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Nipple Knowledge Presented by Diana West, BA, IBCLC

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Nipple Knowledge Presented by Diana West, BA, IBCLC Knipple Knowledge Presented by Diana West, BA, IBCLC Knipple Knowledge NIPPLE Derived from the Old English word neb, meaning "beak," "nose," or "face" cÜxáxÇàxw uç Diana West, BA, IBCLC [email protected] NIPPLE PURPOSE “Handle” infant to grasp breast Point of Sir Astley Cooper (1840) interaction Almost infinite between breast nipple variations and infant (Montagna, 1974) “Genetic Conduit through expression” which milk passes Look cute Nipple = Mammal Nipple = Mammal Characteristic Characteristic Most animals have specialized skin Total number of nipples = areas to interface with environment maximum litter size (Eastwood, 2007) Characterized by Half the total number = Reduced hair/feathers/scales average litter size Specific patterns of cell differentiation Adaptation to changing states Distinctive keratins to withstand mechanical strain Copyright © 2014 by Diana West, BA, IBCLC 1 Knipple Knowledge Presented by Diana West, BA, IBCLC Nipple Growth and Nipple Growth and Development Development Fetal Fetal 4th week gestation: 2-3 months Formation of gestation: Breast symmetrical glandular tissue ectodermal forms near 4th and thickening along 5th ribs, ectodermal embryo’s ventral lines recede lateral sides . This is when 6th week gestation: malformations Milk lines develop (supernumerary nipples/polythelia) occur Tanner Stages of Nipple Nipple Size and Position Development Can vary between breasts Pregnancy and nursing can increase size, often permanently Nipple/Areola Pigment Nipple/Areola Pigment Contains melanin Melanin increases (darkens) during pregnancy to increase resistance to Protection from ultraviolet rays UV rays and abrasion Resists abrasion Copyright © 2014 by Diana West, BA, IBCLC 2 Knipple Knowledge Presented by Diana West, BA, IBCLC Nipple/Areola Nipple Tips Pigment and Pain Tips have dense No research has shown clusters of a relationship between nipple sensitivity or pain protrusions and amount of melanin and BUT redheads have crevices melanocortin-1 receptor gene (MC1R) that makes them more sensitive to pain (Delaney, 2010) Drupelet: The small sections of a Nipple Sides raspberry or blackberry fruit, each containing a seed Sides have intersecting grooves for Kay Hoover, MS, IBCLC expansion when not erect Hoover, K. Proposing a new term: drupelet. Clinical Lactation 2013:4(1);36. Nipple Muscles Nipple Muscles Muscles converge toward nipple in Connective tissue has extensive radial, circular pattern elasticity Longitudinal muscles most prominent Particularly near tip and around ducts in center where they meet ducts Variation in muscle peptides = Variation in leaking Copyright © 2014 by Diana West, BA, IBCLC 3 Knipple Knowledge Presented by Diana West, BA, IBCLC Nipple Muscles Nipple Nerves 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 Location of nerves can vary by women NOT like sexual erection and by breasts (Sarhadi, 1996) Same pilomotor reflex that causes Nerves inside the nipple run along milk goose bumps ducts Few nerves on nipple side or base Copyright © 2012 by Diana West, IBCLC 20 of 140 Wax cast of Human Breast Prepared by Sir Astley Cooper (1840) Nipple Ducts Most ducts branch at 2mm below surface (Ramsay, 2005) Closer than previously thought Geddes Ultrasound Study International Breastfeeding Journal, 2009 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) Copyright © 2014 by Diana West, BA, IBCLC 4 Knipple Knowledge Presented by Diana West, BA, IBCLC Nipple Flat Nipples Variations Short shank Problematic NOT retracted, for Latching but no or very little protrusion or Milk Incidence (Dewey, 2003) Removal 9% Day 1 pp 7% Day 7 pp Edema (Cotterman, 2004; Miller, 2004) Flat Nipples Creates traction on areola Typically improve with nursing Can be caused by: . Excess IV labor fluids Dose dependent – Dilutes plasma proteins . Pitocin (labor or pp) – Chemically close to vasopressin (antidiuretic hormone) . Preeclampsia – Renal (kidney) clearance impaired . Breast pump – Pulls fluids into areola Photo courtesy Mahala Lactation and Perinatal Services, LLC Flat Nipples Other Causes of Flat Nipples Obesity (Jevitt, 2007) Ducts and fibrous Adipose tissue (fat) expands and creates tissue stretch traction on areola Copyright © 2014 by Diana West, BA, IBCLC 5 Knipple Knowledge Presented by Diana West, BA, IBCLC Inverted Nipples Inverted Nipples AKA: tied, invaginated, tethered, 50% congenital non-protractile 50% from trauma, disease, surgery Caused by short ducts or fibrous adhesions 3-10% of all nipples (Alexander, 1992, Park, 