Tuesday, November 4, 2008

Nipple Problem: What is the difference between a retracted nipple and an inverted nipple?

What is the difference between a retracted nipple and an inverted nipple?

A retracted nipple is one which is pulled inward from time to time. It is not permanently turned inwards.

It can be brought out by manipulation with the fingers and it is also brought out by cold weather.

An inverted nipple is one which is permanently turned inwards. This is due to the fact that it is connected to a short milk (lactiferous) duct. Breast function is not affected and the nipple does not usually require medical attention.

If you notice your nipple turning inwards or being pulled to one side, you should discuss this with your doctor. This may be just a normal feature of ageing, however you your doctor will probably suggest a mammogram (X-ray of the breast) to rule out any possible underlying cause such as cancer.

Should I be worried about nipple discharge?

Not usually. Nipple discharge is a fairly common complaint, even among women who are not pregnant. Most discharge from the nipple is not serious.

The discharge can come from the ducts underneath the nipple or from the surface of the nipple itself.

A common type of discharge amongst women who have had babies is a milky discharge, which can continue months or even years after the woman has stopped breastfeeding. In rare cases, a woman who has never been pregnant can also have a milky discharge from her nipples.

All woman, whether pregnant or not, have fluid in their breasts. This fluid does not usually 'leak' because the ducts in the breasts are blocked with plugs of a substance called keratin.

Sometimes these plugs are dislodged, for example after exercise, allowing the fluid to be released. The amount that is discharged is usually very small. It may be white, yellow, green, blue or black.

Older women may also experience a discharge that is cheesy in appearance. This occurs because as a woman gets older, her ducts widen and become filled with a cheese-like material, which can sometimes leak.

When should I be concerned about nipple discharge?

If the discharge is in large quantities and is constant, it could be a sign of duct disease. A persistent milky discharge may be a sign of overactivity of the pituitary gland in the brain, resulting in high levels of the hormone prolactin which may be causing the nipple discharge. This can be diagnosed by checking the prolactin levels in a blood test. If the prolactin level is elevated, it will usually be treated with medications.

A discharge that is bloodstained may be caused by a wart in one of the ducts underneath the nipple. This type of wart is known as a papilloma (benign/non-cancerous growth). In such cases, removal of the duct involved solves the problem. This is a simple procedure.

If the discharge is coming from the surface of the nipple or from the surrounding skin, Paget's disease may be the cause. This disease resembles eczema on the skin and may cause an ulcer on the surface of the nipple. Paget's disease is usually a sign that there is a slow growing cancer or a pre-cancer in the breast. (This should not be mixed up with a chronic disease of the bones, also known as Paget's disease.) Surgical treatment is required.

If you notice anything strange about your discharge or are in any way worried, visit your doctor immediately.

I have a third nipple. Should I be worried?

No. Third nipples, or supernumerary nipples, are more common than people think.

They tend to stay smaller than the main nipples and very rarely need to be removed for medical reasons. It is more likely that a person will have it removed because the appearance causes them some embarrassment.

However if you notice any changes in the third nipple or simply want to have it checked out, visit your doctor to have it checked out.

How To Test may detect breast cancer earlier

How To Test may detect breast cancer earlier

Scientists have developed a blood test that could help to detect breast cancer 'at a very early stage'.

According to the international research team, it has developed an 'ultra-sensitive' test that is 200 - 1,000 times more sensitive than existing tests.

In a study involving 250 women with breast cancer and 95 controls, the blood test successfully detected 95% of cancers.

The test works by detecting very small changes in concentrations of protein in the blood. The researchers believe that with changes, it could also be used to detect other types of cancer such as prostate and ovarian cancer.

"Our pilot studies show that using blood samples, breast cancer and several other types of cancers can be detected with much better sensitivity and specificity. This may allow new, less intrusive, safer and much less expensive approaches for the early diagnosis of cancer, for distinguishing malignant and benign cancers and for monitoring cancer therapy", said lead researcher, Prof Jasminka Godovac-Zimmermann of University College London.

Details of these findings are published in the Journal of Proteomic Research.

Nipple Problem: What is Nipple discharge

Nipple discharge

Nipple discharge is usually harmless and does not signify anything seriously wrong. In fact, most women can squeeze some discharge out of their nipples, especially if they have had children in the past. This may be whitish or may be yellow-green or almost black.

On the other hand, nipple discharge can be a symptom of breast cancer, particularly if it is bloodstained. Therefore, you should definitely discuss any nipple discharge with your doctor. If you are a man, you should see your doctor straight away, because the usual cause is a tumour and you will need treatment.

What your doctor will do. Your doctor will check your medication, because some drugs can cause (non-bloody) nipple discharge. The most common culprits are:

  • cimetidine (for stomach problems)
  • oral contraceptives
  • some antidepressants and other drugs for psychological problems
  • domperidone (for nausea).

Your doctor will ask whether there is any possibility that you could be pregnant. Some women have nipple discharge very early in pregnancy. Your doctor will then examine your whole breast thoroughly (not just the nipple), to make sure you have no lumps.

Even if you have not noticed any blood, your doctor may ask you to try to squeeze a few drops out, and will test it for microscopic blood.

Each nipple has about 15–20 tiny pores on it. These pores are the openings of ducts that connect with the glandular tissue in the breast. You and your doctor should try to work out whether the discharge is coming from just one pore, or from several.

  • The cause is very, very unlikely to be breast cancer if the discharge is coming from several pores, it does not contain any blood and you are under 50 years of age.
  • If the discharge is bloodstained, or it is emerging from just one pore, your doctor will refer you to a hospital clinic for tests (such as ultrasound, mammography and looking at the discharge under the microscope) to make sure that breast cancer is not responsible.
  • If the discharge is milky and coming from both breasts, your doctor can do a blood test to check for an imbalance of the hormone prolactin.

If all the tests are normal, you can stop worrying, but the discharge may still bother you (perhaps soiling your clothes). A possible cause is some inflammation (mastitis) around the ducts. This is linked with smoking, and may improve if you stop smoking and avoid squeezing. A course of antibiotics may help.

It is possible to have an operation to close or remove the ducts that the discharge is coming from. This operation may not be a good idea for anyone who plans to become pregnant afterwards – depending on the number of ducts involved, it might make breastfeeding difficult and the breast might become congested.

Nipple Problem: Inverted nipples

Inverted nipples

Most women’s nipples protrude (stick out) about 5–10 mm. Usually they become about 10 mm longer and 2–3 mm wider during sexual arousal. Some women have nipples that are flat, but become erect during sexual arousal or when a baby is sucking on the nipple. Nipples that are tucked into the breast, instead of being flat or sticking out, are called inverted nipples. Both nipples may be inverted, or just one.

Nipples that have always been inverted. If your nipples have been inverted for as long as you can remember, it is nothing to worry about. It is just the way you are, and a lot of women are the same. A survey of 3000 women attending an antenatal clinic found that 10% had inverted nipples.

A nipple that suddenly becomes inverted can be a sign of a cancer underneath it, so you should see your doctor straight away.

Nipple Problem: Ways of making your nipples protrude.

Ways of making your nipples protrude

Even if you do not intend to breastfeed you may wish to have protruding nipples. Teenagers often have flat nipples and, in some women (especially if their periods did not start until late), they remain flat until the early 20s. So if you are young, there is a possibility that they may gradually start to protrude. Otherwise, you could try stroking the areola with warm hands for a few minutes each day to bring the nipple out. You could also try wearing breast shields. Do not wear them for too long at first, otherwise the breasts may become sore, and do not continue wearing them for more than 6 weeks.

If these measures do not work and your nipples are really distressing you, it is possible to have a small operation to make the nipples protrude. This involves a small incision on each side of the nipple, and the cutting of some ducts and tissue. The drawback is that some women cannot breastfeed after this operation, and the operation is very expensive (and not available on the National Health Service).

Nipple Problem: What is Hairy nipples

Hairy nipples

Coarse, dark hairs around the nipple are quite common. You can pull them out with tweezers, but this can cause irritation because the skin round the nipple is very sensitive. It is probably better simply to cut them off close to the skin. This is easier if you hold the end of the hair with tweezers to keep it taut. The hairs will grow again, so you will have to cut them off again from time to time.

Hairs round the nipple are nothing to worry about unless you have excess hairiness on other parts of the body and your periods are irregular. If this is the case, you may have polycystic ovary syndrome (PCOS) and you should see your doctor.

Nipple Problem: Extra nipples

Extra nipples
Most people have only two nipples, but about 1 in 50 people (both males and females) has more. These extra nipples are not as well formed as the main nipples, so you may have them without realizing what they are. Imagine a line drawn between the armpit and the inner thigh; the extra nipples are usually on this line.