nipple

Synonyms in the broader sense

Breast gland, mamma, mastos, mastodynia, mastopathy, breast carcinoma, breast cancer

Female breast, mom

Anatomy of the nipple

The nipple ( Mamilla, Mamille ) is a circular structure in the middle of the breast region, which is more pigmented, ie darker than the surrounding skin. It consists of the actual nipple, ie the part that bulges outward and is darkest, and the surrounding areola ( areola ), which also has an increased pigmentation, but is located at the level of the skin. The size and color of this areola can vary greatly from person to person, a standard value therefore does not really exist here.

Illustration of a nipple

Figure nipple: vertical section through the nipple

Nipple (Mamilla)
Papilla mammaria

  1. Milk duct
    Ductus lactifer
  2. Milk Bag -
    Sinus lactifer
  3. Nipple Ring Muscle -
    Sphincter papillae
  4. Vein - Vena
  5. Elastic tendons to the skin -
    Fibrae elasticae
  6. Areola -
    Areola mammae
  7. Arechial glands -
    Glandulae areolar
  8. Longitudinal muscle train
  9. Adipose tissue -
    Corpus adiposum mammae

Figure female breast

Figure Breast gland of a young woman: vertical section through the nipple (A) and muscles of the anterior chest wall from the left (B)
  1. Nipple -
    Papilla mammaria
  2. Areola -
    Areola mammae
  3. Milk duct
    Ductus lactifer
  4. Lump of the mammary gland -
    Lobuli glandulae mammariae
  5. Adipose tissue -
    Corpus adiposum mammae
  6. Ribs - Costas
  7. Big Breast Muscle -
    M.pectoralis major
  8. Anterior sawing muscle -
    M. serratus anterior
  9. Outer oblique
    Abdominal Muscle -
    Musculus obliquus
    externus abdominis
  10. Thoracic wall - thorax
  11. Skin - cutis

development

Nipples can be found both in men and in women. This is because they develop in the womb at a very early stage of embryonic development, in which it is not yet possible to distinguish between male and female features. That is why, as many do not know, men also have the mammary glands, which is why hormones are nowadays even able to make men breastfeed.
Normally, however, the mammary glands and warts in men have no function, except that they, as in the woman, through their erection can represent a state of sexual arousal. However, this erection is not comparable to the erection of the sexual organs. It does not happen with the help of special erectile tissue, but is caused by the constriction of smooth muscle triggered by the autonomic nervous system. This is similar to the principle that our body hairs erect in cold or strong emotions and goose bumps arise as a reflex of the hair follicle muscle is triggered. The erection is caused by the release of the hormone oxytocin, which can be caused by cold, touch or other sexual stimuli or the breastfeeding of an infant.

Structure and function of the nipple

In their breasts, females have about 15 to 20 mammary glands embedded in fatty tissue, all of which exhale in the nipple. These mammary glands are formed only by the influence of female hormones during puberty from the previously existing sebaceous gland tissue. In the menopause, there is again a change in the female hormone balance, which is why at this time in many women, the mammary glands, more or less back. The function of the nipples lies in the release of breast milk produced by the mammary gland, which serves the infant as food.

The nipple and the surrounding areola are a very sensitive area. They react very strongly to external stimuli and are therefore also called the erogenous zone. So, if the infant wants to drink and looks for the nipple, finding it on the one hand will be made easier by its erection, and on the other by the presence of many scent and sebaceous glands within the areola. When he sucks on the nipple, the breast milk is emptied.

Appearance

Depending on the person, nipples can look very different, so there is a large frame within which everything is still considered "normal" because every human being is different. However, there are also some anatomical features that occur frequently and deserve special consideration.
These include, for example, the so-called nipples (also: hollow warts). These are nipples that are practically not exposed to the outside, but are permanently turned inside. Usually this is a cosmetic problem, if any at all. However, this may be difficult for some women who want to breastfeed.

