, López-Silva JD, Mainero-Ratchelous F, Zenteno JC. Congenital absence of the breasts: a case report. Am J Obstet Gynecol. 2004;191(1):372–4.

    Article  PubMed  Google Scholar 

  22. Javed A, Lteif A. Development of the human breast. In: Seminars in plastic surgery. New York: Thieme; 2013.

    Google Scholar 

  23. Robinson GW. Identification of signaling pathways in early mammary gland development by mouse genetics. Breast Cancer Res. 2004;6(3):105–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Koltuksuz U, Aydin E. Supernumerary breast tissue: a case of pseudomamma on the face. J Pediatr Surg. 1997;32(9):1377–8.

    Article  CAS  PubMed  Google Scholar 

  25. Conde DM, Kashimoto E, Torresan RZ, Alvarenga M. Pseudomamma on the foot: an unusual presentation of supernumerary breast tissue. Dermatol Online J. 2006;12(4):7.

    PubMed  Google Scholar 

  26. Schmidt H. Supernumerary nipples: prevalence, size, sex and side predilection–a prospective clinical study. Eur J Pediatr. 1998;157(10):821–3.

    Article  CAS  PubMed  Google Scholar 

  27. Kajava Y. The proportions of supernumerary nipples in the Finnish population. Duodecim. 1915;1(1):143–70.

    Google Scholar 

  28. Minić S, Trpinac D, Obradović M. Incontinentia pigmenti diagnostic criteria update. Clin Genet. 2014;85(6):536–42.

    Article  PubMed  Google Scholar 

  29. Landauer W. Supernumerary nipples, congenital hemihypertrophy and congenital hemiatrophy. Hum Biol. 1939;11(4):447–72.

    Google Scholar 

  30. Gurrieri F, Cappa M, Neri G. Further delineation of the Simpson-Golabi-Behmel (SGB) syndrome. Am J Med Genet. 1992;44(2):136–7.

    Article  CAS  PubMed  Google Scholar 

  31. Urbani CE, Betti R. Accessory mammary tissue associated with congenital and hereditary nephrourinary malformations. Int J Dermatol. 1996;35(5):349–52.

    Article  CAS  PubMed  Google Scholar 

  32. Urbani CE, Betti R. Aberrant mammary tissue and nephrourinary malignancy: a man with unilateral polythelia and ipsilateral renal adenocarcinoma associated with polycystic kidney disease. Cancer Genet Cytogenet. 1996;87(1):88–9.

    Article  CAS  PubMed  Google Scholar 

  33. Cohen P. The significance of familial polythelia-reply. St. Louis: Mosby; 1995. p. 688.

    Google Scholar 

  34. Obayashi H, Tsuchida T, Ikeda S. Hyperkeratosis of the nipple and areola. Rinsho Dermatol. 1998;40:147–50.

    Google Scholar 

  35. Vestey JP, Bunney MH. Unilateral hyperkeratosis of the nipple: the response to cryotherapy. Arch Dermatol. 1986;122(12):1360–1.

    Article  CAS  PubMed  Google Scholar 

  36. Özcan M, Özüntürk E, Kahveci R. Congenital mamillary hyperkeratosis—a case report. Eur J Plast Surg. 1987;9(4):179–80.

    Article  Google Scholar 

  37. Perez-Izquierdo JM, Vilata JJ, Sanchez JL, Gargallo E, Millan F, Aliaga A. Retinoic acid treatment of nipple hyperkeratosis. Arch Dermatol. 1990;126(5):687–8.

    Article  CAS  PubMed  Google Scholar 

  38. Bayramgurler D, Bilen N, Apaydin R, Ercin C. Nevoid hyperkeratosis of the nipple and areola: treatment of two patients with topical calcipotriol. J Am Acad Dermatol. 2002;46(1):131–3.

    Article  PubMed  Google Scholar 

  39. Mazzella C, Costa C, Fabbrocini G, Marangi GF, Russo D, Merolla F, et al. Nevoid hyperkeratosis of the nipple mimicking a pigmented basal cell carcinoma. JAAD Case Rep. 2016;2(6):500–1.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Nambi R. Hyperkeratosis of nipple and areola. 2017. http://emedicine.medscape.com/article/1107107-overview#a4.

  41. Schwartz RA. Acanthosis nigricans. J Am Acad Dermatol. 1994;31(1):1–19; quiz 20-2.

    Article  CAS  PubMed  Google Scholar 

  42. Higgins SP, Freemark M, Prose NS. Acanthosis nigricans: a practical approach to evaluation and management. Dermatol Online J. 2008;14(9):2.

