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ALEX COHEN, host:

And now for something you don't hear about all that often on NPR: nipple piercing.

That's right. What was once a practice favored by a small group of brave souls has become a lot more mainstream. Today there plenty of women with small holes in one or both of their breasts, so how does piercing affect a woman's ability to breastfeed?

To find out, we're checking with Dr. Sydney Spiesel. He's a professor at Yale Medical School, and he writes for the online magazine Slate. Welcome back to the program, Sid.

Dr. SYDNEY SPIESEL (Professor, Yale Medical School): Thanks, Alex. Nice to be here.

COHEN: So Sid, have you heard from any of your patients directly who have had pierced nipples? How did it work out with breastfeeding?

Dr. SPIESEL: I've had some patients who had pierced nipples and who had problems with breastfeeding. Some of them had a hard time getting breastfeeding started. They had the sense that there was some problem with milk flow. But everybody has interesting cases. But the question actually hasn't been looked at in a kind of serious way.

MONTAGNE: So there've been no official studies or research done on the topic?

Dr. SPIESEL: No. There have just been a lot of reports of individual cases, or people will say there's a number that's bandied around. In the medical literature suggest that between 10 and 20 percent of women who have nipple piercing have some problem with it, which is often infection or inflammation, and one would expect that those infections and inflammation might well result in the kind of scarring that would plug up the milk ducts. But I'm not even sure where that 10 to 20 percent came from.

COHEN: Okay, Syd. So maybe, you know, punk rock moms aren't a big enough group yet with their pierced nipples to constitute, you know, a valid basis for medical research. What does this say about research in general if it's, you know, an issue that might not affect everyone but is an issue that's out there?

Dr. SPIESEL: Well, research in general, especially around problems that are not that common, is very hard to do, really. You know, a lot of times doctors depend on anecdotal reports - single cases, things that they've seen, interesting cases. But there's a kind of a skew, because when things go well and when things go smoothly, we don't get those reports at all. So it tends to skew the way we look at problems.

So all we can do is guess, and the problem is, it's very easy for doctors to generalize based on a few cases that, you know, or something that seems reasonable. But it's not necessarily a good idea.

COHEN: So Syd, even if there's not a whole lot of research out there on the topic, what advice would you give, let's say, if you had a patient who was thinking that at some point she wanted to breastfeed and she was either thinking about getting her nipples pierced or she had them pierced already - what advice would you give her?

Dr. SPIESEL: Well, I'll give a couple pieces of advice. One is I'd say, gee, I don't know exactly but I've had a couple of patients who have told me they've had problems. On the other hand, the medical literature describes some patients who are said not to have had problems. I would say that there is some problems around people with pierced nipples actually nursing. One of them is that it's really important, most of the time, to get that jewelry out. It's hard to get a good - it's hard to imagine there'd be a good latch for a mother who still had the nipple jewelry in place. That's where the baby holds on to the nipple. And also, there might be danger of small parts of it being inhaled by the baby, which will be the last thing you'd want. And also if once that jewelry is removed, there's a strong probability that the hole is going to grow shut.

Those are the things I think I would say.

COHEN: That's opinion from Dr. Sydney Spiesel of Yale Medical School. You can read his medical examiner column at Slate.com.

Thanks so much, Syd.

Dr. SPIESEL: Thank you.

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