For this pathology are characterized by dense painful formation, retraction of the skin and change its color – these signs make one suspect the presence of cancer.
With occurrence of fat necrosis there is a need in the sectoral resection (the removal section) of the breast.
Fat necrosis of the breast refers to a number of so-called non-enzymatic necrosis. In mammalogy from all of the nodular growths of the breast rolls for 0.6% of all diagnosed clinical cases.
At the mention of this disease refers to the disease in women. With the defeat of males diagnosed sounds like “Fat necrosis of the breast” (breast, there are only women). In men this disease occurs very rarely because of the paucity of adipose tissue of the breast. The exception would be gynecomastia – development of male patients breast on the female type.
Fat necrosis of the breast is more frequently diagnosed in patients with large breast (macromastia), than women with small Breasts.
Mostly affected women of child-bearing years – mainly affects the age group from 25 to 35 years.
Pathology has other names – is oleogranulomas, lipogranulomas and steatorrhoea.
The occurrence of fat necrosis of the breast can provoke fundamentally different reasons – for convenience they are divided into groups:
- traumatic lesions;
- rapid weight loss;
- radiation effects on breast tissue.
Traumatic lesion that can lead to the development of this pathology can be observed:
- when performing medical procedures (in this case, it is called iatrogenic);
- out of the treatment process.
Medical procedures, during which may be compromised the integrity of the breast tissue with a subsequent risk of fat necrosis may be:
- actually medical.
Such diagnostic procedures include biopsy sampling of breast tissue for examination under a microscope. It is:
- puncture the skin and underlying tissues of the breast is pierced, the syringe is aspirated suspicious content;
- sectional cut off area of suspicious tissue. Most often a biopsy is performed during surgery on the breast about cancer.
Describes the cases when the suspicion of the development of fat necrosis of the breast was performed a biopsy which confirmed the diagnosis – however, fat necrosis developed later as a result of the biopsy.
Therapeutic manipulations that can trigger the development of described pathology include any invasive therapeutic action. It can be:
- suctioning of the purulent contents of the abscess of the breast (last time practiced very rarely as controversial and ineffective methods of treatment);
- the opening and emptying of the purulent center of the body;
- erase breast about of a disease – necrosis, benign or malignant tumors, tuberculosis outbreak, and so on;
- plastic surgery. Fat necrosis of the breast can occur in women after mastectomy (radical removal of the affected breast) underwent reconstructive mammoplasty (breast reconstruction) own tissues.
The development of iatrogenic fat necrosis is associated with:
- forced vnutribruchinnah traumatization of the tissues of the glands – for example, removing its large areas, the stopping of bleeding by means of diathermocoagulation (“cauterization” of the destroyed walls of blood vessels with electric current);
- rough sloppy conduct of the diagnostic or therapeutic manipulation that may cause damage to the glandular tissue of the breast and its blood vessels and nerve endings.
Traumatic lesion that is not associated with the medical manipulation, is one of the most common causes of fat necrosis of the breast. The mechanism of development of such injuries are:
The origin of such injuries, can lead to development of fat necrosis of the breast, are:
Household injuries that can lead to the described diseases, can be evidence of trauma:
The most common form of injury of the breast, which can lead to fat necrosis of the breast, are her injuries:
- obtained due to inconveniences (sharp corners of furniture, cramped living quarters and so on);
- caused by a hyperactive or unruly children;
- received transportation (public transport is basically bruised from the handrail of the front seat, in a personal – blow steering wheel in the mammary gland during heavy braking of the vehicle);
- associated with domestic violence.
A special kind of trauma to the breast tissue, which may develop fat necrosis, is considered to be prolonged compression of the gland. Most often it occurs during disasters:
- natural is a sinkhole in the mountains, avalanches, and entrainment in marshes, staying under fragments of buildings during earthquakes;
- manmade – mostly collapses due to a powerful industrial explosions.
Prolonged compression of the breast may occur during road traffic accidents when people are trapped in the vehicle before arrival of rescuers and medics. Basically this type of trauma occurs during:
- car or bus accidents;
- a train derailment.
Injuries of the breast, contributing to the development of fat necrosis are less common than household. In General, they are breaking the rules of labor protection (falling on slippery stairs that lead to office space) or disregard of safety rules (improper care of large farm animals that can be hit in the breast with a hoof or a horn).
Sports trauma often occurs in women who have chosen power sports or those which involve a risk of falls. This:
- women’s Boxing;
- all kinds of struggle;
- women’s football;
Rapid weight loss, which can develop fat necrosis of the breast, can occur when:
- severe diseases and pathological conditions;
- the deliberate adherence to a rigid diet aimed at rapid weight loss before any important event – a wedding, beauty pageant, sports events (especially of high rank, where the important condition is a certain weight).
