Abscess of a mammary gland – the limited inflammatory center in the thickness of soft fabrics of chest gland representing the encapsulated purulent cavity. The disease develops and proceeds sharply, with substantial increase of temperature and the phenomena of intoxication, intensive pain, reddening and hypostasis of a breast, purulent separated from a nipple. In diagnostics the given the anamnesis and the complaint, objective surveys and additional methods of a research are important (ultrasonography of a mammary gland, a X-ray analysis, bacteriological crops separated from a breast). Treatment of abscess of chest gland only surgical (opening of an abscess) with parallel prescription of antibiotics.
Abscess of a mammary gland
Abscess of a mammary gland is always the secondary pathology which is a complication of earlier arisen disease of chest gland (a hematoma, mastitis and other pyoinflammatory processes). The disease meets at women more often, develops in 2% of cases at nursing mothers, but also can affect men, teenagers and newborns. The breast abscess associated with a lactation arises for the first six weeks after the delivery. At newborns purulent formations of mammary glands develop at the age of 1-1,5 months. The abscess is, as a rule, formed on the one hand, bilateral abscesses are diagnosed extremely seldom, usually for babies.
Reasons of abscess of a mammary gland
The disease is caused by penetration into tissue of a mammary gland of pathogenic bacteria (staphylococcus, streptococci, proteas, colibacillus or their associations). Gland fabric fusion happens to formation of an osumkovanny abscess owing to the following diseases:
- Mastitis. Results from stagnation of milk in a breast. The inflammation of a mammary gland leads to active reproduction of bacteria in its fabrics that in 6–11% comes to an end with an abstsedirovaniye.
- Breast injury. The bruise of a mammary gland quite often is followed by formation of a hematoma. In the absence of treatment the hematoma suppurates and encapsulated.
- Galaktoforit. This inflammation of lacteal channels most of which frequent reason the injury of a mammary gland is. The disease belongs to nelaktatsionny mastitis.
- Cyst or benign tumor. New growths squeeze dairy channels, causing their obstruction. Accession of a secondary infection is resulted by formation of osumkovanny purulent education.
- Hormonal failure. Hormonal frustration provoke stagnation of a lymph and blood in mammary glands that intensifies reproduction of pathogenic microflora. The imbalance of hormones is observed at mastopathies, in the period of a neonatality and at various endocrine pathologies.
- Pyoinflammatory diseases. The following diseases can be the cause of abscess of a breast: , axillary lymphadenitis, piodermiya, anthrax. Pathogenic microbes get in the hematogenic way into fabrics of chest glands, cause in them inflammatory process with the subsequent formation of abscess.
There is a number of the contributing factors which existence increases risk of development of a disease. Treat them immunity easing, , cracks of nipples of a mammary gland, smoking, endocrine diseases. Carrying out invasive medical manipulations (a duktografiya, small surgeries on a breast), nipple piercing with non-compliance with conditions of an asepsis can promote penetration of an infection.
Entrance gate for an infection the nipple or its damaged areola serves more often. In certain cases infectious agents get into a mammary gland with blood current from other purulent educations. Bacteria on dairy channels extend in gland fabrics, begin to breed actively, emitting toxins and products of disintegration that leads to development of an intoksikatsionny syndrome. The inflammatory hypostasis arising in walls of the dairy courses is result of the immune response to action of anti-genes of bacteria and causes disorder of microcirculation. Permeability of a vascular wall increases, intercellular liquid comes out in a gleam of dairy channels, there is their obstruction. Laktostaz aggravates inflammatory process in the dairy courses which extends also to surrounding fabrics. Further there is a fusion of the inflamed fabrics, an otgranicheniye them from healthy the dense capsule and formation of the cavity containing pus.
In a mammology use the standard classification of abscesses of a breast. Systematization of purulent formations of a mammary gland is carried out on their localization, quantity of abscesses, defeat of one or both glands. Depending on an arrangement allocate:
- Hypodermic abscess. Is superficially, it is easily diagnosed in view of pus raying.
- Subareolyarny abscess. Settles down under a nipple and its areola. Meets at the lactating women more often.
- Intramammarny abscess. Settles down in the thickness of ferruterous tissue of a breast.
- Retromammarny abscess. Is between retromammarny fatty cellulose and pectoral muscles. The most dangerous form of a disease presenting high risk of purulent fusion of muscles and break of abscess to a chest cavity.
Depending on involvement in pathological process of one or both mammary glands distinguish unilateral and bilateral abscesses. By quantity of abscesses in one gland abscesses are subdivided on single and multiple.
Symptoms of abscess of a mammary gland
The disease begins sharply, with rise in temperature to 38–39 °C. In case of previous breast injury signs of the created purulent education appear for 3–5 days. Patients are disturbed by the sharp, pulsing a mammary gland pain, reddening of skin over the purulent center, its morbidity at a palpation. Pain in iron amplifies when jolting in the car, walking and jumps. At palpation of gland it is possible to reveal pain epicenter precisely. The mammary gland swells, from a nipple emergence purulent separated is possible, it is frequent with blood clots. Axillary lymph nodes from defeat are increased in sizes and are painful at a palpation. The general symptoms of intoxication are added to local symptoms: nausea and vomiting, weakness, adinamiya, lack of appetite, heartbeat increase.
The leading symptoms depend on localization of abscess. At a subareolyarny arrangement of purulent education increase in a nipple and its areola at the expense of hypostasis take place. Under an okolososkovy zone dense and painful education is palpated. At an arrangement of intrammamarny abscess at an insignificant depth in the place of its localization there is a dense and hyperemic site. In case of a deep bedding of an abscess external changes of a mammary gland are absent. If retromammarny abscess was created, then gland rises and takes a form of the hemisphere directed forward and up.
Lack of timely treatment leads to break of abscess and development of complications. At a superficial arrangement of purulent education the probability of formation of fistula is high. Development of phlegmon of a mammary gland, break of an abscess in the lacteal courses with the subsequent release of milk with impurity of pus and blood clots is also possible. The existing purulent inflammation in lacteal channels is long destroys their walls and causes a metaplaziya (regeneration) of epitelialny cages that is fraught with formation of malignant processes. The most dangerous complication of abscess of a breast is development of sepsis at which bacteria with current of blood are carried on all organism that leads to formation of the new multiple purulent centers in different bodies and fabrics.
The mammologist or the surgeon is engaged in diagnosis of abscess of a breast. The doctor finds out the anamnesis, specifies communication of a disease with a lactation, decrease in immunity or a trauma, performs inspection of a mammary gland and reveals characteristic signs of purulent education: skin hyperaemia, morbidity and fluctuation of a certain site of gland, the increased axillary lymph nodes. Also in diagnosis of abscesses of a breast laboratory and tool methods of a research are applied:
- Clinical analyses. In peripheral blood comes to light with shift to the left, acceleration of SOE (inflammation signs), in urine the proteinuria and a leykotsituriya are possible.
- Bacteriological crops of a secret of a breast. It is investigated separated from a nipple or the abscess contents received by means of a puncture the activator and its sensitivity to antibiotics is defined.
- Ultrasonography of a mammary gland. Localization, the sizes, depth of stay and quantity of abscesses, their message with dairy channels and with each other is specified.
- Mammography. Helps to define a form and the amount of purulent education, its approximate localization and to carry out differential diagnostics with not inflammatory diseases of a breast.
- KT of a mammary gland. It is irreplaceable at unsatisfactory results of mammography and ultrasonography, in the presence of retromammarny abscess and when performing differential diagnostics of purulent education with other pathologies of a mammary gland.
Differential diagnosis of abscess of a breast is carried out with phlegmon, a hematoma, fibroadenomy, a carcinoma of a mammary gland, with a fatty necrosis and some other diseases. It is for this purpose carried out the tsitogramm separated from a nipple, a puncture of education and the analysis of a punktat, a biopsy of the suspicious site with the subsequent histologic research.
Treatment of abscess of a mammary gland
The emergency surgical intervention – opening of abscess and its drainage is the cornerstone of treatment of the created abscess. Cuts are made from the center (a nipple areola) to the periphery (gland basis). In some situations it is more expedient to make a section in a fold under a mammary gland. The wound is examined, open all found abscesses and connect them in one cavity, pus is deleted and wash out a wound solution antiseptics. Then establish a drainage and partially take in a wound. The drainage is left in a wound for 3 – 4 days, before the termination separated then the wound is taken in tightly. Punktsionny aspiration of pus from abscess and introduction to his cavity of solution of an antibiotic is possible. Similar intervention malotravmatichno also does not leave a hem after healing, but is insufficiently effective. The puncture is carried out only in the presence of small single abscess.
In parallel with surgical intervention antibiotics according to sensitivity of the allocated activators (penicillin, tsefalosporina, ftorkhinolona) are appointed, for the purpose of desintoxication infusional therapy is carried out. Reception of NPVS which eliminate a pain syndrome is also shown, reduce temperature and reduce inflammation signs. For the purpose of stimulation of immunity reception of immunomodulators is recommended.
Forecast and prevention
At the timely address to the doctor and performing adequate treatment forecast favorable. Function of a mammary gland is restored completely, consequences, except a hem, no. Prevention of abscess of a breast in the period of a lactation consists in observance of rules of breastfeeding: full decantation of mammary glands, reception of air bathtubs for a breast, washing of glands before feeding, the prevention and is more timely treatment of cracks of nipples, daily shift of a bra. Healthy food, observance of a day regimen and rest, identification and correction of endocrine violations, refusal of addictions and piercing of a nipple, immunity strengthening belong to measures of the general prevention.