Malformations of mammary glands – group of the congenital defects including various anomalies of quantity, a form and position of mammary glands, an areola and nipples. Carry an amastiya, a monomastiya, a polimastiya to anomalies of number of mammary glands; to defects of an arrangement – asymmetry and an ektopiya of chest glands; to defects mamillar a complex - expansion of an areola, the invaginirovanny (pulled-in) nipple, etc. Treatment of malformations of mammary glands – surgical by means of different types of a reconstructive mammoplastika.
Malformations of mammary glands
The clinical mammology faces malformations in 1-3% of cases of all pathology of mammary glands. Various congenital anomalies are the embryonic defects which are formed at violation of laying of mammary glands. Malformations occur at representatives of both floors, but are more often observed at women. As the reason of anomalies, as a rule, serves an adverse effect on a maternal organism during this period of a gestation.
Laying of mammary glands at an embryo begins on the 6th week of pre-natal development. In the beginning on a ventrolateralny wall of a body from axillary hollows to inguinal folds symmetric tape-like thickenings – dairy lines appear. Further the thickening and growth of these tyazhy leads to formation of mammary glands. About 3-4 months of pre-natal formation of a fruit the main lacteal channels begin to develop. Development of nipples and an areola begins on 7-8 month of uterine life from primary ferruterous rudiments and skin rollers surrounding them and continues after the birth within the first 2 years of life of the child. By third year of life of a pacifier are formed completely, and further there is an increase in their sizes. At an arrest of development of nipples they can have an appearance of the small flattened eminences (flat nipples); at an arrangement lower than the level of skin is told about the pulled-in nipples.
Mammary glands for the rest of life remain with men in a rudimentary state. Mammary glands at women during life (in a puberty, during a menstrual cycle, pregnancy, a lactation, age involute processes) undergo physiological changes. The main function of mammary glands is secretion of milk and breastfeeding of posterity.
Classification of malformations of mammary glands
According to the etiopatogenetichesky principle of anomaly of development of mammary glands are divided into 2 groups:
- the true defects including manifestations hereditary (gene and chromosomal) diseases, or the resulted adverse effect on embryonic rudiments of chest glands in an initial stage of a differentiation;
- the defects caused endogenous (hormonal, neoplastic) or exogenous (injuries, an infection, radiation) the factors influencing in the post-natal period.
Anatomic classification marks out anomalies of number of nipples and mammary glands, and also defects of a form, situation and the sizes of mammary glands. In all cases meet one - or bilateral defects.
The amastiya, monomastiya, polimastiya, ateliya, politeliya belong to anomalies of number of nipples and mammary glands. The ektopiya and asymmetry of mammary glands enter into group of defects of an arrangement. Anomalies of the sizes of mammary glands include a mikromastiya and a makromastiya, an aplaziya and a hypoplasia of glands; belongs to number of violations of a form . Expansion of an areola, a nipple invagination, etc. occur among defects mamillar a complex.
Anomalies of number of nipples and mammary glands
Monomastiya – the congenital defect which is characterized by unilateral lack of a mammary gland. Monomastiya is defect of pre-natal development which results from violation of laying of mammary glands approximately on the 6th week of pregnancy. At a monomastiya the woman completely has no tissue of a mammary gland and pacifiers.
Polimastiya – the anomaly of physical development which is characterized by existence of additional mammary glands. Normal mammary glands represent the pair ferruterous bodies symmetrized on a chest wall. At a polimastiya additional chest glands can settle down under usual glands on median and clavicular (mamillar) lines (as at animals) or in atypical places – a neck, axillary hollows, extremities, on a back, in big vulvar lips etc. Additional glands at a polimastiya can be developed fully or remain not created and nefunktsioniyushchy: in the latter case nipples are also developed enough or are defined in the form of rudimentary pigmentary spots.
Full-fledged additional mammary glands at a polimastiya are exposed to hormonal and sekretorny changes: during the premenstrual period their swelling and morbidity is noted; after the delivery in them there is a formation of milk. As in additional chest glands at a polimastiya various pathological processes quite often develop (mastitis, fibroadenoma, mastopathy, a breast cancer, etc.) carrying out full inspection at the mammologist is necessary.