    PubMed  Google Scholar 

  43. Ances IG. Serum concentrations of epidermal growth factor in human pregnancy. Am J Obstet Gynecol. 1973;115(3):357–62.

    Article  CAS  PubMed  Google Scholar 

  44. Ellis DL, Nanney LB, King LE Jr. Increased epidermal growth factor receptors in seborrheic keratoses and acrochordons of patients with the dysplastic nevus syndrome. J Am Acad Dermatol. 1990;23(6 Pt 1):1070–7.

    Article  CAS  PubMed  Google Scholar 

  45. Shamsadini S, Wadji MB, Shamsadini A. Surrounding ipsilateral eruptive seborrheic keratosis as a warning sign of intraductal breast carcinoma and Paget’s disease (Leser Trelat sign). Dermatol Online J. 2005;12(6):27.

    Google Scholar 

  46. Schwartz RA. Sign of Leser-Trélat. J Am Acad Dermatol. 1996;35(1):88–95.

    Article  CAS  PubMed  Google Scholar 

  47. Haagensen C. Mammary-duct ectasia. A disease that may simulate carcinoma. Cancer. 1951;4(4):749–61.

    Article  CAS  PubMed  Google Scholar 

  48. Dixon JM, Mansel RE. ABC of breast diseases. Congenital problems and aberrations of normal breast development and involution. BMJ. 1994;309(6957):797–800.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Hidano A, Kobayashi T. Adnexal polyp of neonatal skin. Br J Dermatol. 1975;92(6):659–62.

    Article  CAS  PubMed  Google Scholar 

  50. Brownstein MH, Phelps RG, Magnin PH. Papillary adenoma of the nipple: analysis of fifteeen new cases. J Am Acad Dermatol. 1985;12(4):707–15.

    Article  CAS  PubMed  Google Scholar 

  51. Montemarano AD, Sau P, James WD. Superficial papillary adnomatosis of the nipple: a case report and review of the literature. J Am Acad Dermatol. 1995;33(5:871–5.

    Article  Google Scholar 

  52. Van Mierlo PL, Geelen GM, Neumann HA. Mohs micrographic surgery for an erosive adenomatosis of the nipple. Dermatol Surg. 1998;24(6):681–3.

    Article  PubMed  Google Scholar 

  53. Kuflik EG. Erosive adenomatosis of the nipple treated with cryosurgery. J Am Acad Dermatol. 1998;38(2 Pt 1):270–1.

    Article  CAS  PubMed  Google Scholar 

  54. Ashikari R, Park K, Huvos AG, Urban JA. Paget’s disease of the breast. Cancer. 1970;26(3):680–5.

    Article  CAS  PubMed  Google Scholar 

  55. Sahoo S, Green I, Rosen PP. Bilateral Paget disease of the nipple associated with lobular carcinoma in situ: application of immunohistochemistry to a rare finding. Arch Pathol Lab Med. 2002;126(1):90–2.

    PubMed  Google Scholar 

  56. Laumann AE, Derick AJ. Tattoos and body piercings in the United States: a national data set. J Am Acad Dermatol. 2006;55(3):413–21.

    Article  PubMed  Google Scholar 

  57. Armstrong ML, McConnell C. Tattooing in adolescents: more common than you think—the phenomenon and risks. J Sch Nurs. 1994;10(1):26–33.

    CAS  PubMed  Google Scholar 

  58. Carroll ST, Riffenburgh RH, Roberts TA, Myhre EB. Tattoos and body piercings as indicators of adolescent risk-taking behaviors. Pediatrics. 2002;109(6):1021–7.

    Article  PubMed  Google Scholar 

  59. Pugatch D, Mileno M, Rich JD. Possible transmission of human immunodeficiency virus type 1 from body piercing. Clin Infect Dis. 1998;26(3):767–8.

    Article  CAS  PubMed  Google Scholar 

  60. Ochsenfahrt C, Friedl R, Hannekum A, Schumacher BA. Endocarditis after nipple piercing in a patient with a bicuspid aortic valve. Ann Thorac Surg. 2001;71(4):1365–6.

