Nipple piercing: it is wiser to avoid in patients with hyperprolactinemia.

To the Editor: Cosmetic piercing is a highly popular trend that plastic and dermatologic surgeons are concerned with both the practice itself and the complications. Although facial piercing is common in most societies, piercing nipples and genitals is largely a modern Western phenomenon. Besides, nipple piercing was recently suggested as a treatment for inverted nipple deformity. Each piercing may lead to specific problems depending on its localization, and nipple piercing is sometimes associated with pain, swelling, prolonged bleeding, and local infection. Endocarditis and breast implant infection due to nipple piercing have also been reported. We wanted to share another unusual nipple piercing complication with our colleagues. A 22-year-old man presented with a 9-months history of left nipple enlargement. Three years ago, he was evaluated for a bilateral mild gynecomastia and had a diagnosis of hyperprolactinemia with a serum prolactin level of 35.5 ng/mL (normal o17 ng/mL). Magnetic resonance imaging of the pituitary was normal. His gynecomastia was resolved and prolactin level returned to normal after a course of medication continued for 6 months. Following a 1-year period without any complaints, he had his both nipples pierced. He developed local mastitis on the left side 3 months after the implantation, followed by removal of the rings, during which the prolactin level was measured to be 40.3 ng/mL. The infection subsided with oral antibiotics but a gradually enlarged nipple was present so far (Figure 1). On our examination, the left nipple was significantly larger than the opposite. An ultrasound of the breasts did not demonstrate any pathologic finding and serum prolactin level was normal (5.6 ng/mL). The patient desired an aesthetic improvement, and the nipple was surgically reduced, with a satisfactory cosmetic result. Histologic examination of the resected material affirmed a fibroepithelial benign process. The probable association of an elevated serum prolactin level with the nipple stimulation by piercing in a woman patient was proposed by Modest and Fangman. The piercing case reported by these authors was also complicated by infection. It is reasonable, with these findings, to think that hyperprolactinemia might render a predisposition to infection after nipple piercing, and this infection might further aggravate the hyperprolactinemic effect of nipple piercing. In conclusion, we suggest that nipple piercing, as a fashion or a treatment for inverted nipple, should be performed cautiously, after a detailed history and a physical examination. In patients with hyperprolactinemia, it should perhaps be avoided to prevent any unwanted consequences.