Vascularization in the mammary gland in fatty necrosis. What is breast lipogranuloma and how to treat a benign process with the formation of foci of fat necrosis

The disease is the necrosis of fatty tissue occurring in the chest and its subsequent replacement with scar tissue. According to medical statistics, pathology most often occurs after a traumatic injury to the mammary gland has occurred. Among all breast nodules, this pathology occupies only 0.6%. Most patients are women with large breasts. Necrosis develops against the background of the fact that, due to injury, the permeability of blood in the capillaries is disturbed, and fatty tissue does not receive proper nutrition. Also, in some cases, the pathology appears after the passage of mammoplasty with own tissues after the removal of the mammary gland.

How the disease manifests itself

Symptoms of pathology occur after a chest injury has been received. At the site of injury, a woman develops a dense painful tumor, which is soldered to the skin and has a rounded outline. The consistency of the neoplasm is dense. Gradually, the pain of education disappears. The skin at the site of the focus of necrosis turns red or becomes cyanotic. When necrosis is noted in the areola, the nipple is somewhat retracted inward. There is no increase in body temperature. In severe cases, a focus of septic tissue fusion may be observed. Outwardly, when examining the breast, necrosis looks very similar to breast cancer.

How is pathology diagnosed?

In order for the correct diagnosis to be established as quickly as possible, it is imperative to inform the mammologist about whether there has been a chest injury. The specialist conducts a probing of the mammary gland and after that appoints an examination. The main diagnostic measures are:

• mammography;
• CT scan.

Based on the results of the survey, it is possible to identify formations that have a heterogeneous structure. While the disease is at its initial stage, it is often confused with cancer during examination, and then a biopsy of the altered breast tissue is indicated. When a clear focus of necrosis is formed, it is impossible to confuse the disease with oncology, since in this state the neoplasm is seen during examination as a spherical calcinate.

Treatment of necrosis

Pathology is treated only by surgery. Alternative therapy is not effective and cannot restore the altered tissues. To get rid of the disease, an organ-preserving sectoral (partial) resection of the mammary gland is performed. During the operation, only the affected parts of the gland are excised. To prevent the appearance of suppuration after the intervention, they take a course of antibiotics. The stitches are removed on the 10th day.

After the intervention, the excised tissues are required to undergo a histological examination of the material obtained, in order to completely exclude the presence of cancer.

Necrosis of breast tissues does not give relapses and can only be repeated in case of repeated injury to the breast.

Prevention of pathology

Prevention of the disease gives good results, since in almost all cases the disease can be prevented. To prevent breast injury, women whose mammary glands are number 3 or more should wear a tight bra when active in sports or work, when there is a risk of damage to the mammary gland. In the event that an injury does occur, the woman needs to seek medical help.

Necrosis of breast tissue does not degenerate into malignant tumors, but this does not mean that the pathology does not require therapy.

If you suspect a pathological process in your body, you should immediately consult a doctor. In our clinic on Komendantsky Prospekt in the Primorsky District, you will receive qualified medical assistance. Call us today and make an appointment with the doctor at a convenient time for you.

• Biopsy of the breast.

For many women, the phrase "fat necrosis of the breast" sounds ominous. In fact, this condition is not so scary and does not even always require treatment. The terrible word "necrosis" in this case means only the death of adipose tissue cells. Over time, dead cells are replaced by a scar or form a cyst.

Why does fat necrosis occur in the breast?

The most common reason is breast surgery. After all, any surgical intervention, especially an extensive one, is a tissue injury, it leads to impaired blood supply. Moreover, fat necrosis does not always develop immediately after surgery, it can take years.

There are other possible reasons:

• Chest injury. Fat necrosis can occur after a car accident due to a chest injury from a seat belt.
• Biopsy of the breast.
• Radiation therapy in oncological diseases. Radiation can damage not only tumor, but also healthy tissue, resulting in a complication - fatty necrosis.
• Among the patients, ladies with curvaceous forms predominate, who have more adipose tissue in their breasts. In the high-risk group, middle-aged women with saggy, out of shape breasts.

What are the symptoms of pathology?

Fat necrosis of the mammary gland may be asymptomatic, in which case it is detected only during the examination, after a mammogram.

A painful swelling may appear in the chest, the skin over it becomes red or bluish in color, but the body temperature remains normal. Some women develop discharge from the nipples. The skin over the lesion is retracted, in some cases the nipple is retracted.