    Article  CAS  PubMed  Google Scholar 

  61. Collins RE. Breast disease associated with tassel dancing. Br Med J (Clin Res Ed). 1981;283(6307):1660.

    Article  CAS  Google Scholar 

  62. Garbin CP, Deacon JP, Rowan MK, Hartmann PE, Geddes DT. Association of nipple piercing with abnormal milk production and breastfeeding. JAMA. 2009;301(24):2550–1.

    Article  CAS  PubMed  Google Scholar 

  63. Muallem MM, Rubeiz NG. Physiological and biological skin changes in pregnancy. Clin Dermatol. 2006;24(2):80–3.

    Article  PubMed  Google Scholar 

  64. Doucet S, Soussignan R, Sagot P, Schaal B. The secretion of areolar (Montgomery’s) glands from lactating women elicits selective, unconditional responses in neonates. PLoS One. 2009;4(10):e7579.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  65. Skov L, Baadsgaard O. Bacterial superantigens and inflammatory skin diseases. Clin Exp Dermatol. 2000;25(1):57–61.

    Article  CAS  PubMed  Google Scholar 

  66. Tokura Y, Yagi H, Ohshima A, Kurokawa S, Wakita H, Yokote R, et al. Cutaneous colonization with staphylococci influences the disease activity of Sezary syndrome: a potential role for bacterial superantigens. Br J Dermatol. 1995;133(1):6–12.

    Article  CAS  PubMed  Google Scholar 

  67. Dodiuk-Gad R, Cohen-Barak E, Ziv M, Shani-Adir A, Shalev S, Chazan B, et al. Bacteriological aspects of Darier’s disease. J Eur Acad Dermatol Venereol. 2013;27(11):1405–9.

    Article  CAS  PubMed  Google Scholar 

  68. Hale TW, Rowe HE. Medications and mothers’ milk. Plano: Hale; 2014.

    Google Scholar 

  69. Atkinson AJ Jr. Pharmacokinetics of prednisolone transfer to breast milk. Clin Pharmacol Ther. 1993;53(3):324–8.

    Article  PubMed  Google Scholar 

  70. Chi C-C, Wang S-H, Kirtschig G, Wojnarowska F. Systematic review of the safety of topical corticosteroids in pregnancy. J Am Acad Dermatol. 2010;62:694.

    Article  PubMed  Google Scholar 

  71. Murase JE, Chan KK, Garite TJ, Cooper DM, Weinstein GD. Hormonal effect on psoriasis in pregnancy and post partum. Arch Dermatol. 2005;141(5):601–6.

    Article  CAS  PubMed  Google Scholar 

  72. Krishnan L, Guilbert LJ, Wegmann TG, Belosevic M, Mosmann TR. T helper 1 response against Leishmania major in pregnant C57BL/6 mice increases implantation failure and fetal resorptions. Correlation with increased IFN-gamma and TNF and reduced IL-10 production by placental cells. J Immunol. 1996;156(2):653–62.

    CAS  PubMed  Google Scholar 

  73. Maes M, Ombelet W, De Jongh R, Kenis G, Bosmans E. The inflammatory response following delivery is amplified in women who previously suffered from major depression, suggesting that major depression is accompanied by a sensitization of the inflammatory response system. J Affect Disord. 2001;63(1):85–92.

    Article  CAS  PubMed  Google Scholar 

  74. Groer MW, Davis MW, Smith K, Casey K, Kramer V, Bukovsky E. Immunity, inflammation and infection in post-partum breast and formula feeders. Am J Reprod Immunol. 2005;54(4):222–31.

    Article  CAS  PubMed  Google Scholar 

  75. Hirotsu C, Rydlewski M, Araujo MS, Tufik S, Andersen ML. Sleep loss and cytokines levels in an experimental model of psoriasis. PLoS One. 2012;7(11):e51183.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. Rademaker M, Agnew K, Andrews M, Armour K, Baker C, Foley P, et al. Psoriasis in those planning a family, pregnant or breast-feeding. The Australasian Psoriasis Collaboration. Australas J Dermatol. 2017. https://doi.org/10.1111/ajd.12641.

  77. Bae YS, Van Voorhees AS, Hsu S, Korman NJ, Lebwohl MG, Young M, et al. Review of treatment options for psoriasis in pregnant or lactating women: from the Medical Board of the National Psoriasis Foundation. J Am Acad Dermatol. 2012;67(3):459–77.

