The glands of Montgomery

Can Montgomery tubercles impact aesthetic 3D nipple-areolar complex tattooing? An anatomical, quantitative analysis of breast cancer patients

PURPOSE

We aimed to establish a relationship between the amount of Montgomery tubercles (MTs) per nipple-areolar complex (NAC) given patient characteristics such as age, BMI, menopausal status, race/ethnicity, and NAC size to better inform current 3D NAC tattooing practices.

METHODS

Preoperative photographs of patients pursuing breast reconstruction after mastectomy in 2010 through 2018 were reviewed. The number of MTs on each native NAC was quantified. The impact of patient factors on the quantity of MTs was evaluated via Pearson correlation and bivariate analyses.

RESULTS

Two hundred and eleven patients (399 breasts) were reviewed. On average, patients had 5.0 ± 5.2 MTs (range, 0-25 MTs). Number of MTs did not correlate with patient age, BMI, or NAC size. Premenopausal females were more likely than postmenopausal females to have a greater number of MTs per breast (p-value = 0.0183).

CONCLUSIONS

Postmastectomy patients desiring a more "youthful" NAC may consider additional MTs when pursuing 3D NAC tattooing.

The role of papillary skin glands in guiding mouse pups to the nipple

The nipple odor of lactating mice (Mus musculus) plays a crucial role in attracting newborn pups and motivating them to suck milk. The characteristic odor of a lactating murine nipple is assumed to be a mixture of multiple odorous substrates, that is, milk, dam's and pups' saliva, skin glands' secretions, and amniotic fluid. The present study aimed to characterize the behavioral activity of the original odor mixture that develops over the nipples in the first 2 days postpartum. We extracted this odor mixture in water and evaluated its attractive and appetitive potencies using two behavioral assays (viz., relative attraction and oral activation assays). It resulted that the so-called nipple wash was as appetitive as fresh milk, and even more attractive than it. The behavioral potency of the nipples was shown to be specific to lactating nipples (relative to nulliparous nipples) and to be preserved for 2 weeks when stored at -80°C. Finally, we perfected a nipple deodorization procedure by inactivating the nipples' behavioral potency. We observed that such altered appetitive potency was fully restored 30 min after its washing, but without any maternal self-licking and pups' sucking, indicating that the secretions of the nipple skin glands' were sufficient to explain the success of neonatal guidance to the nipple.

The scent of emotions: A systematic review of human intra- and interspecific chemical communication of emotions

OBJECTIVE

The sense of olfaction has been considered of minor importance in human communication. In recent years, evidence has emerged that humans might be influenced by unconscious messages sent through chemosignals in body odors. Data concerning the ability of humans to recognize fear, maybe related to the evolutionary role of these emotions in the fight-or-flight reactions, are well known.

METHODS

To further understand the role of emotional chemosignals in mediating communication in humans and its influence on animal behaviors, we conducted a systematic literature review.

RESULTS

Chemosignals derived from axillary odors collected under a variety of emotional stimuli and sad tears in humans affect receivers' social interactions, danger detection and risk-taking behavior, social aspects of eating, and performance under stressing conditions. In addition, beyond the fight-or-flight response, even the body odors of happiness can be perceived by others. Furthermore, human chemosignals can influence behaviors and stressful responses in animals, particularly dogs and horses, which may partially explain their special relationship with humans.

CONCLUSION

Our review highlights the importance of chemosignaling in human intra- and interspecific interactions and suggests the need for further investigations, both in physiological conditions and in patients with psychiatric or neurodegenerative disorders.

Neglected aspect of the strategy for human breast diseases: trans-areolar drug delivery

Breast cancer is the most common malignancy in women worldwide. Oncoplastic surgery and partial-breast reconstruction have already developed to improve cosmetic outcomes. However, new strategies for breast diseases are still needed. The principles of evolutionary biology and phylogeny can help solve specific medical problems. But the phylogeny of human breast areola had not been researched ever since proposed. The breast areola has a unique phylogeny, it has all different types of skin glands and includes a few hairs towards the periphery. These skin appendages, including Montgomery's glands - whose miniature mammary acini are in the subcutaneous tissue - make the dermal microvascular "sink" phenomenon imperfect, resulting in that more drug molecules can penetrate into deeper tissue. Meanwhile, the wrinkled skin of the areola increases the total delivery area. Here, we emphasize that the human breast areola has the potential to increase transdermal drug delivery to the breast. We anticipate that our hypothesis may help to provide new, optimized therapeutic and prophylactic strategies for the human breast diseases.

Human breast areolae as scent organs: morphological data and possible involvement in maternal-neonatal coadaptation

In humans, areolar skin glands (AG) enlarge during pregnancy and lactation. Their role in mother-infant interactions may pertain to protective, mechanical, and communicative functions. It was questioned here whether more profuse AG could be related to more optimal adaptation to breastfeeding. A morphological study of the areolae was undertaken between birth and day 3 to assess the number, secretory status, and spatial distribution of AG. These data were related to infants' weight variation, mothers' perception of their infant's behavior at breast, and time between delivery and onset of lactation. AG were seen in virtually all women but with great interindividual variations; their areolar distribution was nonrandom, and about 1/5 of the women had AG giving off a secretion. The AG number was positively related with neonatal weight gain between birth and day 3, and with the mother's perception of infant's latching speed and sucking activity. AG numbers were also positively related with the onset of lactation in first-time mothers. In conclusion, the maternal endowment in AG may contribute to the infants' breastfeeding performance, early growth, and the mother's lactation onset.

Total skin-sparing mastectomy without preservation of the nipple-areola complex

BACKGROUND

We hypothesized that total skin-sparing mastectomy (TSM) including where the skin overlying the nipple and areola is preserved would be oncologically safe and facilitate improved cosmetic reconstruction.

METHODS

A review (May 2003 through January 2005) was completed on all procedures that were performed through an inframammary incision or a previous scar with reconstruction using Botox, AlloDerm, and a subpectoral tissue implant.

RESULTS

Thirty-one patients had 50 TSMs. Twelve percent (6/50) of TSMs had the skin of the nipple and areola resected: 4 (14% of tumors) because of tumor involvement and 2 (4%) because of skin necrosis. Fourteen percent of patients had other complications: 4% (2/50) had infection and/or flap necrosis and 10% (5/50) had superficial epidermolysis requiring no intervention, for a total complication rate of 18%. Average cosmetic score was 8.5 (range 4 to 10). No recurrences are evident after mean follow-up of 7.9 +/- 5.4 months.

CONCLUSION

Our short-term experience suggests that TSM has an acceptable complication rate, is theoretically oncologically safe, and facilitates an improved cosmetic result.

Histology of the pouch epithelium and the mammary glands during chemically induced oestrus in the brushtail possum (Trichosurus vulpecula)

Changes in the epithelium of the maternal pouch and the mammary gland of brushtail possums (Trichosurus vulpecula) were examined after animals were treated to induce ovulation with follicle-stimulating hormone (FSH), luteinizing hormone (LH), pregnant mares' serum gonadotrophin (PMSG) and oestradiol. The mammary glands were similar in appearance to those described in eutherian mammals and in previous studies on other marsupials. Exposure of possums to these compounds, particularly PMSG, appeared to result in changes in the mammary glands that could be associated with milk/secretion production. In contrast, the pouch epithelium had a similar histological appearance to that of epithelium from other parts of the body regardless of whether the animal was exposed to stimulants. These preliminary observations are discussed in the context of the purported role of the pouch epithelium and the mammary gland in production of secretions at oestrus and provision of immunological protection to the neonatal marsupial.

Nipple-areolar pigmentation: histology and potential for reconstitution in breast reconstruction

The makeup of nipple-areolar skin, in terms of its melanin and melanocyte content has not previously been established. This histological information is required if pigmentation of the reconstructed nipple-areola is to be successful in post-mastectomy breast reconstruction. We describe examination of 200 parallel sections of nipple-areolar skin of 20 women using histochemical (Masson-Fontana) and immunohistochemical (Mel-5) techniques, evaluated using quantitative image analysis. The amount of melanin present per length of basement membrane was 2.14 times higher in areolar skin than breast skin. The ratio of melanocytes to keratinocytes was 1:9.7 in areolar skin vs. 1:14.7 in breast skin. We also describe a cell culture and skin construct method using autologous human serum without toxic growth promoting additives, which could be used in the clinical setting of nipple-areolar reconstruction.

Nipple discharge and breast lump related to Montgomery's tubercles in adolescent females

Four adolescent girls, aged 12 to 14 years, were seen for evaluation of spontaneous nipple discharge, two of whom had associated breast lumps in the ipsilateral breast. Clinical examination showed the discharge to be arising from one or several of Montgomery's areolar tubercles, with the breast lumps localized to the subareolar region immediately beneath the discharging tubercle. The secretions were episodic, thin, varied in color from clear to brown, but were not milky. All discharges resolved within 3 to 5 weeks, and the associated breast lumps resolved within 4 months without treatment. There were no associated clinical complaints or physical findings and detailed endocrinologic assessments including serum prolactin, luteinizing hormone (LH), follicle-stimulating hormone (FSH), thyroid function tests, and 17 beta estradiol; they were all normal. None of these patients was pregnant, and follow-up from 4 to 18 months did not reveal evidence of recurrence or other pathology. Experience gained from these four cases suggests that cysts and spontaneous, non-milky discharge related to Montgomery's tubercles in otherwise healthy, nonpregnant adolescent females, represents a benign, self-limiting problem. Unless other indications are present, endocrinologic investigation is unnecessary and spontaneous resolution can be expected.

Melanogenic melanocytes in human sebaceous glands

Electron microscopic observations revealed for the first time a small number of active melanocytes synthesizing distinctive melanin-containing organelles (melanin granules)in the ducts and acini of human sebaceous glands.