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Rev. argent. mastología ; 39(144): 101-125, sept. 2020. graf, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1150869


Introducción: La mastectomía de reducción de riesgo contalateral (MRRC) es una procedimiento que ha ido incrementándose en los últimos años sin demostrar un claro beneficio en cuanto a supervivencia global. Este incremento paradójicamente se ve reflejado en pacientes con bajo riesgo de desarrollar un carcinoma de mama contralateral. Objetivo: El objetivo de este trabajo es analizar las características de las pacientes con diagnóstico de cáncer de mama unilateral, que optan por realizar MRRC y su calidad de vida, evaluado el procedimiento, la satisfacción global y el impacto que genera en las pacientes, tanto a nivel psicológico, cosmético, social y sexual. Material y método: Se realizó un estudio retrospectivo transversal de pacientes con diagnostico de cáncer de mama unilateral tratadas con mastectomía que optaron por realizar MRRC entre el año 2005 y octubre del año 2019. Se incluyeron 74 pacientes que realizaron MRRC. Resultados: La edad de las pacientes fue de 43.6 años. Dentro de nuestra casuística el 92.8% de las pacientes se encuentran satisfechas reflejando una buena calidad de vida. La totalidad de las pacientes volvería a optar por este procedimiento y están satisfechas con la decisión tomada. Por el contrario el 7.2% no se encuentran satisfechas, reflejándose negativamente en su bienestar sexual, imagen corporal y comodidad frente a una reunión social. Conclusiones: Si bien el grado de satisfacción en cuanto a la realización de la MRRC es elevado, hay que tener en cuenta que este procedimiento no está libre de complicaciones y efectos adversos los cuales impactan en diferentes aspectos psicosociales de las pacientes afectando así su calidad de vida, Es por esto que la decisión para realizar este procedimiento debe ser contemplada con cuidado asesorando a las pacientes e informando tanto los riesgos como los beneficios del mismo.

Introduction: Contralateral Prophylactic Mastectomy (CPM) it's a procedure that has been increasing in the last years, without demonstrating a clear benefit in overall survival. Paradoxically this increase is reflected in low risk patients who decide to undergo CPM. Objetive: The purpose of this study is to describe the characteristics of the patients with unilateral breast cancer who decide to undergo CPM, analyzing this procedure, evaluating quality of life, global satisfaction and the psychological, cosmetic social and sexual outcomes. Material and method: A restrospective trial was conducted on patients diagnosed with unilateral breast cancer, who underwent mastectomy and CPM between the year 2005 and october 2019. 74 patients were included in this tria. Results: The mean age of patients in this study was 43.6 years. In our study 92.8% of the patients were satisfied, reflecting this in their quality of life. All patients would choose this procedure again, and are satisfied with the decision they have mad. On the other end 7.2% were dissatisfied, reflecting this result negatively in their sexual well being, body image and comfort in social meeting. Conclusions: Although the rate of satisfaction with performance of CPM is elevated, we must consider that this procedure is not free of complications and adverse errects. In fact they do exist and they impact in different psychosocial aspect, and quality of lige. This is why the decision to carry out this procedure must be carefully considered, advising patients and informing both the risks and benefits of it.

Humans , Female , Mastectomy , Personal Satisfaction , Quality of Life , Body Image , Unilateral Breast Neoplasms , Prophylactic Mastectomy
Cancer Research and Treatment ; : 1370-1379, 2019.
Article in English | WPRIM | ID: wpr-763223


PURPOSE: This first Korean prospective study is to evaluate the feasibility of prone breast radiotherapy after breast conserving surgery for left breast cancer patients who have relatively small breast size and we present dosimetric comparison between prone and supine positions. MATERIALS AND METHODS: Fifty patients underwent two computed tomography (CT) simulations in supine and prone positions. Whole breast, ipsilateral lung, heart, and left-anterior-descending coronary artery were contoured on each simulation CT images. Tangential-fields treatment plan in each position was designed with total 50 Gy in 2-Gy fractions, and then one of the positions was designated for the treatment by comparing target coverage and dose to normal organs. Also, interfractional and intrafractional motion was evaluated using portal images. RESULTS: In total 50 patients, 32 cases were decided as prone-position–beneficial group and 18 cases as supine-position–beneficial group based on dosimetric advantage. Target dose homogeneity was comparable, but target conformity in prone position was closer to optimal than in supine position. For both group, prone position significantly increased lung volume. However, heart volumewas decreased by prone position for prone-position–beneficial group but was comparable between two positions for supine-position–beneficial group. Lung and heart doses were significantly decreased by prone position for prone-position–beneficial group. However, prone position for supine-position–beneficial group increased heart dose while decreasing lung dose. Prone position showed larger interfractional motion but smaller intra-fractional motion than supine position. CONCLUSION: Prone breast radiotherapy could be beneficial to a subset of small breast patients since it substantially spared normal organs while achieving adequate target coverage.

