الفهرس 
Anatomy of Nipple-Areola ComplexOnly 14 pages are availabe for public view
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Abstract
The nipple-areolar complex may be affected by many disorders, many of which have similar appearances. The detection of these disorders of the nipple-areolar region may be challenging because of the complex anatomy of this region thus, understanding of anatomic variants, benign and pathologic processes, and the imaging features specific to each is the necessary basis for a comprehensive and appropriate imaging assessment, diagnosis, and, if necessary, intervention.
These disorders of the nipple-areolar complex are unique or differ in important ways from those that occur elsewhere in the breast, and they require a diagnostically specific imaging evaluation. Also, a clinical evaluation by the patient’s surgeon should be part of the diagnostic work-up.
The standard dual-view mammography may be necessary to visualize or exclude an underlying mass or other abnormality. But when routine mammographic findings are negative and clinical findings arouse suspicion about the presence of a malignancy, US and MR imaging may facilitate the diagnosis. US may be performed to further characterize a mammographic or clinical finding particularly intraductal papillary lesions. Higher sensitivity was demonstrated with MR imaging than with mammography for the diagnosis and assessment of nipple and retroareolar tumors.
The diseases of nipple areola complex may be classified as congenital or acquired. Congenital disorders as athelia, supernumerary nipples, bifid nipple and inverted nipple. While acquired disorders as Paget’s disease, bowen disease, adenoma of the nipple, melanoma of the nipple and eczema.
Surgical management for these congenital nipple areola disorders differ according to each disorder. For surgical management of athelia, nipple reconstruction is done, for supernumery nipples, surgical removal of the extra nipple is done, while for inverted nipple, surgical correction is done.
Paget’s disease is a chronic, eczematous rash on the nipple and adjacent areolar skin. Proper recognition of this disorder is required to initiate an appropriate workup for differentiating it from other diseases. Its surgical management varies according to the disease invasiveness. So modified radical mastectomy and lymph node clearance are appropriate therapies for patients with invasive breast carcinoma, while Conservative management and radiation therapy are therapies for patients with disease limited to the nipple. Also, central quadrantectomy with rotation-advancement of a dermaglandular flap is used in management of paget disease. Skin sparing mastectomy is indicated in case of small breast, where it is followed by reconstruction.
Adenoma of the nipple is treated by complete surgical excision. While Bowen disease is treated medically by topical therapy as 5-Fluorouracil, and Imiquimod 5% cream, or surgical management in the form of Simple excision. Melanoma is treated through excision with surgical margins for primary melanoma and elective lymph node dissection.
Reconstruction of the nipple-areola complex is indicated to complete breast reconstruction and to restore the patient’s body image. Following mastectomy for breast cancer, NAC reconstruction is mostly the final aspect of breast reconstruction. Other conditions requiring nipple-areola complex reconstruction include congenital or developmental pathology.
Ideal reconstruction of the NAC requires symmetry in position, size, shape, texture, pigmentation and permanent projection. It can be safely performed on an outpatient basis under local anaesthesia.