1999, Sanuki, 2008) Inverted Nipples Other Causes of Inverted Nipples Han & Hong Inverted Nipple Classification System Nipple is easily pulled out Grade 1 manually, maintains protrusion FLN Nipple can be pulled out Grade 2 manually, but does not maintain Funny Looking Nipple protrusion Nipple can pulled out manually Grade 3 with difficulty Other Causes of Other Causes of Inverted Nipples Inverted Nipples Fat necrosis Cancer Benign inflammatory Timing is condition very important Secondary to: . If it happened . Breast injury or recently and trauma spontaneously: . Surgery or – Could be from biopsy scar tissue in or around lesion or duct . Radiation Unilateral, even slight, is more suspicious Common in very large breasts Copyright © 2014 by Diana West, BA, IBCLC 6 Knipple Knowledge Presented by Diana West, BA, IBCLC Other Causes of Inverted Nipple Surgeries Inverted Nipples Breast abscess Inverted due to Duct ectasia adhesions Plug and inflammation when NOT lactating Benign Inverted Nipple Surgeries Positional Modifications for Flat or Inverted Nipples Inverted due to short ducts Laid-Back/ Biological Nurturing Nipple Nudge for Flat or Nipple Shield for Flat or Inverted Nipples Inverted Nipples Can be excellent tool if baby cannot otherwise latch (Wilson-Clay, 2003) Does not affect prolactin levels or reduce milk transfer (Chertok, 2006) Extended use has not been shown to be detrimental (Bodley, 1996) Copyright © 2014 by Diana West, BA, IBCLC 7 Knipple Knowledge Presented by Diana West, BA, IBCLC Nipple Shield for Flat or Nipple Shield for Inverted Inverted Nipples or Flat Nipples MUST be Baby MUST applied be latched deeply correctly Supple Cup for Flat Reverse Pressure Softening or Inverted Nipes (RPS) for Flat Nipples Due to Edema Pumping to Evert Flat or Other Suction Devices for Inverted Nipples Flat or Inverted Nipples Avent Niplette (McGeorge, 1994) Copyright © 2014 by Diana West, BA, IBCLC 8 Knipple Knowledge Presented by Diana West, BA, IBCLC Other Suction Devices for Other Suction Devices for Flat or Inverted Nipples Flat or Inverted Nipples Maternal Concepts Evert-It Lansinoh LatchAssist Other Suction Devices for What’s NOT EFFECTIVE for Flat or Inverted Nipples Flat or Inverted Nipples Modified Syringe Hoffman’s exercises (Thorley, 1997) No permanent effect (Alexander,1991; MAIN Trial, 1994) Breast shells No permanent effect (Alexander,1991) Retracted or Dimpled Nipples Retracted or Dimpled Nipples Unilateral or bilateral Interior retains Sides normal moisture Center area pulled Susceptible inward to infection Copyright © 2014 by Diana West, BA, IBCLC 9 Knipple Knowledge Presented by Diana West, BA, IBCLC Nipple Tags Bulbous Areola May indicate hypoplasia (insufficient glandular tissue) Can Have Accessory Supernumerary Nipples Breast Tissue “Polythelia” Accessory nipple May or may not include glandular tissue May or may not include areola May or may not include hair patch Supernumerary Nipples Supernumerary Nipples Can appear on areola (Abramson, 1975; Can form Arranz López, 2005; Onesti, 2010) anywhere Most common location: on milk line along milk just below breast lines Copyright © 2014 by Diana West, BA, IBCLC 10 Knipple Knowledge Presented by Diana West, BA, IBCLC Kajava’s 1915 Supernumerary Supernumerary Nipples Nipple Classification System Classification Description 1 nipple, areola, glandular tissue 0.22-6% Polymastia + 2 + nipple, glandular tissue population – areola 3 + glandular tissue, areola – nipple Ethnic, 4 + glandular tissue only geographic 5 + nipple, areola, adipose tissue – glandular tissue variance 6 nipple only (most common type) Polythelia + 7 areola only Polythelia areolaris + 8 hair patch only Polythelia pilosa + Distribution of Supernumerary Nipples Supernumerary Nipples Among Selected Populations Held magical powers Population Prevalence Citation Sign of virility and Caucasian Europeans 0.22% Mathes, 2006 divine powers in men Caucasian Americans 0.6% Kenny, 1997 Sign of a witch in women African Americans 1.6% Rahbar, 1982 To suckle the devil Israelis 2.5% Mimouni, 1983 Arabs 4.7% Jaber, 1988 Japanese 5% Johnson, 1986 Supernumerary Nipples Bifurcated or Double Nipples 14.5% have kidney and urinary tract Actually two malformations (Varsano, 1984; Kenney, 1987; Mimouni, nipples 1988; Ferrara, 2009) “Intra- Areolar Polythelia” Tend to run in families May or may (Casey, 1996; Cellini, 1988) not be fused Incidence of kidney together Each nipple and urinary tract has own malformations ↑ 30% duct system (Casey, 1996) (Onesti, 2008) Copyright © 2014 by Diana West, BA, IBCLC 11 Knipple Knowledge Presented by Diana West, BA, IBCLC Surgery for Bifurcated or Bifurcated or Double Nipples
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