The elastic nipples symptoms are a conical or cylindrical protrusion located at the apex of the breast. This structure represents the point where the glandular ducts (or galactophorous) converge, to open to the external surface of the body.
The elastic nipple is hyperpigmented and has a soft and supple texture. At its top, this has a wrinkled appearance, due to the presence of the small outlet orifices of the milk ducts. The latter carries out the milk produced by the mammary gland.
Compared to the cutaneous plane, the nipple is more or less raised. Occasionally, this can be retracted below the skin surface, but, when stimulated, it ejects upwards and outwards.
When it remains permanently inverted, on the other hand, we speak of inversion of the nipple; this condition is abnormal and must be checked from a medical point of view.
The nipple can be the site of various pathological processes, including malformations, infections, traumas, and neoplasms.
Anatomy of the elastic nipple
The breast is an organ made up of glandular tissue (organized into lobules), a series of ducts (which carry milk up to the nipple), and a part of fatty tissue.
At the apex of the breast, there is the nipple, which is a conical or cylindrical relief, more or less protruding and pigmented (generally dark pink or brown in color).
Usually, this structure is located at the level of the fourth intercostal space, on the mid-clavicular line (i.e. slightly below the middle of the chest), but the position is inconstant, as the breasts are pendulous.
The size of the nipple is usually proportional to that of the breast: the relief has an average height of 10-12 mm and a diameter of 9-10 mm.
The skin that covers it is corrugated (area crib Rosa) by dimples and papillae, in which 15-20 milk ducts open; in fact, on its surface, the small outlet orifices can be observed.
The elastic nipple also contains smooth muscle tissue, arranged circularly and radially, and responsible for its erection.
The nipple is surrounded by the mammary areola, that is, by a circular area of hairless skin (a couple of centimeters in diameter). The latter contains the Montgomery glands (important for making the nipple soft and elastic during breastfeeding), and sometimes also the accessory breast tissue, which becomes evident with the milk secretion.
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Elastic Nipples Symptoms and Alterations
Inversion of the elastic nipple
How to know If you have elastic nipples symptoms? Normally, the nipples are protruding. In some cases, however, they appear inverted, therefore reentering the breast, even if stimulated manually or with the cold.
Nipple inversion is often a benign condition, but it can also indicate the presence of a more severe problem. This abnormality can affect only one breast or both.
The inversion of the elastic nipple can be present from birth (due to congenital shortness of the milk ducts) or acquired. In the latter case, the retraction is sustained, more often than not, by periductal fibrosis resulting from inflammatory processor surgery. If the nipple does not protrude, it can interfere with the normal ability to breastfeed.
Sometimes, nipple inversion can be the first sign of breast cancer, especially when it is asymmetrical or associated with blood discharge or the presence of a lump.
In some cases, a small amount of clear or yellow, white, or green liquid may be squeezed out of the ducts in response to breast manipulation or spontaneously. This manifestation can occur in males or in women, outside the period of pregnancy and breastfeeding.
Serum secretion can be an abnormal or harmless elastic nipples symptom; a blood loss from the nipple (at a microscopic and macroscopic level) is never, however, to be considered normal.
For this reason, the causes of these secretions must be investigated. The most serious condition related to this sign is breast cancer (usual carcinoma of the intraductal or invasive ductal type). In most cases, however, the cause is benign and attributable to pathologies of the benign mammary ducts (e.g. ductal ectasia and intraductal papilloma) or breast infections (mastitis).
Galactorrhea is the secretion of a milky, non- puerperal serum from several ducts of both breasts.
Often, this phenomenon is due to a prolactin-secreting pituitary adenoma ( prolactinoma ), a hormone that at high levels stimulates the glandular tissue of the breast.
Galactorrhea can also result from hypothalamic tumors and other endocrine disorders, such as acromegaly, thyrotoxicosis, primary hypothyroidism, and Cushing’s disease.
Supernumerary nipples (polythelia)
In addition to the typical location, the nipples can develop in excess, usually along two mammary lines, which run from the armpits to the groin. Polythelia is a generally sporadic condition, but it can also recognize a genetic predisposition.
Supernumerary nipples may appear as simple pigmented patches, similar to moles.
The malformations of the nipple are attributable to variations in its shape. These conditions can be detrimental to breastfeeding: the structure may be too bulky, short, or even absent, making sucking more difficult.
Sometimes, instead of protruding, the nipple appears umbilicated, that is, flat or recessed in the center of the mammary areola, due to the arrest of its embryonic development.
