Nipple

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Nipple
African Breast SG.jpg
A nipple, areola and breast of a female human
Details
Part of Breast
Identifiers
Latin papilla mammaria
MeSH D009558
TA98 A16.0.02.004
TA2 7105
FMA 67771
Anatomical terminology

The nipple is a raised region of tissue on the surface of the breast from which, in lactating females, milk from the mammary gland leaves the body through the lactiferous ducts to nurse an infant. [1] [2] The milk can flow through the nipple passively, or it can be ejected by smooth muscle contractions that occur along with the ductal system. The nipple is surrounded by the areola, which is often a darker colour than the surrounding skin. [3]

Contents

Male mammals also have nipples but without the same level of function or prominence. A nipple is often called a teat when referring to non-humans. "Nipple" or "teat" can also be used to describe the flexible mouthpiece of a baby bottle.

In humans, the nipples of both males and females can be sexually stimulated as part of sexual arousal. In many cultures, female nipples are sexualized, [4] or regarded as sex objects and evaluated in terms of their physical characteristics and sex appeal. [5] Some cultures have little to no sexualization of the nipple, and going topless presents no barrier.[ clarification needed ]

Etymology

The word "nipple" most likely originates as a diminutive of neb, an Old English word meaning "beak", "nose", or "face", and which is of Germanic origin. [6] The words "teat" and "tit" share a Germanic ancestor. The second of the two, tit, was inherited directly from Proto-Germanic, while the first entered English via Old French. [7] [8]

Structure

The breast: cross-section scheme of the mammary gland: Chest wall Pectoralis muscles Lobules Nipple Areola Milk duct Fatty tissue Skin Breast anatomy normal scheme.png
The breast: cross-section scheme of the mammary gland:

In mammals, a nipple (also called mammary papilla or teat) is a small projection of skin containing the outlets for 15–20 lactiferous ducts arranged cylindrically around the tip. Marsupials and eutherian mammals typically have an even number of nipples arranged bilaterally, from as few as 2 to as many as 19. [9]

The skin of the nipple is rich in a supply of special nerves that are sensitive to certain stimuli: these are slowly-adapting and rapidly-adapting cutaneous mechanoreceptors. Mechanoreceptors are identified respectively by Type I slowly-adapting with multiple Merkel corpuscle end-organs and Type II slowly-adapting with single Ruffini corpuscle end-organs, as well as Type I rapidly-adapting with multiple Meissner corpuscle end-organs and Type II rapidly-adapting with single Pacinian corpuscle end-organs. The dominant nerve supply to the nipple comes from the lateral cutaneous branches of fourth intercostal nerve. [10] The nipple is also used as an anatomical landmark. It marks the T4 (fourth thoracic vertebra) dermatome and rests over the approximate level of the diaphragm. [11]

The arterial supply to the nipple and breast originates from the anterior intercostal branches of the internal thoracic (mammary) arteries; lateral thoracic artery; and thoracodorsal arteries. The venous vessels parallel the arteries. [2] The lymphatic ducts that drain the nipple are the same for the breast. [2] The axillary nodes are the apical axillary nodes, the lateral group and the anterior group. [12] 75% of the lymph is drained through the axillary lymph nodes located near the armpit. The rest of the drainage leaves the nipple and breast through infroclavicular, pectoral, or parasternal nodes.

Since nipples change throughout the life span in men and women, the anatomy of the nipple can change and this change may be expected and considered normal.[ citation needed ]

In male mammals

nipple of an human male Nipple of male human.jpg
nipple of an human male

Almost all mammals have nipples. Why males have nipples has been the subject of scientific research. Differences among the sexes (called sexual dimorphism) within a given species are considered by evolutionary biologists to be mostly the result of sexual selection, directly or indirectly. There is a consensus that the male nipple exists because there is no particular advantage to males losing the trait. In consequence, some biologists would call the male nipple a spandrel. [13] [14] [15]

In humans, the nipples are often surrounded by body hair.

Function

Infant latched on to a nipple to breastfeed Breastfeeding infant.jpg
Infant latched on to a nipple to breastfeed
Silicone teat or nipple, used for bottle feeding Smoczek od butelki.JPG
Silicone teat or nipple, used for bottle feeding

The physiological purpose of nipples is to deliver milk, produced in the female mammary glands during lactation, to an infant. During breastfeeding, nipple stimulation by an infant will stimulate the release of oxytocin from the hypothalamus. Oxytocin is a hormone that increases during pregnancy and acts on the breast to help produce the milk-ejection reflex. Oxytocin release from the nipple stimulation of the infant causes the uterus to contract even after childbirth. [16] [17] The strong uterine contractions that are caused by the stimulation of the mother's nipples help the uterus contract to clamp down the uterine arteries. These contractions are necessary to prevent post-partum haemorrhage. [18]

When the infant suckles or stimulates the nipple, oxytocin levels rise and small muscles in the breast contract, moving the milk through the milk ducts. The result of nipple stimulation by the infant helps to move breast milk out through the ducts and to the nipple. This contraction of milk is called the "let-down reflex". [19] Latching on refers to the infant fastening onto the nipple to breastfeed. A good attachment is when the bottom of the areola (the area around the nipple) is in the infant's mouth and the nipple is drawn back inside his or her mouth. A poor latch results in insufficient nipple stimulation to create the let down reflex. The nipple is poorly stimulated when the baby latches on too close to the tip of the nipple. This poor attachment can cause sore and cracked nipples and a reluctance of the mother to continue to breastfeed. [20] [21] After birth, the milk supply increases based upon the continuous and increasing stimulation of the nipple by the infant. If the baby increases nursing time at the nipple, the mammary glands respond to this stimulation by increasing milk production.

Clinical significance

Pain

Nipple pain can be a disincentive for breastfeeding. [22] Sore nipples that progress to cracked nipples is of concern since many women cease breastfeeding due to the pain. In some instances, an ulcer will form on the nipple. [23] One reason for the development of cracked and sore nipples is the incorrect latching-on of the infant to the nipple. If a nipple appears to be wedge-shaped, white and flattened, this may indicate that the attachment of the infant is not good and there is a potential of developing cracked nipples. [24] Herpes infection of the nipple is painful. [25] Nipple pain can also be caused by excessive friction of clothing against the nipple that causes a fissure.

Discharge

Nipple discharge refers to any fluid that seeps out of the nipple of the breast. Discharge from the nipple does not occur in lactating women. And discharge in non-pregnant women or women who are not breastfeeding may not cause concern. Men that have discharge from their nipples are not typical. Discharge from the nipples of men or boys may indicate a problem. Discharge from the nipples can appear without squeezing or may only be noticeable if the nipples are squeezed. One nipple can have discharge while the other does not. The discharge can be clear, green, bloody, brown or straw-coloured. The consistency can be thick, thin, sticky or watery. [26] [27]

Some cases of nipple discharge will clear on their own without treatment. Nipple discharge is most often not cancer (benign), but rarely, it can be a sign of breast cancer. It is important to determine what is causing the discharge and to get treatment. Reasons for nipple discharge include: [26]

Sometimes, babies can have nipple discharge. This is caused by hormones from the mother before birth. It usually goes away in two weeks. Cancers such as Paget's disease (a rare type of cancer involving the skin of the nipple) can also cause nipple discharge. [26]

Nipple discharge that is not normal is bloody, comes from only one nipple, or comes out on its own without squeezing or touching the nipple. Nipple discharge is more likely to be normal if it comes out of both nipples or happens when the nipples are squeezed. Squeezing the nipple to check for discharge can make it worse. Leaving the nipple alone may make the discharge stop. [26]

Nipple discharge in a male is usually of more concern. Most of the time a mammogram and an examination of the fluid is done. A biopsy is often performed. A fine needle aspiration (FNA) biopsy can be fast and least painful. A very thin, hollow needle and slight suction will be used to remove a small sample from under the nipple. Using a local anesthetic to numb the skin may not be necessary since a thin needle is used for the biopsy. Receiving an injection to prevent pain from the biopsy may be more painful than the biopsy itself. [28]

Some men develop a condition known as gynecomastia, in which the breast tissue under the nipple develops and grows. Discharge from the nipple can occur. The nipple may swell in some men possibly due to increased levels of estrogen. [29]

Appearance

Prior to puberty, the nipples on girls are very similar to boys. DSC0216 Burma Chin Village near Lemro River Pretty little girl (7374973732).jpg
Prior to puberty, the nipples on girls are very similar to boys.

Changes in appearance may be normal or related to disease.

The average projection and size of human female nipples is slightly more than 3⁄8 inch (9.5 mm). [32]

Breast cancer

Symptoms of breast cancer can often be seen first by changes of the nipple and areola, although not all women have the same symptoms, and some people do not have any signs or symptoms at all. A person may find out they have breast cancer after a routine mammogram. Warning signs can include: [33] [34]

Changes in the nipple are not necessarily symptoms or signs of breast cancer. Other conditions of the nipple can mimic the signs and symptoms of breast cancer. [33]

Vertical transmission

Some infections are transmitted through the nipple, especially if irritation or injury to the nipple has occurred. In these circumstances, the nipple itself can become infected with Candida that is present in the mouth of the breastfeeding infant. The infant will transmit the infection to the mother. Most of the time, this infection is localized to the area of the nipple. In some cases, the infection can progress to become a full-blown case of mastitis or breast infection. [35] In some cases, if the mother has an infection with no nipple cracks or ulcerations, it is still safe to breastfeed the infant.

Herpes infection of the nipple can go unnoticed because the lesions are small but usually are quite painful. Herpes in the newborn is a serious and sometimes fatal infection. [25] Transmission of Hepatitis C and B to the infant can occur if the nipples are cracked. [36]

Other infections can be transmitted through a break of the skin of the nipple and can infect the infant.

Other disorders

Surgery

A nipple-sparing/subcutaneous mastectomy is a surgical procedure where breast tissue is removed, but the nipple and areola are preserved. This procedure was historically done only prophylactically or with mastectomy for the benign disease over the fear of increased cancer development in retained areolar ductal tissue. Recent series suggest that it may be an oncologically sound procedure for tumours not in the subareolar position. [39] [40] [41]

Society and culture

Duplessis's portrait of Marie Therese Louise of Savoy baring a nipple dates from 18th-century France. Duplessis's semi-topless portrait of the Princess of Lamballe dates from 18th Century France.png
Duplessis's portrait of Marie Thérèse Louise of Savoy baring a nipple dates from 18th-century France.

Exposure

The cultural tendency to hide the female nipple under clothing has existed in Western culture since the 1800s. [4] [5] [42] As female nipples are often perceived an intimate part, covering them might have originated under Victorian morality as with riding side saddle. Exposing the entire breast and nipple is a form of protest for some and a crime for others. [42] [43] The exposure of nipples is usually considered immodest and in some instances is viewed as lewd or indecent behavior. [44]

A case in Erie, Pennsylvania, concerning the exposure of breasts and nipple proceeded to the United States Supreme Court. [45] The Erie ordinance was regulating the nipple in public as an act that is committed when a person "knowingly or intentionally, ... appears in a state of nudity commits Public Indecency." Later in the statute, nudity is further described as an uncovered female nipple. But nipple exposure of a man was not regulated. An opinion column credited to Cecil Adams noted: "Ponder the significance of that. A man walks around bare-chested and the worst that happens is he won't get served in restaurants. But a woman who goes topless is legally in the same boat as if she'd had sex in public. That may seem crazy, but in the US it's a permissible law." [43]

The legality around the exposure of nipples is inconsistently regulated throughout the US. Some states do not allow the visualization of any part of the breast. Other jurisdictions prohibit any female chest anatomy by banning anatomical structures that lie below the top of the areola or nipple. Such is the case in West Virginia and Massachusetts. West Virginia's regulation is very specific and is not likely to be misinterpreted, stating: "[The] display of 'any portion of the cleavage of the human female breast exhibited by a dress, blouse, skirt, leotard, bathing suit, or other wearing apparel [is permitted] provided the areola is not exposed, in whole or in part.'" [43]

A Namibian woman going topless Namibie Himba 0716a.jpg
A Namibian woman going topless

The Instagram social media site has a "no nipples" policy with exceptions: material that is not allowed includes "some photos of female nipples, but photos of post-mastectomy scarring and women actively breastfeeding are allowed. Nudity in photos of paintings and sculptures is OK, too". [46] Previously, Instagram had removed images of nursing mothers. Instagram removed images of Rihanna and had her account cancelled in 2014 when she posted selfies with nipples. This was incentive for the Twitter campaign #FreeTheNipple. [47] [ better source needed ] In 2016, an Instagram page invited users to post images of nipples from both sexes; @genderless_nipples, which displays close ups of both the nipples of men and women for the purpose of spotlighting what may be inconsistency. [48] Some contributors have circumvented the policy. [49] [50] Facebook has also been struggling to define its nipple policy. [48] [51] [52]

Filmmaker Lina Esco made a film entitled Free the Nipple , which is about "laws against female toplessness or restrictions on images of female, but not male, nipples", which Esco states is an example of sexism in society. [53]

Sexuality

Nipples can be sensitive to touch, and nipple stimulation can incite sexual arousal. [54] Few women report experiencing orgasm from nipple stimulation. [55] [56] Before Komisaruk et al.'s functional magnetic resonance (fMRI) research on nipple stimulation in 2011, reports of women achieving orgasm from nipple stimulation relied solely on anecdotal evidence. [57] Komisaruk's study was the first to map the female genitals onto the sensory portion of the brain; it indicates that sensation from the nipples travels to the same part of the brain as sensations from the vagina, clitoris and cervix, and that these reported orgasms are genital orgasms caused by nipple stimulation, and may be directly linked to the genital sensory cortex ("the genital area of the brain"). [57] [58] [59]

Piercings

This section is an excerpt from Nipple piercing.[ edit ]
Nipple piercing in women and men.jpg
A nipple piercing is a type of body piercing, centered usually at the base of the nipple. It can be pierced at any angle but is usually done horizontally or, less often, vertically. It is also possible to place multiple piercings on top of one another.

In business

Some companies and non-profit organisations have used the word nipple or images of nipples to draw attention to their product or cause. [53] [60]

See also

Related Research Articles

<span class="mw-page-title-main">Breast</span> Region of the torso of a primate that in females serves as a mammary gland

The breasts are two prominences located on the upper ventral region of the torso among humans and other primates. Both sexes develop breasts from the same embryological tissues. The relative size and development of the breasts is a major secondary sex distinction between females and males. There is also considerable variation in size between individuals. Female humans are the only mammals which permanently develop breasts at puberty; all other mammals develop their mammary tissue during the latter period of pregnancy; at puberty, estrogens, in conjunction with growth hormone, cause permanent breast growth.

<span class="mw-page-title-main">Mastectomy</span> Surgical removal of one or both breasts

Mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. A mastectomy is usually carried out to treat breast cancer. In some cases, women believed to be at high risk of breast cancer have the operation as a preventive measure. Alternatively, some women can choose to have a wide local excision, also known as a lumpectomy, an operation in which a small volume of breast tissue containing the tumor and a surrounding margin of healthy tissue is removed to conserve the breast. Both mastectomy and lumpectomy are referred to as "local therapies" for breast cancer, targeting the area of the tumor, as opposed to systemic therapies, such as chemotherapy, hormonal therapy, or immunotherapy.

<span class="mw-page-title-main">Areola</span> Pigmented area on the breast around the nipple

The human areola is the pigmented area on the breast around the nipple. More generally, an areola is a small circular area on the body with a different histology from the surrounding tissue, or other small circular areas such as an inflamed region of skin.

<span class="mw-page-title-main">Mastitis</span> Medical condition

Mastitis is inflammation of the breast or udder, usually associated with breastfeeding. Symptoms typically include local pain and redness. There is often an associated fever and general soreness. Onset is typically fairly rapid and usually occurs within the first few months of delivery. Complications can include abscess formation.

<span class="mw-page-title-main">Paget's disease of the breast</span> Medical condition

Paget's disease of the breast is a rare skin change at the nipple nearly always associated with underlying breast cancer. Paget's disease of the breast was first described by Sir James Paget in 1874. The condition is an uncommon disease accounting for 1 to 4% of all breast cancers cases. 92% to 100% of patients with Paget's disease of the breast have an underlying breast cancer.

<span class="mw-page-title-main">Areolar gland</span> Oil glands around the nipple that promote breastfeeding

Areolar glands, also known as glandulae areolares, Montgomery glands, and tubercula areolae, are 10-15 elevations found on the areola. They are usually arranged in a circle around the nipple, and can be particularly visible when the nipple is erect. Their role is to promote adequate breastfeeding of the infant.

<span class="mw-page-title-main">Breast engorgement</span> Medical condition

Breast engorgement occurs in the mammary glands due to expansion and pressure exerted by the synthesis and storage of breast milk. It is also a main factor in altering the ability of the infant to latch-on. Engorgement changes the shape and curvature of the nipple region by making the breast inflexible, flat, hard, and swollen. The nipples on an engorged breast are flat or inverted. Sometimes it may lead to striae on nipples, mainly a preceding symptom of septation mastitis.

<span class="mw-page-title-main">Nipple piercing</span> Body piercing, centered usually at the base of the nipple

A nipple piercing is a type of body piercing, centered usually at the base of the nipple. It can be pierced at any angle but is usually done horizontally or, less often, vertically. It is also possible to place multiple piercings on top of one another.

<span class="mw-page-title-main">Nipple discharge</span> Medical condition

Nipple discharge is fluid from the nipple, with or without squeezing the breast. The discharge can be milky, clear, green, purulent, bloody, or faintly yellow. The consistency can be thick, thin, sticky, or watery.

Breast pain is the symptom of discomfort in either one or both breasts. Pain in both breasts is often described as breast tenderness, is usually associated with the menstrual period and is not serious. Pain that involves only one part of a breast is more concerning, particularly if a hard mass or nipple discharge is also present.

<span class="mw-page-title-main">Inverted nipple</span> Medical condition

An inverted nipple is a condition where the nipple, instead of pointing outward, is retracted into the breast. In some cases, the nipple will be temporarily protruded if stimulated. Both women and men can have inverted nipples.

<span class="mw-page-title-main">Lactiferous duct</span> Structure carrying milk to the nipple

Lactiferous ducts are ducts that converge and form a branched system connecting the nipple to the lobules of the mammary gland. When lactogenesis occurs, under the influence of hormones, the milk is moved to the nipple by the action of smooth muscle contractions along the ductal system to the tip of the nipple. They are also referred to as galactophores, galactophorous ducts, mammary ducts, mamillary ducts or milk ducts.

<span class="mw-page-title-main">Nipple shield (breastfeeding)</span>

A nipple shield is a nipple-shaped sheath worn over the areola and nipple during breastfeeding. Modern nipple shields are made of soft, thin, flexible silicone and have holes at the end of the nipple section to allow the breast milk to pass through.

<span class="mw-page-title-main">Erotic lactation</span> Sexual activity involving the stimulation of a female or male breast

Erotic lactation is sexual arousal by sucking on a female or male breast. Depending on the context, the practice can also be referred to as adult suckling, adult nursing, and adult breastfeeding. Practitioners sometimes refer to themselves as being in an adult nursing relationship (ANR). Two persons in an exclusive relationship can be called a nursing couple.

<span class="mw-page-title-main">Breastfeeding difficulties</span> Medical condition

Breastfeeding difficulties refers to problems that arise from breastfeeding, the feeding of an infant or young child with milk from a woman's breasts. Although babies have a sucking reflex that enables them to suck and swallow milk, and human breast milk is usually the best source of nourishment for human infants, there are circumstances under which breastfeeding can be problematic, or even in rare instances, contraindicated.

<span class="mw-page-title-main">Lactation</span> Release of milk from the mammary glands

Lactation describes the secretion of milk from the mammary glands and the period of time that a mother lactates to feed her young. The process naturally occurs with all sexually mature female mammals, although it may predate mammals. The process of feeding milk in all female creatures is called nursing, and in humans it is also called breastfeeding. Newborn infants often produce some milk from their own breast tissue, known colloquially as witch's milk.

<span class="mw-page-title-main">Nipple stimulation</span> Human sexual practice

Nipple stimulation or breast stimulation is stimulation of the breast. Stimulation may be by breastfeeding, sexual activity, an indirect non-sexual response, or kissing the nipple. As part of sexual activity, the practice may be performed upon, or by, people of any gender or sexual orientation. It may occur with the use of fingers, orally, such as by sucking or licking, as well as by use of an object.

Cracked nipple is a condition that can occur in breastfeeding women as a result of a number of possible causes. Developing a cracked nipple can result in soreness, dryness or irritation to, or bleeding of, one or both nipples during breastfeeding. The mother with a cracked nipple can have severe nipple pain when the baby is nursing. This severe pain is a disincentive for continued breastfeeding. The crack can appear as a cut across the tip of the nipple and may extend to its base. Cracked nipple can develop after the birth of the infant and is managed with pharmacological and nonpharmacological treatment.

<span class="mw-page-title-main">Latch (breastfeeding)</span> The way a baby fastens onto the breast while breastfeeding

Latch refers to how the baby fastens onto the breast while breastfeeding. A good latch promotes high milk flow and minimizes nipple discomfort for the mother, whereas poor latch results in poor milk transfer to the baby and can quickly lead to sore and cracked nipples. In a good latch, both the nipple and a large portion of the areola are in the baby's mouth.

Nipple pain is a common symptom of pain at the nipple that occurs in women during breastfeeding after childbirth. The pain shows the highest intensity during the third to the seventh day postpartum and becomes most severe on the third day postpartum.

References

Citations

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  48. 1 2 Toor, Amar (6 December 2016). "Genderless Nipples exposes Instagram's double standard on nudity". The Verge. Retrieved 13 August 2017.
  49. ↑ "Art student challenges 'sexist' ban on nipples on Instagram with new project - BBC Newsbeat". BBC News. 6 June 2017. Retrieved 14 August 2017.
  50. ↑ Shire, Emily (9 September 2014). "Women, It's Time to Reclaim Our Breasts". The Daily Beast– via www.thedailybeast.com.
  51. ↑ "Community Standards". m.facebook.com. Retrieved 14 August 2017.
  52. ↑ "Is Facebook going to start freeing the nipple?". Fox News . 24 October 2016. Retrieved 14 August 2017.
  53. 1 2 Shire, Emily (9 September 2014). "Women, It's Time to Reclaim Our Breasts". The Daily Beast.
  54. ↑ Harvey, John H.; Wenzel, Amy; Sprecher, Susan (2004). The Handbook of Sexuality in Close Relationships. Psychology Press. p. 427. ISBN   978-1135624705 . Retrieved August 12, 2017.
  55. ↑ Kinsey, Alfred C.; Pomeroy, Wardell B.; Martin, Clyde E.; Gebhard, Paul H. (1998). Sexual Behavior in the Human Female. Indiana University Press. p. 587. ISBN   978-0253019240 . Retrieved August 12, 2017. There are some females who appear to find no erotic satisfaction in having their breasts manipulated; perhaps half of them derive some distinct satisfaction, but not more than a very small percentage ever respond intensely enough to reach orgasm as a result of such stimulation (Chapter 5). [...] Records of females reaching orgasm from breast stimulation alone are rare.
  56. ↑ Boston Women's Health Book Collective (1996). The New Our Bodies, Ourselves: A Book by and for Women. Simon & Schuster. p. 575. ISBN   978-0684823522 . Retrieved August 12, 2017. A few women can even experience orgasm from breast stimulation alone.
  57. 1 2 Merril D. Smith (2014). Cultural Encyclopedia of the Breast. Rowman & Littlefield. p. 71. ISBN   978-0759123328 . Retrieved August 12, 2017.
  58. ↑ Justin J. Lehmiller (2013). The Psychology of Human Sexuality. John Wiley & Sons. p. 120. ISBN   978-1118351321 . Retrieved August 12, 2017.
  59. ↑ Komisaruk, B. R.; Wise, N.; Frangos, E.; Liu, W.-C.; Allen, K; Brody, S. (2011). "Women's Clitoris, Vagina, and Cervix Mapped on the Sensory Cortex: fMRI Evidence". The Journal of Sexual Medicine . 8 (10): 2822–30. doi:10.1111/j.1743-6109.2011.02388.x. PMC   3186818 . PMID   21797981.
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Bibliography

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