    Article  PubMed  Google Scholar 

  78. Mahadevan U, Wolf DC, Dubinsky M, Cortot A, Lee SD, Siegel CA, et al. Placental transfer of anti-tumor necrosis factor agents in pregnant patients with inflammatory bowel disease. Clin Gastroenterol Hepatol. 2013;11(3):286–92; quiz e24.

    Article  CAS  PubMed  Google Scholar 

  79. Baker K, Qiao S-W, Kuo T, Kobayashi K, Yoshida M, Lencer WI, et al. Immune and non-immune functions of the (not so) neonatal Fc receptor, FcRn. Semin Immunopathol. 2009;31:223.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  80. Vasiliauskas EA, Church JA, Silverman N, Barry M, Targan SR, Dubinsky MC. Case report: evidence for transplacental transfer of maternally administered infliximab to the newborn. Clin Gastroenterol Hepatol. 2006;4(10):1255–8.

    Article  PubMed  Google Scholar 

  81. Zelinkova Z, de Haar C, de Ridder L, Pierik MJ, Kuipers EJ, Peppelenbosch MP, et al. High intra-uterine exposure to infliximab following maternal anti-TNF treatment during pregnancy. Aliment Pharmacol Ther. 2011;33(9):1053–8.

    Article  CAS  PubMed  Google Scholar 

  82. Cheent K, Nolan J, Shariq S, Kiho L, Pal A, Arnold J. Case report: fatal case of disseminated BCG infection in an infant born to a mother taking infliximab for Crohn’s disease. J Crohns Colitis. 2010;4(5):603–5.

    Article  PubMed  Google Scholar 

  83. Porter ML, Lockwood SJ, Kimball AB. Update on biologic safety for patients with psoriasis during pregnancy. Int J Womens Dermatol. 2017;3(1):21–5.

    Article  PubMed  PubMed Central  Google Scholar 

  84. Oz BB, Hackman R, Einarson T, Koren G. Pregnancy outcome after cyclosporine therapy during pregnancy: a meta-analysis. Transplantation. 2001;71(8):1051–5.

    Article  CAS  PubMed  Google Scholar 

  85. Palmer CN, Irvine AD, Terron-Kwiatkowski A, Zhao Y, Liao H, Lee SP, et al. Common loss-of-function variants of the epidermal barrier protein filaggrin are a major predisposing factor for atopic dermatitis. Nat Genet. 2006;38(4):441–6.

    Article  CAS  PubMed  Google Scholar 

  86. Darwazeh AM, al-Bashir A. Oral candidal flora in healthy infants. J Oral Pathol Med. 1995;24(8):361–4.

    Article  CAS  PubMed  Google Scholar 

  87. McCarthy C, Snyder ML, Parker RB. The indigenous oral flora of man. I. The newborn to the 1-year-old infant. Arch Oral Biol. 1965;10(1):61–70.

    Article  CAS  PubMed  Google Scholar 

  88. Shaffer KK, Jaimes JP, Hordinsky MK, Zielke GR, Warshaw EM. Allergenicity and cross-reactivity of coconut oil derivatives: a double-blind randomized controlled pilot study. Dermatitis. 2006;17(2):71–6.

    PubMed  Google Scholar 

  89. Kapur N, Goldsmith P. Nipple dermatitis–not all what it ‘seams’. Contact Dermatitis. 2001;45(1):44–5.

    Article  CAS  PubMed  Google Scholar 

  90. Levit F. Jogger’s nipples. N Engl J Med. 1977;297(20):1127.

    CAS  PubMed  Google Scholar 

  91. Powell B. Bicyclist’s nipples. JAMA. 1983;249(18):2457.

    Article  CAS  PubMed  Google Scholar 

  92. Bischof RO. Surf rider’s dermatitis. Contact Dermatitis. 1995;32(4):247.

    Article  CAS  PubMed  Google Scholar 

  93. Fisher AA. Sports-related allergic dermatitis. Cutis. 1992;50(2):95–7.

    CAS  PubMed  Google Scholar 

  94. McGforge BC, Steele MC. Allergic contact dermatitis of the nipple from Roman chamomile ointment. Contact Dermatitis. 1991;24(2):139–40.

    Article  Google Scholar 

  95. Warshaw EM, Nelsen DD, Maibach HI, Marks JG, Zug KA, Taylor JS, et al. Positive patch test reactions to lanolin: cross-sectional data from the north american contact dermatitis group, 1994 to 2006. Dermatitis. 2009;20(2):79–88.