Breast Neoplasms , Breast , Coronary Vessels , Feasibility Studies , Heart , Humans , Lung , Mastectomy, Segmental , Prone Position , Prospective Studies , Radiotherapy , Supine Position , Unilateral Breast Neoplasms
Article in English | WPRIM | ID: wpr-762699


PURPOSE: There has been an increasing trend in the use of contralateral prophylactic mastectomy (CPM) among women diagnosed with unilateral breast cancer or mutations in BRCA1 or BRCA2 to reduce the occurrence of contralateral breast cancer. This study aimed to examine trends in the CPM rate according to clinicopathologic and socioeconomic status at a single institution in Korea. METHODS: This study included 128 patients with mutations in BRCA1 or BRCA2. Patients were divided into a CPM group (n = 8) and a non-CPM group (n = 120) between May 2013 and March 2016. The main outcome variables, including epidemiology, clinical features, socioeconomic status, and tumor characteristics, were analyzed. RESULTS: A total of 8 CPMs were performed among 128 patients. All CPM patients were married. The proportion of professional working women was higher in the CPM group (P = 0.049). Most patients who underwent CPM graduated college, compared to less than a third of the non-CPM group (P = 0.013). The CPM group had a higher rate of visits to the Hereditary Breast and Ovarian Cancer (HBOC) clinic (P = 0.021). The risk-reducing salpingo-oophorectomy (RRSO) rate was significantly higher in the CPM group (P < 0.01). CONCLUSION: CPM rates were significantly different according to socioeconomic status. The CPM rate tends to increase in highly educated and professional working women. The socioeconomic status of patients is an important factor in the decision to participate in the HBOC clinic and undergo CPM or RRSO.

Breast , Breast Neoplasms , Epidemiology , Female , Humans , Korea , Mastectomy , Ovarian Neoplasms , Social Class , Unilateral Breast Neoplasms , Women, Working
Radiation Oncology Journal ; : 254-258, 2019.
Article | WPRIM | ID: wpr-786565


PURPOSE: Deep inspiration breath hold (DIBH) is a well-established technique that enables efficient cardiac sparing in patients with left-sided breast cancer. The aim of the current study was to determine if DIBH is effective for reducing radiation exposure of of liver and other organs at risk in right breast radiotherapy (RT).MATERIALS AND METHODS: Twenty patients with right-sided breast cancer were enrolled in this study. Three-dimensional conformal RT plans were generated for each patient, with two different computed tomography scans of free breathing (FB) and DIBH. Nodes were contoured according to the Radiation Therapy Oncology Group contouring guidelines. Dose-volume histograms for the target volume coverage and organs at risk were evaluated and analyzed.RESULTS: DIBH plans showed significant reduction in mean liver dose (5.59 ± 2.07 Gy vs. 2.54 ± 1.40 Gy; p = 0.0003), V(20Gy) (148.38 ± 73.05 vs. 64.19 ± 51.07 mL; p = 0.0003) and V(10Gy) (195.34 ± 93.57 vs. 89.81 ± 57.28 mL; p = 0.0003) volumes compared with FB plans. Right lung doses were also significantly reduced in DIBH plans. Heart and left lung doses showed small but statistically significant improvement with application of the DIBH technique.CONCLUSION: We report that the use of DIBH for right-sided breast cancer significantly reduces the radiation doses to the liver, lungs, and heart.

