Association of Nipple Piercing With Abnormal Milk Production and Breastfeeding
- Catherine P. Garbin cgarbin{at}cyllene.uwa.edu.au;
- Jane P. Deacon, MBBS;
- Marnie K. Rowan, BPharm, MBBS;
- Peter E. Hartmann, BSc, PhD;
- Donna T. Geddes, PhDSchool of Biomedical, Biomolecular and Chemical SciencesUniversity of Western AustraliaCrawley, Australia
- KEYWORDS:
- BODY PIERCING
- BREAST FEEDING
- NIPPLES
- WOMEN'S HEALTH
To the Editor: Body piercing has become increasingly popular and socially accepted throughout all age groups; it is particularly prevalent in the adolescent population.1 Current information states that nipple piercing is generally not deemed to be detrimental to maternal milk supply.2 However, irritation or trauma may predispose a nipple-pierced breast to infant attachment problems or blocked ducts.3 We present 3 patients with lactation difficulties suggesting that nipple piercings can lead to complications and that these complications can be associated with breastfeeding difficulties.
Methods
Patients were lactating women referred to the Human Lactation Research Group at the University of Western Australia for unilateral breast engorgement or poor milk supply. The ethics committee of the University of Western Australia provided approval for this study, and all participants gave informed consent for publication of these data.
Histories were obtained from the patients. All women were given advice regarding positioning and attachment of the infant to the breast. All women also attempted to increase breast-milk supply by expressing after feeds; in particular, mother-infant dyad 1 expressed immediately at secretory activation (lactogenesis II). Expressing was performed to assess whether lack of milk flow was due to nonuse of the breast. In addition, dyads 2 and 3 had been prescribed a galactagogue (domperidone).
Breastfeed volumes were measured by the test weight method.4 Mammary blood flow was measured by Doppler ultrasound. Breast anatomy and milk ejection were assessed by ultrasound.
Results
History, breastfeeding assessment, and management of the mother-infant dyads are presented in the Table. All women reported clinical signs of secretory activation in both breasts. However, they reported and we observed that their infants, when fed from the pierced breast, were extremely unsettled compared with feeding from the contralateral breast.
Table. Characteristics of 3 Mother-Infant Dyads Referred for Difficulties With Lactation in Which the Women Had Healed Nipple Piercing
On examination, the nipple piercings were completely healed, with no milk leakage. None of the breasts appeared hypoplastic.
For dyads 1 and 2, minimal milk was expressed or removed by the infant from the pierced breast. There was a marked reduction in blood flow to the pierced breast. Septa were clearly visible with ultrasound in the milk ducts of the pierced breast of dyad 3. Milk ejection was confirmed by visualization of duct dilation. A decrease in the volume of complementary feeds was achieved after postfeed expression and the administration of domperidone in dyads 2 and 3.
Comment
These cases indicate that nipple piercing may cause complications leading to duct obstruction so that only negligible amounts of milk can be removed from the breast during lactation. Ineffective milk removal from the breast causes a decrease in milk supply due to local feedback.5
These women expressed minimal amounts of milk from their pierced breasts despite frequent breast pumping. The reduction in mammary blood flow is consistent with low milk production because a positive relationship between milk production and blood flow has been shown in animals.6 Although ductal obstruction is difficult to prove, ductal septa were confirmed in 1 woman. Although a ductogram might have shown ductal patency, the test is limited to 1 ductal system; moreover, catheterization of the nipple duct may be inhibited by scar tissue and carries a risk of infection.
Although the possibility of a spurious association exists, this potential complication should be recognized. Dyad 1 illustrates that with management of lactation, unilateral breastfeeding is possible. Many women have successfully breastfed with a nipple piercing, so it is likely that only a small percentage of women may encounter difficulties during lactation subsequent to the procedure. Because these patients suggest that nipple piercing may in some cases lead to duct obstruction and impaired lactation, further investigation of potential effects of nipple piercing is necessary to identify factors that might contribute to lactation difficulties.
Author Contributions: Ms Garbin had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Garbin, Deacon, Rowan, Geddes.
Acquisition of data: Garbin, Deacon, Rowan, Geddes.
Analysis and interpretation of data: Garbin, Deacon, Rowan, Hartmann, Geddes.
Drafting of the manuscript: Garbin, Deacon, Rowan, Hartmann, Geddes.
Critical revision of the manuscript for important intellectual content: Garbin, Deacon, Rowan, Hartmann, Geddes.
Statistical analysis: Garbin, Deacon, Rowan, Geddes.
Obtained funding: Hartmann.
Study supervision: Hartmann, Geddes.
Financial Disclosures: None reported.
Funding/Support: The research was funded by Medela AG, Baar, Switzerland.
Role of the Sponsor: The funding organization had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript.
Letters Section Editor: Robert M. Golub, MD, Senior Editor.