    CAS  PubMed  Google Scholar 

  96. Garcia M, del Pozo MD, Diez J, Munoz D, de Corres LF. Allergic contact dermatitis from a beeswax nipple-protective. Contact Dermatitis. 1995;33(6):440–1.

    Article  CAS  PubMed  Google Scholar 

  97. Goossens A, Verhamme B. Contact allergy to permanent colorants used for tattooing a nipple after breast reconstruction. Contact Dermatitis. 2002;47(4):250.

    Article  CAS  PubMed  Google Scholar 

  98. Wold AE, Adlerberth I. Breast feeding and the intestinal microflora of the infant—implications for protection against infectious diseases. In: Koletzko B, Michaelsen KF, Hernell O, editors. Short and long term effects of breast feeding on child health. Boston: Springer; 2002. p. 77–93.

    Chapter  Google Scholar 

  99. Johnston M, Landers S, Noble L, Szucs K, Viehmann L. Breastfeeding and the use of human milk. Pediatrics. 2012;129(3):e827–41.

    Article  Google Scholar 

  100. The World Health Organization’s infant feeding recommendation. 2002. http://www.who.int/nutrition/topics/infantfeeding_recommendation/en/.

  101. Kramer MS, Aboud F, Mironova E, Vanilovich I, Platt RW, Matush L, et al. Breastfeeding and child cognitive development: new evidence from a large randomized trial. Arch Gen Psychiatry. 2008;65(5):578–84.

    Article  PubMed  Google Scholar 

  102. Jordan SJ, Na R, Johnatty SE, Wise LA, Adami HO, Brinton LA, et al. Breastfeeding and endometrial cancer risk: an analysis from the epidemiology of endometrial cancer consortium. Obstet Gynecol. 2017;129(6):1059–67.

    Article  PubMed  PubMed Central  Google Scholar 

  103. Victora CG, Bahl R, Barros AJ, Franca GV, Horton S, Krasevec J, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475–90.

    Article  PubMed  Google Scholar 

  104. Chowdhury R, Sinha B, Sankar MJ, Taneja S, Bhandari N, Rollins N, et al. Breastfeeding and maternal health outcomes: a systematic review and meta-analysis. Acta Paediatr. 2015;104(467):96–113.

    Article  PubMed  PubMed Central  Google Scholar 

  105. Kent JC, Ashton E, Hardwick CM, Rowan MK, Chia ES, Fairclough KA, et al. Nipple pain in breastfeeding mothers: incidence, causes and treatments. Int J Environ Res Public Health. 2015;12(10):12247–63.

    Article  PubMed  PubMed Central  Google Scholar 

  106. Buck ML, Amir LH, Cullinane M, Donath SM, Team CS. Nipple pain, damage, and vasospasm in the first 8 weeks postpartum. Breastfeed Med. 2014;9(2):56–62.

    Article  PubMed  PubMed Central  Google Scholar 

  107. Wagner EA, Chantry CJ, Dewey KG, Nommsen-Rivers LA. Breastfeeding concerns at 3 and 7 days postpartum and feeding status at 2 months. Pediatrics. 2013. https://doi.org/10.1542/peds.2013-0724.

  108. McClellan HL, Hepworth AR, Garbin CP, Rowan MK, Deacon J, Hartmann PE, et al. Nipple pain during breastfeeding with or without visible trauma. J Hum Lact. 2012;28(4):511–21.

    Article  PubMed  Google Scholar 

  109. Brown S, Lumley J. Maternal health after childbirth: results of an Australian population based survey. Br J Obstet Gynaecol. 1998;105(2):156–61.

    Article  CAS  PubMed  Google Scholar 

  110. Jager S, Jacobs S, Kroger J, Fritsche A, Schienkiewitz A, Rubin D, et al. Breast-feeding and maternal risk of type 2 diabetes: a prospective study and meta-analysis. Diabetologia. 2014;57(7):1355–65.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  111. Eidelman AI, Schanler RJ, Johnston M, Landers S, Noble L, Szucs K, et al. Breastfeeding and the use of human milk. Pediatrics. 2012;129(3):e827–e41.

    Article  Google Scholar 

  112. Amir LH, Jones LE, Buck ML. Nipple pain associated with breastfeeding: Incorporating current neurophysiology into clinical reasoning. Aust Fam Physician. 2015;44(3):127.