Polimasty should distinguish from a politeliya when only additional nipples are created. In turn, the additional nipple is quite often taken for fibroma or a nevus, making its insufficiently radical removal. Opposite option is the ateliya – the anomaly which is characterized by lack of nipples at normally created mammary glands. The amastiya is meant as unilateral or bilateral total lack of mammary glands and mamillar a complex, connected with the termination of an embryonal development of dairy rudiments.
Anomalies of situation, form, sizes of mammary glands and nipples
At the congenital shift of an arrangement of body speak about an ektopiya of a mammary gland. At the same time the ektopirovanny mammary gland can be as full, and morphologically and functionally underdeveloped. Natural asymmetric position of mammary glands occurs at the most part of women. In certain cases asymmetry of mammary glands can be characterized by the expressed disproportion that is noticeable cosmetic defect. Asymmetry can be combined with a mikromastiya or a makromastiya.
Speak about a mikromastiya (gipomastiya) in case there are small mammary glands at normal development of gonads and genitals. At a mikromastiya the sizes of mammary glands do not correspond to age, growth, body weight, proportions of a thorax, shoulders, hips.
In case of a hypoplasia (underdevelopment) mammary glands and mamillar a complex are developed partially. At an aplaziya – a full underdevelopment of mammary glands on skin existence of a small areola and an underdeveloped nipple comes to light. In rare instances at a unilateral aplaziya of a mammary gland the compensatory giperplaziya of other mammary gland – an anizomastiya meets.
Makromastiya (gigantomastiya) is characterized increase in volume of mammary glands at the expense of a hypertrophy of all elements of tissues of breast. Makromastiya is often combined with mastoptozy – omission of a breast and juice a complex.
The secondary monomastiya and unilateral hypoplasia can be a consequence of surgeries (mastectomy), mastitis of newborns, radiations (for example, at a gemangioma). Surgical or beam influence can lead to loss of ferruterous fabric, rough cicatricial deformations and the termination of development of mammary glands.
In medicine genetic syndromes at which anomalies of development of mammary glands are also noted are described. So, at Poland's syndrome, along with a congenital sindaktiliya, deformation of a thorax and partial lack of a big pectoral muscle it is observed unilateral aplaziya of a mammary gland. Also at this pathology quite often there are defects of a structure of a backbone, heart diseases and lungs. External manifestations of a syndrome of Thinley include the bulged ears, baldness and a hypoplasia of mammary glands.
Mamillar a complex treat the most frequent anomalies of a structure the flat and invaginirovanny (pulled-in) nipple which is excessively acting a nipple, expansion of borders of an areola. Expansion of an areola can meet separately or be a consequence of a makromastiya.
Diagnostics and treatment of malformations of mammary glands
Diagnostics of congenital defects of mammary glands (an amastiya, a monomastiya, an ateliya, some options of a polimastiya and a politeliya) is usually made right after the birth. In certain cases anomalies are shown only after puberty.
At detection of malformations of mammary glands consultation of the mammologist, endocrinologist, gynecologist is shown. Carrying out additional inspections (ultrasonography of mammary glands, KT, MPT, mammography) helps to define functional full value of glands, existence in them of pathological processes. Elimination of malformations of mammary glands is made by methods of plastic surgery.
As indications to a mammoplastika at various forms of defects of mammary glands serve esthetic defect, a pain syndrome, the revealed diseases, malfunction, etc. In case of a monomastiya cosmetic elimination of defect is possible by means of a reconstruction of the absent gland by endoprosthesis replacement or reconstruction by a TRAM rag. Identification of a polimastiya demands carrying out a mastectomy – removal of additional mammary glands.
At a makromastiya reducing plasticity of mammary glands (reduction of a breast) is carried out; at a mastoptoza – the mastopeksiya, sometimes with simultaneous endoprosthesis replacement of mammary glands is shown. Increase in a breast is made in case of an aplaziya and a hypoplasia of mammary glands. At various options of anomalies mamillar a complex correction of the pulled-in nipples, reduction of a nipple and an areola, correction of excessively acting nipple can be required.