Diseases of the nipple

Some people find more than two nipples. This condition is called polythelia. The extra nipple can be anywhere along the milk strips that run from the axillary to the groin area.
Pain in the nipple can have various causes. Sometimes just wearing some clothes can cause pain or itching of the nipple or nipples. In most cases, however, the symptoms are hormonal, so come especially in women during puberty, pregnancy (read also our topic pregnancy nipples) or breast-feeding.
However, the mammary glands can also inflame, which usually leads to pain, redness, swelling and overheating of the nipple area in addition to pain.
Inflammations of the nipple mainly occur during breastfeeding, but can also be caused by other factors such as thyroid dysfunction. Whenever it comes to externally visible changes in the nipples and / or liquid (whether clear, milky or bloody secretion) escapes from them (except, of course, breastfeeding mothers), you should be attentive and, as a precaution, seek medical attention to a malignant Disease such as exclude a tumor that is partially associated with these symptoms.

Burning / itchy nipple

There are numerous causes that can cause itching or burning of the nipple. An irritation of the Mamille by various things is a frequent trigger of these complaints.

Here, for example, the clothing - especially the bra - irritating to the skin. The skin of the wart responds to the constant irritation and it comes to burning and / or itching.
Even cosmetics can be a cause. If the itching occurs shortly after you have used a new care product, so here is the context close. In question are all products, from body lotion on soap to perfumes.
In this case, a break in the application of the cosmetic product should clarify the question of whether this is the trigger for the symptoms. If this is indeed the case, then of course you should switch to another product.
The same is true when a bra is the reason for itching or burning. Here, the substance, but also the unfavorable seat of the bra, the cause can be.

Also, a mechanical over-stimulation of the nipple in breastfeeding mothers can cause discomfort that show as itching or burning. In this case, cooling and skin soothing ointments can provide relief.

To itchy nipples may also rarely cause inflammation of the mammary glands. This is called mastitis. This is usually a part of the breast reddened, overheated, swollen and clearly painful. These symptoms should guide you to see a doctor. If there is actually mastitis, treatment with antibiotics, medications that inhibit the milk-stimulating hormone prolactin, or small surgical procedures may be used.
Often, cooling the affected breast provides relief.

Even a rash of the skin, an eczema, can lead to excruciating itching. The skin may then be reddened and dry, with various changes. With such symptoms, a presentation with the dermatologist makes sense, this may possibly contain an ointment containing cortisone or a similar drug, remedy.

Even a fungal infection of the skin can cause itching and burning of the nipple, even in this case, a dermatologist may provide relief with ointments.

Another relatively common cause of itching or burning of the nipple are phases of hormonal conversion during puberty and pregnancy and lactation, as well as menopause.

Another very important though rare cause of a one-sided itchy nipple is breast cancer. Here are usually other symptoms such as palpable lumps, milky or bloody discharge from the nipple, swollen lymph nodes, skin lesions of the breast and others.
However, even if the persistent itching is the only symptom, a doctor should always be consulted who can detect a possible breast cancer through physical examination and an X-ray of the breast (mammography). Because the earlier a breast cancer is detected, the better the treatment options.

Pain on the nipple

There are many causes for painful nipples. Often they can be triggered by mechanical irritation of the nipple. Reason for such irritation may be, for example, garments, especially the bra.
If this is the case, then the bra should be changed and it should wait to see if the pain is declining. Both the fabric and the seat of a bra can cause irritation to the chest.
Another cause of mechanical irritation of the nipple is breastfeeding the infant. Therefore breastfeeding mothers often suffer from itchy, burning or painful nipples. Here, ointments that soothe the skin, often provide relief.
A cooling of the nipple is usually good for such complaints.

Another cause of pain in the area of ​​the nipple may be inflammation of the mammary glands. This disease is called mastitis. It is common in breastfeeding mothers, but is more common in non-breastfeeding and non-pregnant women.
Mostly the breast is clearly red in a limited area, overheated, swollen and tender.

In addition to cooling measures - depending on the cause - antibiotics or drugs that lead to an inhibition of the hormone prolactin, which causes an increased milk flow, are used. If an abscess has already formed after prolonged mastitis, small surgical procedures may be necessary.

Often, periods of hormonal change can cause chest pain. Especially girls in puberty and women during and after pregnancy but also during menopause are affected.
Skin disorders can also trigger chest pain. In this case, skin changes and symptoms such as itching or burning are usually present. In this case, a presentation with the dermatologist may be useful.