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Desquamation of the nipple
Nipple peeling is a manifestation mostly associated with dried nipple discharge. On some occasions, however, this sign may depend on an eczematous type lesion. Other times, peeling off the nipple indicates the presence of Paget’s disease or erosive adenoma.
Development and functions
During the first years of life, the nipple is small in size. Upon reaching puberty, this structure increases in volume particularly in women, while it remains “rudimentary” in men. During pregnancy and breastfeeding, the nipple reaches its maximum development, becoming more prominent and pigmented.
Under the influence of director reflex stimuli, the nipple goes into erection, lengthening and increasing inconsistency; this phenomenon, called elitism, is due to the presence of smooth muscle cells similar to those of the areolar muscle.
In both men and women, the nipples also represent an erogenous zone. Their prolonged and intense stimulation during sexual activity can therefore lead to arousal.
The main physiological purpose of the nipples is the ejection of breast milk in the period following the birth event. This phenomenon allows the initiation of breastfeeding.
Milk is produced in the breasts by a set of acinar glands (called alveoli) and is carried to the elastic nipples through the milk ducts. After childbirth, in fact, the decrease in estrogen and progesterone allows the stimulating effect of prolactin on the secretion of milk by the cells of the alveoli and allows lactation to take place.
To get milk, the baby simply sucks on the nipples (known as sucking), causing milk to flow through the ducts.
Sucking stimulates the contraction of the myoepithelial cells that surround the alveoli and pushes the milk to flow through the milk ducts (ejection).
Main pathologies of the elastic nipples
Cracks are particularly painful small cracks, which are found especially during the period of breastfeeding. These lesions deepen beyond the dermis and may have a circular pattern (i.e. around the implantation of the nipple on the areola) or run from the apex to the base of the nipple. This condition can favor the colonization of the milk ducts by infectious agents. Nipple fissures
often regress spontaneously with cessation of breastfeeding.
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Paget’s disease of the nipple
Paget’s disease of the nipple is a malignant tumor that results from the neoplastic proliferation of cells in the milk ducts. Usually, the disease affects only one breast and is often associated with ductal in situ or invasive breast cancer. The risk factors that predispose the onset are the same that make you susceptible to the development of other types of breast cancer.
Paget’s disease produces visible changes in the skin of the areola-nipple complex: the skin appears red, dry, irritated, or scaly (the appearance is similar to that of a psoriatic plaque or eczema). In about half of all cases, an underlying breast lump may be found on palpation. Other frequent elastic nipples symptoms of Paget’s disease are straw-colored discharge (serous or purulent), itching and burning sensation around the nipple and breast areola. In addition, edema, nipple inversion, and ulcerative-erosive lesions with crusting may occur.
Paget’s disease of the nipple can be diagnosed with a biopsy, but other medical investigations, such as mammography and magnetic resonance.
Treatment involves surgical removal of diagnosed tumors (conservative or radical). Depending on the case, an adjuvant intervention with chemotherapy drugs, radiotherapy, or hormone therapy may also be recommended, in order to prevent recurrence of breast cancer and destroy any residual cancer cells.
Nipple and areola eczema
Eczema can involve areola and/or nipple to varying degrees and can be part of a generalized skin disorder. However, it can also be due to Paget’s disease of the nipple or invasion of the epidermis by intraductal breast cancer.
The nipple area can sometimes be involved with molluscum contagiosum (swelling with the associated ulcer), herpetic lesions, and warts.
Nipple sebaceous cysts are rare. This condition manifests itself as a painless swelling in close relationship with the nipple, and communicating or not with a milk duct. Sebaceous cysts can become infected.
One or both nipples may be affected by protracted friction from a shirt or other clothing, especially when performing a sporting activity. The people most exposed to this condition are those who practice running (hence the name “runner’s nipple”) or breastfeeding. In most cases, this trauma is associated with the presence of sweat and heat and can cause irritation, redness of the skin, soreness, dryness, or bleeding.
On the other hand, friction associated with cold can result in painful lesions, often with aspects similar to those of eczema and, sometimes, with micro- hemorrhage simulating blood secretions from the nipple. The latter condition is found above all among cyclists.
Erosive adenoma of the elastic nipple
An erosive adenoma is a rare condition in which the elastic nipple appears enlarged, sometimes ulcerated, and bleeding. In addition, burning or itchy pain is reported. The diagnosis of erosive adenoma is confirmed with a biopsy. The treatment does not require the removal of the entire nipple, but only the affected part.
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