    PubMed  Google Scholar 

  113. Ardran GM, Kemp FH, Lind J. A cineradiographic study of bottle feeding. Br J Radiol. 1958;31(361):11–22.

    Article  CAS  PubMed  Google Scholar 

  114. Sakalidis VS, Geddes DT. Suck-swallow-breathe dynamics in breastfed infants. J Hum Lact. 2016;32(2):201–11.

    Article  PubMed  Google Scholar 

  115. Park HS, Yoon CH, Kim HJ. The prevalence of congenital inverted nipple. Aesthet Plast Surg. 1999;23(2):144–6.

    Article  CAS  Google Scholar 

  116. Barrett ME, Heller MM, Fullerton Stone H, Murase JE. Dermatoses of the breast in lactation. Dermatol Ther. 2013;26(4):331–6.

    Article  PubMed  Google Scholar 

  117. Barrett ME, Heller MM, Stone HF, Murase JE. Raynaud phenomenon of the nipple in breastfeeding mothers: an underdiagnosed cause of nipple pain. JAMA Dermatol. 2013;149(3):300–6.

    Article  PubMed  Google Scholar 

  118. McGuinness N, Cording V. Raynaud’s phenomenon of the nipple associated with labetalol use. J Hum Lact. 2013;29(1):17–9.

    Article  PubMed  Google Scholar 

  119. Anderson JE, Held N, Wright K. Raynaud’s phenomenon of the nipple: a treatable cause of painful breastfeeding. Pediatrics. 2004;113(4):e360–4.

    Article  PubMed  Google Scholar 

  120. Smith W, Erenberg A, Nowak A, Franken E Jr. Physiology of sucking in the normal term infant using real-time US. Radiology. 1985;156(2):379–81.

    Article  CAS  PubMed  Google Scholar 

  121. Messner AH, Lalakea ML, Aby J, Macmahon J, Bair E. Ankyloglossia: incidence and associated feeding difficulties. Arch Otolaryngol Head Neck Surg. 2000;126(1):36–9.

    Article  CAS  PubMed  Google Scholar 

  122. Hazelbaker A. The assessment tool for lingual frenulum function (ATLFF): use in a lactation consultant private practice. Thesis. Pasadena, CA: Pacific Oaks College; 1993.

    Google Scholar 

  123. Messner AH, Lalakea ML. Ankyloglossia: controversies in management. Int J Pediatr Otorhinolaryngol. 2000;54(2-3):123–31.

    Article  CAS  PubMed  Google Scholar 

  124. Ballard JL, Auer CE, Khoury JC. Ankyloglossia: assessment, incidence, and effect of frenuloplasty on the breastfeeding dyad. Pediatrics. 2002;110(5):e63.

    Article  PubMed  Google Scholar 

  125. Masaitis NS, Kaempf JW. Developing a frenotomy policy at one medical center: a case study approach. J Hum Lact. 1996;12(3):229–32.

    Article  CAS  PubMed  Google Scholar 

  126. Williams WN, Waldron CM. Assessment of lingual function when ankyloglossia (tongue-tie) is suspected. J Am Dent Assoc. 1985;110(3):353–6.

    Article  CAS  PubMed  Google Scholar 

  127. Dollberg S, Botzer E, Grunis E, Mimouni FB. Immediate nipple pain relief after frenotomy in breast-fed infants with ankyloglossia: a randomized, prospective study. J Pediatr Surg. 2006;41(9):1598–600.

    Article  PubMed  Google Scholar 

  128. Kotlow LA. Diagnosing and understanding the maxillary lip-tie (superior labial, the maxillary labial frenum) as it relates to breastfeeding. J Hum Lact. 2013;29(4):458–64.

    Article  PubMed  Google Scholar 

  129. McClellan H, Geddes D, Kent J, Garbin C, Mitoulas L, Hartmann P. Infants of mothers with persistent nipple pain exert strong sucking vacuums. Acta Paediatr. 2008;97(9):1205–9.

    Article  PubMed  Google Scholar 

  130. Brimdyr K, Blair A, Cadwell K, Turner-Maffei C. The relationship between positioning, the breastfeeding dynamic, the latching process and pain in breastfeeding mothers with sore nipples. Breastfeed Rev. 2003;11(2):5.

    PubMed  Google Scholar 

  131. Chiu IM, Heesters BA, Ghasemlou N, Von Hehn CA, Zhao F, Tran J, et al. Bacteria activate sensory neurons that modulate pain and inflammation. Nature. 2013;501(7465):52.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  132. Heikkila MP, Saris PE. Inhibition of Staphylococcus aureus by the commensal bacteria of human milk. J Appl Microbiol. 2003;95(3):471–8.

