Stanley Medical Journal CASE REPORT - GENERAL SURGERY Polythelia - Six Nipples in a middle aged woman Varun Arunagiri(1), Kothai Anbalagan(1) Abstract Vol 3 | Issue 2 | April - June | 2016 - June 2 | April 3 | Issue Vol Supernumerary nipples are more than two nipples which normally exist in humans. Polythelia or supernumerary nipple is a rare condition with higher prevalence in males than in females with the ratio of 1.7:1. The maximum reported number of nipples in a person with Polythelia is seven in a male. The usual presentation of Polythelia is with three nipples. Here is an image of Polythelia in a 40 year old female presenting with six nipples without lactation from the supernumer- ary nipples and any other anomalies. She has breast fed her two children. Key-words: Polythelia; Supernumerary Nipples; Mammary ridge; Kajava Classification; Clear cells of Toker. Key Messages: 1. Polythelia is a benign condition with chances of malignancy in the accessory nipples. 2. Constant follow-up is needed when the patient says lump in the region of accessory nipple. 3. Lactation during the pregnancy is common. INTRODUCTION: reported number of nipples in a person with Polythelia is seven in a male. The usual presentation of polythelia is with Polythelia is a congenital anomaly of the breast three nipples where in there are accessory nipples along the milk line Mammals have six to seven nipples, which are apart from the normal two nipples. Amazia, polymazia, common among canines and felines. It is rare to see humans Polythelia, athelia are few congenital anomalies of the nip- with more than three nipples. The incidence is 1-5 percent ple areolar complex. Though Polythelia is incidental, the in the population [1]. Breast and nipples develop along the clinical significance here is lactational mothers can lactate mammary ridge and Supernumerary nipples are found in the accessory nipples. along this ridge starting from both axilla running down on the ventral aspect of the chest and abdomen and end in CASE REPORT: the groin on each side. Accessory nipples are supernumer- ary nipples found along the mammary ridge and Ectopic A 40 year old female presented to the breast clinic nipples occur away from the mammary ridge. The various with queries regarding her nipples and its association with sites of ectopic polythelia are vulva, sole of the foot and um- breast carcinoma. She had six nipples and she complained bilicus. of pain in her both the breast. On examination she had Polythelia is associated with urinary tract anomalies, cardi- Polythelia (Fig1) with no lump breast. She denied of lacta- ac conduction disturbances, preauricular appendages, epib- tion from the accessory nipples. She underwent triple as- ulbar lipodermoids and segmentation of the vertebrae. 90% sessment for breast pathology. There was no evidence of of the polythelia occur in the chest and 5% occurs in axilla breast carcinoma. She was reassured and advised follow up. DISCUSSION: Please Scan this QR Code to View this Article Online Supernumerary nipples are more than two nipples DOI: 22nd July 2016 which normally exist in humans. Polythelia or supernu- Article ID: 2016:03:02:07 merary nipple is a rare condition with higher prevalence in 31 males than in females with the ratio of 1.7:1. The maximum 1. Department of General Surgery, Madras Medical College, Chennai, TN, India Stanley Medical Journal Vol 3 | Issue 2 | April - June | 2016 - June 2 | April 3 | Issue Vol Fig1: Polythelia with Six nipples. and abdomen. Familial polythelia runs in families and are associated with anomalies. It is rare to see more than three nipples in humans. In the year 1915, Kajava classified anomalies of the nipple based on the presence of glandular tissue; nipple, areola, fat and hair patch [2]. Clear cells of Toker are increased in the supernumerary nipples [3]. Polythelia is a cosmetic disfig- urement and surgical excision is done if patient requests. REFERENCES: 1. Dixon JM, Mansel RE, ABC of Breast diseases. Congenital problems and aberrations of normal breast de- velopment and involution. BMJ 1994;309:797-800. 2. Kajava Y. “The proportions of Supernumerary nip- ples in the finnish population” Duodecim 1915; 1:143-70 3. Willman JH1, Golitz LE, Fitzpatrick JE, J Cutan Pathol. 2003 Apr;30[4]:256-60 Acknowledgement: None Conflicts of interest: Nil Sources of support: Nil 32.