Severe disease or pathological condition, which can happen quick weight loss, contributing to the development of fat necrosis of the breast is:
- rapidly progressing cancer (in particular, lose their aggressive forms);
- tuberculosis – infection caused by Mycobacterium tuberculosis (tubercle Bacillus);
- diabetes mellitus is a metabolic disorder of carbohydrates, caused by the scarcity of insulin in the body;
- thyrotoxicosis – intoxication (poisoning) of the body’s hormones produced by your own thyroid gland;
- gross violation on the part of the psychoemotional sphere;
- the adrenal insufficiency (called Addison’s syndrome, gipokortitsizm);
- Alzheimer’s disease – senile dementia;
- lymphoma (Hodgkin disease) is a malignant lesion of the lymphoid tissue;
- drug addiction;
- any chronic intoxication, which regularly vomiting and diarrhea.
Radiation effects on breast tissue, which can lead to development of fat necrosis, observed in cases such as:
- radiation therapy – in particular, the impact on malignant neoplasms of the breast;
- common diagnostic procedures, is fraught with radiation exposure (radiography, fluoroscopy, etc.);
- contact with radioactive substances due to their professional activities. Fraught with strong radiation effects on the body in case of violation of safety rules or disregard of safety (personal protective equipment);
- unauthorized access to radioactive substances.
Also factors that are not the direct instigators of the development of fat necrosis of the breast, but may contribute to the necrosis of its tissues. Does not mean that when such factors are described pathology develops mandatory – however, the risks should be considered. Such diseases and conditions as:
- a vascular disorder because of her impaired circulation and nutrition of tissues of the mammary glands;
- of the disease by blood – the consequences are the same as in the pathology of blood vessels;
- regular wearing tight clothes.
The development of the pathology
Based on maximum most of the violations that lead to necrosis of the mammary gland and the formation sites of fat necrosis – disturbances of blood supply and as a result, the sharp deterioration in the nutrition of these tissues.
The mechanism of development of pathology following. Capillary damage (traumatic or background of a disease) leads to a sharp violation of blood supply of certain area of fatty tissue (therefore, fat necrosis and evolves in the form of foci). The body reacts to such a process a reactive inflammation at the initial stage it is aseptic (non-infectious). Mentioned inflammation develops on the damaged part with the formation around the so-called demarcation line – it separates the affected tissue from the healthy.
Necrotic tissue after some time apart, decomposition products derived from the mammary gland with the blood flow. If necrotic foci in the breast many or they are large, the abundance of the decay products can trigger the occurrence of the intoxication syndrome.
As included defense mechanisms, inflammation, after some time docked. In the location where it occurred, you start the process of fibrosis – begin to develop the connective tissue cells that eventually displace necrotic foci and form a connective tissue scar.
Sometimes the necrotic areas do not have time to decompose and are deposited calcium salts – there are pockets of petrification (calcification). In some cases this process is so intense that it triggered the process of ossification (ossification) in mammary gland forms a hearth, on the structure and physical characteristics (density) similar to the plot of the bone tissue.
In unfavorable cases, the progression of the described pathology of the breast can take place with:
- with septic melting hearth;
- the sequestration – the formation of cavities in the place of dead tissue.
Symptoms of fat necrosis of the breast
Since the formation of the fat necrosis is preceded by a traumatic impact, a clinical picture begins to develop even before the full formation of necrotic foci.
Symptoms of fat necrosis of the breast are:
- tumor formation;
- retraction of the nipple;
- pain syndrome;
- signs of violation of the General condition of the body.
Tumor formation appears at the place of exposure to a pathogenic factor in breast tissue. Its characteristics are:
- the form – rounded or ovoid (egg-shaped);
- consistency – dense, at the same time, elastic;
- mobility – welded to the skin, so its mobility is limited;
- sensitivity is painful. In the future, when formation of fat necrosis pain may fade, also can increase the loss of sensitivity of the soft tissues. Both processes are related to the fact that in the process of necrosis also mortify the nerve endings;
- the characteristics of the skin – the skin over the tumor becomes cyanotic (bluish) or red, sometimes the combination of these two shades.
Retraction of the nipple may occur if the lesion fat necrosis is formed in the thickness of the breast in the region of the areola.
Characteristics of the pain syndrome:
- localization – in the formation of necrotic lesion;
- distribution can sometimes be a feeling that hurts the entire breast;
- by nature pain is often aching, when you attach an infectious agent with subsequent suppuration – twitch, “vomiting”;
- intensity – according to the formation of necrosis is increasing, then subside;
- the appearance is observed almost from the onset of the disease.