    Article  CAS  PubMed  Google Scholar 

  133. Vuong C, Otto M. Staphylococcus epidermidis infections. Microbes Infect. 2002;4(4):481–9.

    Article  PubMed  Google Scholar 

  134. Delgado S, Arroyo R, Martin R, Rodriguez JM. PCR-DGGE assessment of the bacterial diversity of breast milk in women with lactational infectious mastitis. BMC Infect Dis. 2008;8(1):51.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  135. Amir LH, Academy of Breastfeeding Medicine Protocol Committee. ABM clinical protocol #4: Mastitis, revised March 2014. Breastfeed Med. 2014;9(5):239–43.

    Article  PubMed  PubMed Central  Google Scholar 

  136. Szajewska H, Ruszczynski M, Radzikowski A. Probiotics in the prevention of antibiotic-associated diarrhea in children: a meta-analysis of randomized controlled trials. J Pediatr. 2006;149(3):367–72.

    Article  PubMed  Google Scholar 

  137. D’Souza AL, Rajkumar C, Cooke J, Bulpitt CJ. Probiotics in prevention of antibiotic associated diarrhoea: meta-analysis. BMJ. 2002;324(7350):1361.

    Article  PubMed  PubMed Central  Google Scholar 

  138. Moorhead AM, Amir LH, O’Brien PW, Wong S. A prospective study of fluconazole treatment for breast and nipple thrush. Breastfeed Rev. 2011;19(3):25–9.

    PubMed  Google Scholar 

  139. Francis-Morrill J, Heinig MJ, Pappagianis D, Dewey KG. Diagnostic value of signs and symptoms of mammary candidosis among lactating women. J Hum Lact. 2004;20(3):288–95.

    Article  PubMed  Google Scholar 

  140. Carmichael A, Dixon J. Is lactation mastitis and shooting breast pain experienced by women during lactation caused by Candida albicans? Breast. 2002;11(1):88–90.

    Article  CAS  PubMed  Google Scholar 

  141. Viejo-Diaz M, Andres MT, Fierro JF. Different anti-Candida activities of two human lactoferrin-derived peptides, Lfpep and kaliocin-1. Antimicrob Agents Chemother. 2005;49(7):2583–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  142. Montagne P, Cuilliere M, Mole C, Bene M, Faure G. Changes in lactoferrin and lysozyme levels in human milk during the first twelve weeks of lactation. In: Bioactive components of human milk. New York: Springer; 2001. p. 241–7.

    Chapter  Google Scholar 

  143. Amir LH, Donath SM, Garland SM, Tabrizi SN, Bennett CM, Cullinane M, et al. Does Candida and/or Staphylococcus play a role in nipple and breast pain in lactation? A cohort study in Melbourne, Australia. BMJ Open. 2013;3(3):e002351.

    Article  PubMed  PubMed Central  Google Scholar 

  144. Morrill JF, Heinig MJ, Pappagianis D, Dewey KG. Risk factors for mammary candidosis among lactating women. J Obstet Gynecol Neonatal Nurs. 2005;34(1):37–45.

    Article  PubMed  Google Scholar 

  145. Amir LH. Candida and the lactating breast: predisposing factors. J Hum Lact. 1991;7(4):177–81.

    Article  CAS  PubMed  Google Scholar 

  146. Berens P, Eglash A, Malloy M, Steube AM. ABM clinical protocol# 26: persistent pain with breastfeeding. Breastfeed Med. 2016;11(2):46–53.

    Article  PubMed  Google Scholar 

  147. Wiener S. Diagnosis and management of Candida of the nipple and breast. J Midwifery Womens Health. 2006;51(2):125–8.

    Article  PubMed  Google Scholar 

  148. Wambach K, Riordan J. Breastfeeding and human lactation. Burlington: Jones & Bartlett Publishers; 2014.

    Google Scholar 

  149. Kramer A, Schwebke I, Kampf G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis. 2006;6(1):130.

    Article  PubMed  PubMed Central  Google Scholar 

  150. Wilson-Clay B, Hoover K. The breastfeeding atlas. Manchaca: LactNews Press; 2008.

    Google Scholar 

  151. Whitley RJ, Kimberlin DW, Roizman B. Herpes simplex viruses. Clin Infect Dis. 1998;26(3):541–53; quiz 54-5.

    Article  CAS  PubMed  Google Scholar 

  152. Miller CS, Danaher RJ. Asymptomatic shedding of herpes simplex virus (HSV) in the oral cavity. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105(1):43–50.