It should never be forgotten that breast cancer can manifest itself in a variety of symptoms. Therefore, unilateral chest pain should not be taken lightly. Rarely, pain alone is an indication of breast cancer, and there are often other symptoms such as discharge from the nipple, palpable lumps, skin lesions of the breast or lymph node swelling.
However, this is not always the case. Therefore, for chest pain that persists for more than a few days, the gynecologist's visit should always be considered. This can find out by a palpation examination and an x-ray examination of the breast (mammography) and possibly further examinations such as blood tests, whether it is breast cancer or another cause of the pain.

Fed nipple

Retraction of the nipple is referred to as nipple retraction. It can be unilaterally or bilaterally and may be innate or acquired. A harmless cause for a withdrawal of the nipple is the image of the nipple or nipple. Here is the nipple of one or both breasts pulled inwards. This usually develops to full extent during the course of breast development during puberty. Slip warts are a purely cosmetic problem, many women with cavities disturb the appearance of her breast.
In addition, it can come after pregnancy while breastfeeding to difficulties if the infant can not properly grip the nipple.

There are both conservative and surgical options for treatment.
Conservative massage techniques or a nipple shaper come into question. In the field of cosmetic surgery, the nipples can be erected by means of minor surgical procedures.

A second important cause of nipple retraction and thus an essential differential diagnosis of the nipple wart is breast cancer (breast cancer). In addition to a palpable knot in the breast, a retracted nipple can be a sign of cancer. Therefore, a one-sided retraction of the nipple that has not previously existed should always exalt increased awareness. Other possible breast cancer symptoms include orange peel around the breast, unilateral bloody nipple secretion, and a permanently eczematous nipple.
It should be promptly visited a gynecologist on the occurrence of such symptoms. This can draw first conclusions by inspection and keys and if necessary narrow the diagnosis by creating an X-ray image of the breast (mammography). Although it ultimately turns out to be a harmless finding, healthy caution is never wrong with changes in the chest.

nipples inflammation

Inflammation of the nipple is rarely isolated. In most cases there is inflammation of the breast itself, more specifically the glandular body in the interior of the breast. Such an inflammation of the glandular body is called mastitis. Two types are distinguished here.

Mastitis puerperalis occurs only in women who have given birth to a child for days or a few weeks, so it is a disease of the weekbed.
In contrast, non-puerperal mastitis occurs independently of the puerperium.

Mastitis in the puerperium most often occurs in the second week after birth. The causative agent that causes the inflammation is usually Staphylococcus aureus and is transmitted during breastfeeding. The inflammation is usually present only in one part of the breast, often it is the upper outer quadrant of the breast. The area is red, overheated, painful and swollen.
The nursing function is restricted. There is a marked malaise with fever and swollen lymph nodes around the armpit of the affected side.
If the inflammation is not treated, an abscess may develop, which then has to be treated surgically.

Therapeutic - depending on the stage of the disease - cooling, immobilization by a firm bra and pumping out the milk in question. The pumping is done to prevent a milk congestion, the milk is then discarded because it is germinated.
The use of antibiotics is quite useful in the early stages. Possibly, the milk production is also inhibited by medication. If there is already an abscess, it must - depending on the size - be punctured or split and emptied.

Mastitis non-puerperalis is a disease of the sexually mature but not pregnant woman, usually before the menopause. It can be caused by bacteria, here are most often staphylococci the triggering agents.
Non-bacterial mastitis also occurs. Reasons for this may include milk flow (galactorrhoea), mastopathy or warts (nipples) be. The increased milk flow can be hormonally or medically triggered or caused by stress.

The symptoms of non-puerperal mastitis are similar to those of mastitis puerperalis, it comes in a circumscribed area of ​​the chest to redness, overheating, pressure pain and swelling. A very important differential diagnosis is inflammatory breast cancer, a type of breast cancer. Again, the breast is often red and overheated.
If the therapy does not respond or otherwise uncertainty about the diagnosis is therefore a sampling (biopsy) for accurate differentiation conceivable. Therapeutically, in non-puerperal mastitis especially prolactin inhibitors in question, since the often causative milk flow is caused by too much of the hormone prolactin. One drug from this group is bromocriptine.

The therapy should be continued for up to 6 weeks as it can quickly lead to recurrence. Furthermore, cooling causes a complaint. Antibiotics are used for non-puerperal mastitis caused by bacteria.


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