Breast Neoplasms , Breast , Heart , Humans , Liver , Lung , Organs at Risk , Radiation Exposure , Radiotherapy , Respiration , Unilateral Breast Neoplasms
Radiation Oncology Journal ; : 201-206, 2019.
Article in English | WPRIM | ID: wpr-761009


PURPOSE: To observe the effectiveness of the practical instruction sheet and the educational video for left-sided breast treatment in a patient receiving deep inspiration breath hold (DIBH) technique. Two parameters, simulation time and patient satisfaction, were assessed through the questionnaire. METHODS: Two different approaches, which were the instruction sheet and educational video, were combinedly used to assist patients during DIBH procedures. The guideline was assigned at least 1 week before the simulation date. On the simulation day, patients would fill the questionnaire regarding their satisfaction with the DIBH instruction. The questionnaire was categorized into five levels: extremely satisfied to dissatisfied, sequentially. The patients were divided into four groups: not DIBH technique, DIBH without instruction materials, the DIBH with instruction sheet or educational video, and DIBH with both of instruction sheet and educational video. RESULTS: Total number of 112 cases of left-sided breast cancer were analyzed. The simulation time during DIBH procedure significantly reduced when patients followed the instruction. There was no significant difference in simulation time on the DIBH procedures between patient compliance via instruction sheet or educational video or even following both of them. The excellent level was found at 4.6 ± 0.1 and 4.5 ± 0.1, for patients coaching via instruction sheet as well as on the educational video, respectively. CONCLUSION: Patient coaching before simulation could potentially reduce the lengthy time in the simulation process for DIBH technique. Practicing the DIBH technique before treatment is strongly advised.

Breast Neoplasms , Breast , Cardiotoxicity , Humans , Patient Compliance , Patient Satisfaction , Unilateral Breast Neoplasms
Article in English | WPRIM | ID: wpr-741926


PURPOSE: To compare the dose distribution of three-dimensional conformal radiation therapy (3DCRT) with intensity-modulated radiation therapy (IMRT) for post-mastectomy radiotherapy (PMRT) to left chest wall. MATERIALS AND METHODS: One hundred and seven patients were randomised for PMRT in 3DCRT group (n = 64) and IMRT group (n = 43). All patients received 50 Gy in 25 fractions. Planning target volume (PTV) parameters—Dnear-max (D2), Dnear-min (D98), Dmean, V95, and V107—homogeneity index (HI), and conformity index (CI) were compared. The mean doses of lung and heart, percentage volume of ipsilateral lung receiving 5 Gy (V5), 20 Gy (V20), and 55 Gy (V55) and that of heart receiving 5 Gy (V5), 25 Gy (V25), and 45 Gy (V45) were extracted from dose-volume histograms and compared. RESULTS: PTV parameters were comparable between the two groups. CI was significantly improved with IMRT (1.127 vs. 1.254, p < 0.001) but HI was similar (0.094 vs. 0.096, p = 0.83) compared to 3DCRT. IMRT in comparison to 3DCRT significantly reduced the high-dose volumes of lung (V20, 22.09% vs. 30.16%; V55, 5.16% vs. 10.27%; p < 0.001) and heart (V25, 4.59% vs. 9.19%; V45, 1.85% vs. 7.09%; p < 0.001); mean dose of lung and heart (11.39 vs. 14.22 Gy and 4.57 vs. 8.96 Gy, respectively; p < 0.001) but not the low-dose volume (V5 lung, 61.48% vs. 51.05%; V5 heart, 31.02% vs. 23.27%; p < 0.001). CONCLUSIONS: For left sided breast cancer, IMRT significantly improves the conformity of plan and reduce the mean dose and high-dose volumes of ipsilateral lung and heart compared to 3DCRT, but 3DCRT is superior in terms of low-dose volume.

Breast Neoplasms , Heart , Humans , Lung , Mastectomy, Modified Radical , Radiometry , Radiotherapy , Radiotherapy, Intensity-Modulated , Thoracic Wall , Thorax , Unilateral Breast Neoplasms
Article in English | WPRIM | ID: wpr-741925


Deep inspiration breathing hold (DIBH) compared to free-breathing (FB) during radiotherapy (RT) has significantly decreased radiation dose to heart and has been one of the techniques adopted for patients with breast cancer. However, patients who are unable to make suitable deep inspiration breath may not be eligible for DIBH, yet still need to spare the heart and lung during breast cancer RT (left-sided RT in particular). Continuous positive airway pressure (CPAP) is a positive airway pressure ventilator, which keeps the airways continuously open and subsequently inflates the thorax resembling thoracic changes from DIBH. In this report, authors applied CPAP instead of FB during left-sided breast cancer RT including internal mammary node in a patient who was unable to tolerate DIBH, and substantially decreased radiation dose the heart and lung with CPAP compared to FB.

Breast Neoplasms , Continuous Positive Airway Pressure , Heart , Humans , Lung , Radiotherapy , Respiration , Thorax , Unilateral Breast Neoplasms , Ventilators, Mechanical
Repert. med. cir ; 27(1): 65-68, 2018.
Article in English, Spanish | LILACS, COLNAL | ID: biblio-912093


"Betsabé en su baño" de Rembrand es un ejemplo por excelencia de la forma en que el arte se convierte en un medio único para contar historias y, al mismo tiempo, el objeto de escrutinio para el ojo de innumerables personas, incluidos los médicos, que buscan desesperadamente pistas en las pinturas. Los médicos han analizado la pintura, especialmente los pechos de Betsabé, que muestran signos distintivos de la presencia de malignos tumores.

Rembrand's "Bathsheba at her Bath" is a quintessential example of the way art becomes a unique mean for telling stories and, at the same time, the object of scrutiny for the eye of countless people, including doctors, that desperately seek for clues in paintings. Physicians have analyzed the painting, particularly Bathsheba's breasts, which show distinct signs of the presence of malignant tumours.

Female , Behavior/physiology , Breast Neoplasms/history , Paint , Unilateral Breast Neoplasms
Article in English | WPRIM | ID: wpr-739156


Various reconstructive and/or oncoplastic options are available for breast cancer patients. In properly selected patients, autologous tissue-based reconstruction usually results in aesthetic, natural breasts. The choice of a reconstructive option for a breast cancer patient is a multifactorial decision that should consider the patient's values and preferences, as well as oncologic variables. A case of a 47-year-old woman who underwent bilateral skin-sparing mastectomy (SSM) and bilateral abdominally-based reconstruction despite having unilateral breast cancer. Right SSM and left lumpectomy were indicated for ductal carcinoma in situ in the right breast and benign tumors with microcalcifications in the left breast. The patient had very small breasts and wished for larger breasts, using her own tissue, to be created in a single-stage operation. Right SSM and left subcutaneous mastectomy were followed by bilateral free transverse rectus abdominis flap reconstruction and nipple sharing.

Breast Neoplasms , Breast , Carcinoma, Intraductal, Noninfiltrating , Female , Humans , Mammaplasty , Mastectomy , Mastectomy, Segmental , Mastectomy, Subcutaneous , Middle Aged , Nipples , Rectus Abdominis , Unilateral Breast Neoplasms
Rev. cuba. cir ; 56(2): 79-87, abr.-jun. 2017.
Article in Spanish | LILACS | ID: biblio-900977


El cáncer de mama en hombres es una entidad poco frecuente y muy poco estudiada. Su pronóstico y manejo aun distan de lo ideal y de lo que se ha logrado en cáncer mamario en mujeres. Los tumores neuroendocrinos de la mama son aún más raros. Su comportamiento tiende en la mayoría de los casos a ser incierto y su manejo controversial. El reporte de caso se trata de un paciente masculino de 67 años, con historia de aparición de masa en mama derecha, con diagnóstico inicial de tumor mal diferenciado, con posterior inmunohistoquimica que informa tumor neuroendocrino primario de la mama. El diagnóstico temprano de cáncer de mama en hombres implica un verdadero reto para los sistemas de salud. Debemos conocer más sobre su fisiopatología y factores de riesgo(AU)

The early diagnosis of breast cancer in men represents a real challenge for the health systems. Therefore, our knowledge about its physiopathology and risk factors must be expandedBreast cancer in men is a rare and poorly studied malady. The prognosis and management is far from being ideal and from the achievements of the female breast cancer treatment. Even rare are neuroendocine breast tumors. In most of cases, its behavior is uncertain and its management is controversial. This was the report of a male patient aged 67 years, with history of right breast mass, initially diagnosed as a poorly differentiated tumor with later immunohistochemical test that reported the existence of a primary neuroendocrine breast tumor(AU)

Humans , Male , Aged , Breast Neoplasms, Male/diagnostic imaging , Mastectomy, Modified Radical/adverse effects , Neuroendocrine Tumors/surgery , Unilateral Breast Neoplasms/radiotherapy
Article in English | WPRIM | ID: wpr-11661


OBJECTIVE: To predict the probability of lymphedema development in breast cancer patients in the early post-operation stage, we investigated the ability of quantitative lymphoscintigraphic assessment. METHODS: This retrospective study included 201 patients without lymphedema after unilateral breast cancer surgery. Lymphoscintigraphy was performed between 4 and 8 weeks after surgery to evaluate the lymphatic system in the early postoperative stage. Quantitative lymphoscintigraphy was performed using four methods: ratio of radiopharmaceutical clearance rate of the affected to normal hand; ratio of radioactivity of the affected to normal hand; ratio of radiopharmaceutical uptake rate of the affected to normal axilla (RUA); and ratio of radioactivity of the affected to normal axilla (RRA). During a 1-year follow-up, patients with a circumferential interlimb difference of 2 cm at any measurement location and a 200-mL interlimb volume difference were diagnosed with lymphedema. We investigated the difference in quantitative lymphoscintigraphic assessment between the non-lymphedema and lymphedema groups. RESULTS: Quantitative lymphoscintigraphic assessment revealed that the RUA and RRA were significantly lower in the lymphedema group than in the non-lymphedema group. After adjusting the model for all significant variables (body mass index, N-stage, T-stage, type of surgery, and type of lymph node surgery), RRA was associated with lymphedema (odds ratio=0.14; 95% confidence interval, 0.04–0.46; p=0.001). CONCLUSION: In patients in the early postoperative stage after unilateral breast cancer surgery, quantitative lymphoscintigraphic assessment can be used to predict the probability of developing lymphedema.

Axilla , Breast Neoplasms , Breast , Clinical Study , Follow-Up Studies , Hand , Humans , Lymph Nodes , Lymphatic System , Lymphedema , Lymphoscintigraphy , Radioactivity , Retrospective Studies , Unilateral Breast Neoplasms
rev. cuid. (Bucaramanga. 2010) ; 5(2): 842-850, july.-dic. 2014. tab
Article in Spanish | LILACS, BDENF | ID: lil-790053


Introducción: El cáncer de mama es una de las neoplasias más frecuentes en mujeres a nivel mundial y causan más muertes cada año. El diagnóstico oportuno es muy importante ya que es de relevancia en la elección y eficacia del tratamiento, teniendo mayor éxito cuando se detecta temprano. La mejor estrategia para la detección temprana es a través de la prevención primaria mediante información, orientación y educación a la población femenina acerca de los factores de riesgo y la promoción de conductas favorables a la salud. El objetivo del estudio fue identificar dominios y clases afectadas en paciente postoperada de mastectomía. Materiales y Métodos: Estudio de caso en paciente femenina de 47 años de edad diagnosticada con cáncer de mama izquierda, realizándole mastectomía radical izquierda en una institución de salud del sector privado de Tampico, Tamaulipas, México. Se aplicó el proceso enfermero, realizando la valoración de enfermería con la Taxonomía II de Diagnósticos de enfermería, se describen los dominios y clases afectadas en el periodo posoperatorio, implementándose el plan de cuidados de enfermería con las interrelaciones diagnósticos, intervenciones y resultados. Resultados: La paciente evolucionó favorablemente, egresando al tercer día de la intervención quirúrgica, se proporcionó educación para sus cuidados en el domicilio. Discusión y Conclusiones: Al finalizar la investigación del caso, se observó la importancia de llevar a cabo el plan de cuidados de enfermería con las respectivas interrelaciones para brindar atención de calidad.

Introduction: Breast cancer is one of the most common cancers in women worldwide and causes more deaths each year. Early diagnosis is very important because it is relevant in the choice and treatment efficacy, with greater success when caught early. The best strategy for early detection is through primary prevention through information, guidance and education to the female population about risk factors and promoting positive health behaviors. The aim of the study was to identify domains and affected classes in a postoperative mastectomy patient. Materials and Methods: A case study in female patients of 47 years of age diagnosed with left breast cancer, performing left radical mastectomy in a private health institution in Tampico, Tamaulipas, Mexico. The nursing process was applied, making the nursing assessment with Taxonomy II Nursing Diagnoses, domains and affected classes in the postoperative period are described, implementing the nursing care plan with interrelationships, diagnoses, interventions and outcomes. Results: The patient improved, egressing the third day after surgery, education was provided for care at home. Discussion and Conclusions: After investigating the case, the importance of carrying out the plan of nursing care with the respective relationships to provide quality care was observed.

Humans , Female , Middle Aged , Postoperative Care/nursing , Mastectomy, Radical/nursing , Unilateral Breast Neoplasms/diagnosis , Mastectomy, Radical/psychology , Unilateral Breast Neoplasms/psychology
Cambios rev. méd ; Vol. 13(23): 64-66, ene. 2015. ilus
Article in Spanish | LILACS | ID: biblio-1008064


Introducción: el cáncer de mama es el tumor más frecuente en las mujeres y la primera causa de muerte en este grupo con cerca de 230.000 casos nuevos al año en los Estados Unidos. En el tratamiento adyuvante del cáncer de mama con receptores hormonales positivos el tamoxifeno cumple un papel fundamental sin embargo es bien conocido que su uso incrementa el riesgo de cáncer endometrial. Las metástasis del cáncer de mama hacia el útero son poco comunes aunque existen algunos casos reportados en la literatura. El diagnóstico diferencial entre tumor primario y metástasis distantes de cáncer de mama hacia el útero determina el tipo de tratamiento que se deberá realizar. Caso: nosotros reportamos un caso de cáncer de mama que se presenta con metástasis uterina durante el tratamiento con tamoxifeno y demostramos la utilidad del estudio histopatológico con inmunohistoquimica para llegar al diagnóstico.

Introduction: breast cancer is the most common tumor in women and the leading cause of cancer death in this group with about 230,000 new cases per year in the United States. Adjuvant treatment of breast cancer with hormone receptor-positive tamoxifen plays a critical role but is nevertheless well known the increased risk of endometrial cancer with its use. Metastases of breast cancer to the uterus are rare but there are some cases reported in the literature. The differential diagnosis between primary tumor and distant metastases to the uterus from breast cancer determines the type of treatment that should be administered. Case: we report a case of breast cancer that presented uterine metastases during treatment with tamoxifen and demonstrate the usefulness of histopathology with immunohistochemistry to reach the diagnosis.

Humans , Female , Middle Aged , Tamoxifen , Breast Neoplasms , Endometrial Neoplasms , Endometrium , Unilateral Breast Neoplasms , Neoplasm Metastasis , Immunohistochemistry , Carcinoma, Ductal, Breast , Death , Drug Therapy
Folia dermatol. peru ; 23(1): 21-24, ene.-abr. 2012. ilus
Article in Spanish | LILACS, LIPECS | ID: lil-786627


La adenomatosis erosiva del pezón es un tumor raro y benigno que se origina a partir de los conductores lactíferos del pezón y afecta principalmente a mujeres de mediana edad. Clínicamente se presenta como eritema, costras, erosiones, ulceraciones o nódulos, con o sin exudación serosa o sanguinolenta, pudiendo ser asintomática o presentar prurito, sensibilidad o dolor. La biopsia de piel es necesaria para llegar al diagnóstico, pues clínicamente puede ser indistinguible de la enfermedad de Paget. Histológicamente, su principal diagnóstico diferencial es el de adenocarcinoma de mama. El tratamiento es usualmente quirúrgico. Presentamos el caso de un paciente de 32 años de edad con una lesión inicialmente eritematosa y luego costrosa en el pezón derecho de 8 años de evolución.

Erosive adenomatosis of the nipple is a rare and benign tumor of the lactiferous ducts of the breast that affects primarily middle-aged women. Erythema, crusts, erosions, ulcerations or nodules, with or without serous or bloody discharge, are common clinical findings; pruritus, tenderness or pain may occur or it can be asymptomatic. Since the lesions are clinically indistinguishable from PagetÆs disease of the breast, a skin biopsy is mandatory for diagnosis. Adenocarcinoma of the breast is the main histologically differential diagnosis. Surgical resection is the treatment of choice. We present such a case in a 32-year-old woman with an 8-year history that begun as an erythematous, crusty lesion on her right nipple.

Humans , Adult , Female , Unilateral Breast Neoplasms , Papilloma, Intraductal , Nipples