    Article  PubMed  Google Scholar 

  153. Parra J, Cneude F, Huin N, Bru CB, Debillon T. Mammary herpes: a little known mode of neonatal herpes contamination. J Perinatol. 2013;33(9):736–7.

    Article  CAS  PubMed  Google Scholar 

  154. Sabin AB, Fieldsteel AH. Antipoliomyelitic activity of human and bovine colostrum and milk. Pediatrics. 1962;29(1):105–15.

    CAS  PubMed  Google Scholar 

  155. Noble R. Milk under the skin (milk blister). A simple problem causing other breast conditions. Breastfeed Rev J. 1991;2:118–9.

    Google Scholar 

  156. O’Hara M. Bleb histology reveals inflammatory infiltrate that regresses with topical steroids; a case series [platform abstract]. Breastfeed Med. 2012;7(Suppl 1):2.

    Google Scholar 

  157. Ducic I, Zakaria HM, Felder JM 3rd, Fantus S. Nerve Injuries in aesthetic breast surgery: systematic review and treatment options. Aesthet Surg J. 2014;34(6):841–56.

    Article  PubMed  Google Scholar 

  158. Jindal N, Jain VK, Aggarwal S, Kaur S. Ipsilateral galactorrhea following zoster of the T4 dermatome. Indian J Dermatol Venereol Leprol. 2014;80(6):540–2.

    Article  PubMed  Google Scholar 

  159. Eccleston C, Williams AC, Morley S. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev. 2009;2:CD007407.

    Google Scholar 

  160. Kernerman E, Park E. Severe breast pain resolved with pectoral muscle massage. J Hum Lact. 2014;30(3):287–91.

    Article  PubMed  Google Scholar 

  161. Rowbotham M, Harden N, Stacey B, Bernstein P, Magnus-Miller L. Gabapentin for the treatment of postherpetic neuralgia: a randomized controlled trial. JAMA. 1998;280(21):1837–42.

    Article  CAS  PubMed  Google Scholar 

  162. Pugh LC, Buchko BL, Bishop BA, Cochran JF, Smith LR, Lerew DJ. A comparison of topical agents to relieve nipple pain and enhance breastfeeding. Birth. 1996;23(2):88–93.

    Article  CAS  PubMed  Google Scholar 

  163. Shanazi M, Farshbaf Khalili A, Kamalifard M, Asghari Jafarabadi M, Masoudin K, Esmaeli F. Comparison of the effects of lanolin, peppermint, and dexpanthenol creams on treatment of traumatic nipples in breastfeeding mothers. J Caring Sci. 2015;4(4):297–307.

    Article  PubMed  PubMed Central  Google Scholar 

  164. Jackson KT, Dennis CL. Lanolin for the treatment of nipple pain in breastfeeding women: a randomized controlled trial. Matern Child Nutr. 2016;13:e12357.

    Article  PubMed Central  Google Scholar 

  165. Cable B, Stewart M, Davis J. Nipple wound care: a new approach to an old problem. J Hum Lact. 1997;13(4):313–8.

    Article  CAS  PubMed  Google Scholar 

  166. Tait P. Nipple pain in breastfeeding women: causes, treatment, and prevention strategies. J Midwifery Womens Health. 2000;45(3):212–5.

    Article  CAS  PubMed  Google Scholar 

  167. WHO. Protecting, promoting and supporting breast-feeding: the special role of maternity services. 1989.

    Google Scholar 

  168. Huggins KE, Billon SF. Twenty cases of persistent sore nipples: collaboration between lactation consultant and dermatologist. J Hum Lact. 1993;9(3):155–60.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

With gratitude to the ever-generous Dr. Mei Tam for her contribution to the section on contact dermatitis. Her expert advice has helped many of my patients over the years.

And with tremendous gratitude to my brother, Associate Professor David Finkelstein for helping me with everything technical.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Eve Finkelstein .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Finkelstein, E., Meerkin, D.Y., Weissman, G. (2018). Nipples: A Sensitive Topic. In: Tur, E., Maibach, H. (eds) Gender and Dermatology. Springer, Cham. https://doi.org/10.1007/978-3-319-72156-9_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-72156-9_11

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-72155-2

  • Online ISBN: 978-3-319-72156-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics