Escolar Documentos
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Cultura Documentos
DOI 10.1245/s10434-015-4760-4
generally located just below the center of the breast and are
smaller in men than women.
Most nipples do not stick straight out but rather are
slightly askew towards the axilla, making it easier to
breastfeed. Sanuki et al. studied the morphologic characteristics of the nipples of 300 women (600 breasts) and
reported a mean diameter of the areola of 4.0 cm, a mean
diameter of the nipple of 1.3 cm, and a mean nipple height
of 0.9 cm. The differences in nipple projection can be
affected by age, race, weight, and hormonal changes.2
The sulcus is a fold at the intersection of the areola and the
rising edge of the nipple. It can often look like a wrinkle,
dimpling, or a smooth curve of skin. The areola is the pigmented circle surrounding the nipple and can range from pink
to red, to dark brown or nearly black. It generally tends to be
paler among people with lighter skin tones and darker among
people with darker skin tones. The areola changes color
during the various stages of sexual arousal and orgasm.3
The surface of the nipple is irregular, with a cobblestone texture and crevices that lead to the duct orifices.
Cellular debris can be found within these crevices and can
form a keratin plug. The pigmented skin of the areola
contains numerous apocrine sweat glands, sebaceous
glands, and hair follicles from the dermal layer of the
skin.4 The skin layer of the areola is usually between 0.5
and 2.0 mm thick and composed of epidermal cells, while
the epidermal skin of the nipple is continuous with the
epithelium of the ducts. It is possible to develop skin tags
on the nipple due to friction. There is little or no fat
between the skin and underlying breast glandular tissue at
the NAC.
Montgomery glands (also referred to as tubercles) are
below the surface of the areola and may be seen as small
bumps in the skin (Fig. 1). These modified sebaceous
glands are associated with a lactiferous duct that communicates with a rudimentary mammary gland. They provide
lubrication during breastfeeding and are more apparent
during pregnancy. Montgomery glands can become
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K. Stone, A. Wheeler
the sloughing of epithelial cells. Benign physiologic discharge is usually bilateral, involving multiple ducts and
being nonspontaneous.18
Galactorrhea is defined by milky nipple discharge that is
not associated with pregnancy or a recent history of
breastfeeding. Medications are also known to cause discharge, and include birth control, antihypertensives, and
sedatives, among others. A pituitary tumor can rarely
secrete prolactin indiscriminately, resulting in bilateral
spontaneous nipple discharge.
CONGENITAL ANOMALIES OF NIPPLES
Nipple Inversion
Approximately 1020 % of all women are born with
nipple inversion, referring to when the entire nipple is
pulled inward, whereas retraction implies the nipple only
has an inward slit-like area. The most common causes of
congenital inversion are short ducts or a wide areolar
muscle sphincter.3,19 Other common causes of nipple
inversion include breastfeeding, trauma resulting in fat
necrosis or surgery, ptosis, breast cancer, breast infections,
genetic variation of the nipple shape, pregnancy, sudden
and major weight loss, and tuberculosis.
Nipple Cleft
These ducts are lined by stratified squamous epithelium
near the opening, and the lumens are frequently filled with
desquamated cells. Deeper in the connective tissue, the
ducts acquire a stratified columnar appearance that is really
a cuboidal duct cell sitting on a myoepithelial cell, as in
the sweat gland. This forms what is known as a nipple
cleft.20
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