- Email: [email protected]
A suggested treatment for inverted nipples
A SUGGESTED TREATMENT FOR INVERTED NIPPLES
J. BROOKS HOFFMAN, M.D., GREENWICH, CONN. LTHOUGH during the last ten years there has seemed to be a gradual turning away from breast feeding, due perhaps to the intricacies of our present-day society, there is still a large group of women who seriously desire and plan to nurse their babies. For the most part these patients do very well, with the exception of an occasional cracked nipple, which can prove to be most distressing for a period of time. Breast abscess still sometimes proves to be a disturbing complication with patients who breast feed. With careful instruction, however, as to proper breast care this complication should he avoided. One of the main difficulties with proper breast feeding today is the so-called fiat or inverted nipple. If this abnormality is not corrected or at least an attempt made at correction before breast feeding begins, the procedure is usually not satisfactory nor successful. Sometimes a breast pump is used to exert considerable suction upon the nipple as a whole to withdraw it from its inverted position and, after this process has been carried out for a period of time, the child is allowed to go to the breast directly.
A
/ Fi g . 1.- Horizontal position.
When one consults the usual texts in obstetrics, it is impossible to find specific means of therapy for this condition. In the tenth edition of Williams Obstetrics, Eastman1 states, "In the presence of this anomaly daily attempts should be made during the last few months of pregnancy to draw the nipple out by traction with the fingers. This, however, is rarely successful so that if the 346
Volume 66 Number 2
SUGGESTED TREATMENT FOR INVERTED NIPPLES
347
nipples cannot be made available by the temporary use of an electric pump, suckling will have to be discontinued." GreenhilP likewise has little to offer for this difficulty. He states, "If the nipples are flat, they may be drawn out for a few minutes each day during the last few weeks of pregnancy. This must be done most gently and only after demonstration by a physician or a nurse." It has been my impression that the lay journals have done a better job in describing this difficulty and its treatment than we have in our authoritative texts. For the last two years I have been carrying out a procedure which is unusually simple to do and so far has proved to be quite rewarding with those patients who have inverted nipples and who desire to breast feed. Since beginning this type of instruction no patient has had to stop breast feeding because of this difficulty. The accompanying two diagrams portray the procedure which I have been following. The procedure is one of placing the thumbs, or the forefingers, close to the inverted nipple, then pressing into the breast tissue quite firmly and gradually pushing the fingers away from the areola. An imaginary cross is drawn on the breast, that is, a vertical line and a horizontal line, and the patient is instructed to put her two thumbs close to the nipple, press in firmly against the breast tissue, and then pull the thumb or finger laterally in the horizontal position or upward and dqwnward in the
l!'ig. 2.-Vertical positi on .
vertical position. If she does this procedure four or five times in succession when she awakens in the morning, the nipple will immediately assume an erect and projected position. After it has been brought out to this projected position, it is easier to grasp as a whole unit and, by grasping it at its base, she can gently tease it out a bit further.
348
HOFFMAN
Am.
J, Obst. & Gynec. August, 1953
The patient is instructed to begin these exercises at about the fifth or sixth month of pregnancy. I have had some patients carry them out from the beginning with excellent results. I offer these suggestions for this minor difficulty hoping that others may be willing to try this simple procedure and perhaps get the same gratifying results which have come to me.
References 1. Eastman, N . .J.:
Williams Obstetrics, ed. 10, New York, 19501 Appleton-Century-Croft~, Inc., p. 971. 2. DeLee, .J. B., and Greenhill, J. P.: Principles and Practice o:f Obstetrics, ed. 9, Philadelphia, 1947, W. B. Saunders Company, p. 99.
J. BROOKS HOFFMAN, M.D., GREENWICH, CONN. LTHOUGH during the last ten years there has seemed to be a gradual turning away from breast feeding, due perhaps to the intricacies of our present-day society, there is still a large group of women who seriously desire and plan to nurse their babies. For the most part these patients do very well, with the exception of an occasional cracked nipple, which can prove to be most distressing for a period of time. Breast abscess still sometimes proves to be a disturbing complication with patients who breast feed. With careful instruction, however, as to proper breast care this complication should he avoided. One of the main difficulties with proper breast feeding today is the so-called fiat or inverted nipple. If this abnormality is not corrected or at least an attempt made at correction before breast feeding begins, the procedure is usually not satisfactory nor successful. Sometimes a breast pump is used to exert considerable suction upon the nipple as a whole to withdraw it from its inverted position and, after this process has been carried out for a period of time, the child is allowed to go to the breast directly.
A
/ Fi g . 1.- Horizontal position.
When one consults the usual texts in obstetrics, it is impossible to find specific means of therapy for this condition. In the tenth edition of Williams Obstetrics, Eastman1 states, "In the presence of this anomaly daily attempts should be made during the last few months of pregnancy to draw the nipple out by traction with the fingers. This, however, is rarely successful so that if the 346
Volume 66 Number 2
SUGGESTED TREATMENT FOR INVERTED NIPPLES
347
nipples cannot be made available by the temporary use of an electric pump, suckling will have to be discontinued." GreenhilP likewise has little to offer for this difficulty. He states, "If the nipples are flat, they may be drawn out for a few minutes each day during the last few weeks of pregnancy. This must be done most gently and only after demonstration by a physician or a nurse." It has been my impression that the lay journals have done a better job in describing this difficulty and its treatment than we have in our authoritative texts. For the last two years I have been carrying out a procedure which is unusually simple to do and so far has proved to be quite rewarding with those patients who have inverted nipples and who desire to breast feed. Since beginning this type of instruction no patient has had to stop breast feeding because of this difficulty. The accompanying two diagrams portray the procedure which I have been following. The procedure is one of placing the thumbs, or the forefingers, close to the inverted nipple, then pressing into the breast tissue quite firmly and gradually pushing the fingers away from the areola. An imaginary cross is drawn on the breast, that is, a vertical line and a horizontal line, and the patient is instructed to put her two thumbs close to the nipple, press in firmly against the breast tissue, and then pull the thumb or finger laterally in the horizontal position or upward and dqwnward in the
l!'ig. 2.-Vertical positi on .
vertical position. If she does this procedure four or five times in succession when she awakens in the morning, the nipple will immediately assume an erect and projected position. After it has been brought out to this projected position, it is easier to grasp as a whole unit and, by grasping it at its base, she can gently tease it out a bit further.
348
HOFFMAN
Am.
J, Obst. & Gynec. August, 1953
The patient is instructed to begin these exercises at about the fifth or sixth month of pregnancy. I have had some patients carry them out from the beginning with excellent results. I offer these suggestions for this minor difficulty hoping that others may be willing to try this simple procedure and perhaps get the same gratifying results which have come to me.
References 1. Eastman, N . .J.:
Williams Obstetrics, ed. 10, New York, 19501 Appleton-Century-Croft~, Inc., p. 971. 2. DeLee, .J. B., and Greenhill, J. P.: Principles and Practice o:f Obstetrics, ed. 9, Philadelphia, 1947, W. B. Saunders Company, p. 99.