Signs of deterioration of the General condition associated with exposure of necrotic elements in the bloodstream. This is the classic symptoms of intoxication syndrome, namely:
- deterioration of the General condition, the feeling of malaise;
- General weakness and lethargy;
- loss of sleep until the insomnia;
- poor appetite, with the progression of the disease – its complete absence.
It is important
If fat necrosis of the breast temperature is usually normal and rises only in the presence of large areas of necrosis.
The diagnosis of fat necrosis of the breast is placed on the basis of complaints, anamnesis and the results of additional methods of examination.
When physical examination is determined by the following:
- on examination – of the affected mammary gland is enlarged, swollen tissue, the skin over the lesion or bluish red;
- palpation (feeling) – a swelling is confirmed, also is determined by tenderness of the breast. In tissues is determined by one or more foci of seals.
In some cases, there may be changes similar to the signs of breast cancer – its deformation, the formation of “dimples” on the skin, dense infiltration, and the increase in peripheral lymph nodes.
In the diagnosis of fat necrosis of the breast using such research methods as:
- mammography, a set of methods that use sighting to determine the condition of the breast;
- breast biopsy – make a fence fabrics with the subsequent study under a microscope.
During mammography are used:
- x-ray mammography;
- ultrasound mammography – helps detect areas of necrosis, and to assess their size, number, and condition of surrounding tissues;
- tomosynthesis is the creation of a two-dimensional image of the breast with all the changes in the tissue;
- MRI-mammography – high tech method of obtaining a tomographic image of the breast;
- optical mammography – it is used optical equipment.
Informative in the diagnosis of fat necrosis of the breast are the following laboratory techniques:
- Cytology – biopsy examined under the microscope, along with its cellular composition. First, the method is important for the detection of atypical cells;
- histological examination – biopsy investigated from the standpoint of the structure of tissues;
- General analysis of blood – when joining the infectious agent and the development of the inflammatory process increases the number of white blood cells (a condition called leukocytosis) and erythrocyte sedimentation rate.
Differential diagnosis of
Differential (distinctive) diagnosis of fat necrosis of the breast are often carried out with such diseases and pathological conditions, such as:
- acute mastitis – acute inflammatory lesions of the breast;
- abscess – a limited abscess of the breast. Especially careful differential diagnosis should be carried out in the case of multiple abscesses;
- phlegmon – diffuse purulent lesions of the breast;
- syphilis of the breast is a pathological process caused by a pale Treponema;
- tuberculosis of the breast is a pathological process in it, triggered by Mycobacterium tuberculosis (tubercle Bacillus);
- actinomycosis is an infectious disease of the prostate caused by actinomycetes (radiant mushrooms).
The complications that often accompany fat necrosis of the breast is:
- the accession of the infectious agent with the formation of infectious-inflammatory pathology – mastitis, abscess, cellulitis;
- fistula (fistula) – the abnormal moves that take place inside the tissues from the septic area to the surface of the breast;
- sepsis – spread of infection throughout the body;
- gangrene of the breast – her mortification, accompanied by processes of decay. Develops with the addition of putrid infection.
Treatment fat necrosis of the breast (lipogranulomas)
The main treatment fat necrosis of the breast is a surgical method. Operation is expedient for reasons such as:
- the irreversibility of focal tissue in adipose tissue (tissue can’t be restored);
- the difficulty in the differential diagnosis with a neoplastic process.
Spend organoboranes surgery – sectoral resection of a mammary gland. Tissue removed is sent for histological examination – only it allows to exclude the presence of tumor in the breast.
Conservative therapy is also used in the treatment of fat necrosis of the breast – it is prescribed in the postoperative period. The basis of the assignments are:
- antibiotics – for the prevention of infectious complications;
- vitamin therapy – to improve processes of reparation (recovery) tissues.
The main prevention of fat necrosis of the breast – the following activities:
- avoidance of injury to the breast at home and in the workplace;
- careful completion of medical procedures;
- avoidance of crash diets that lead to rapid weight loss;
- safety when working with radioactive substances;
- avoidance power sports;
- prevention, early detection and treatment of pathologies that can contribute to the development of fat necrosis of the breast – endocrine disorders, oncological processes, tuberculosis, drug addiction, and chronic intoxications;
- the wearing of clothes (including underwear), which leads to compression of the breast;
- regular preventive checkups mammalogy (doctor, dealing with the problems of the mammary glands) even in the absence of any complaints.
The prognosis of fat necrosis of the breast difficult. On the one hand, rapid detection of pathology and surgical correction to cure the disease, on the other – have to remove part of the breast.
Prognosis worsens with:
- late treatment and the progression of disease;
- the occurrence of complications.
Kovtonyuk O. V., medical columnist, surgeon, consultant physician