Similar manifestations occur with malignant tumors of the breast. Do not delay a visit to the doctor. Timely examination helps to exclude cancer.

Fatty necrosis of the mammary gland is characterized by gradual necrosis of the tissue of the same name, followed by scarring of the problem area. This process develops in foci. By external signs and sensations, it is quite difficult to differentiate fat necrosis or cancer. In both cases, pain occurs and the shape of the breast changes in both women and men.

general information

Fat necrosis is diagnosed in 0.6% of cases of breast growths. In men, this process in this zone is extremely rare. This fact is due to the lack of a sufficient amount of adipose tissue. However, more often Fat necrosis is diagnosed in overweight men.

The pathological process is most typical for women with large breasts. The risk zone includes patients of reproductive age (25-35 years).

The reasons

The main reason for the development of necrosis of adipose tissue of the breast is trauma to the mammary glands resulting from:

• injury;
• surgical intervention;
• sampling during a biopsy.

Rapid weight loss contributes to the appearance of fat necrosis. Weight loss occurs against the background of severe systemic pathologies or while following a strict diet.

Among the factors provoking necrosis of adipose tissue of the breast include:

• tuberculosis;
• malignant tumors;
• endocrine disorders;
• severe stress;
• body intoxication.

Also, the possibility of developing necrosis after radiation therapy and against the background of cardiovascular pathologies is not excluded.

Tissue death occurs due to impaired blood circulation in the mammary glands. Because of this, the cells receive insufficient nutrients, which triggers the necrotic process.

When blood vessels are damaged, the body strives to repair tissue. Because of this, foci of inflammation appear in the problem area, separated from healthy areas. As the process progresses, tissue necrosis starts. But due to the activity of the body, the affected cells are removed naturally. And the necrotic focus is tightened by fibrous tissue.

Symptoms

Due to the fact that necrosis develops after injuries, signs of damage become noticeable before the onset of tissue death. The problem is indicated by:

• the appearance of seals in the chest;
• retraction of the nipple;
• pain, aggravated by contact;
• deterioration in the general condition of the body.

The tumor, which is formed against the background of the inflammatory process, has an oval (rounded) shape. On palpation, an elastic structure is noted. The tumor is characterized by low mobility due to cohesion with neighboring tissues.

As the necrotic process progresses, the intensity of pain may decrease due to skin numbness. Covers over the focus of inflammation acquire a red or cyanotic hue.

The deterioration of the general condition is associated with the fact that the decay products that occur in the process of necrosis spread throughout the body, provoking intoxication. Because of this, a decrease in appetite, poor sleep, and lethargy are possible. Body temperature remains within the normal range in most patients.

Diagnostic methods

If breast necrosis is suspected, information about the patient's condition is first collected, and then the problem area is palpated. To make an accurate diagnosis, the following studies will be required:

• x-ray;
• tomosynthesis, which creates a two-dimensional image of the gland;
• optical mammography.

To exclude a malignant tumor, a material is taken (biopsy) followed by histological and cytological examination of tissues. Additionally, a general blood test is prescribed to rule out bacterial infection.

Possible Complications

Necrosis of adipose tissue provokes the formation of fistulas in the problem area. The course of the pathological process contributes to the attachment of bacterial microflora and suppuration of tissues, which can cause the development of sepsis.

In advanced cases, gangrene occurs in patients with adipose tissue necrosis.

Methods of treatment

Elimination of necrosis of adipose tissue of the mammary glands is carried out through surgical intervention. Conservative therapy and treatment with folk remedies in this case are not applicable. Medications are recommended to eliminate the consequences of the operation, as well as to suppress the bacterial microflora. For this apply:

1. Broad spectrum antibiotics. Drugs not only suppress infections, but also prevent infection.
2. Vitamin complexes. Stimulates the repair of damaged tissues.

Surgery for necrosis is used due to the difficulty in differentiating such a lesion from a cancerous tumor. Besides, tissue does not regenerate after death.

The type of operation is selected depending on the localization of the necrotic process. Sectoral is mainly used, in which only part of the mammary gland is removed. Tissues after excision are sent for histological examination in order to exclude a malignant tumor.

Forecast and prevention

The prognosis for adipose tissue necrosis is ambiguous. In most cases, there are no complications after the operation, except for the fact that the woman is missing part of her breast. Tissue plastic surgery is used to restore the mammary gland.

The prognosis is poor in cases of late presentation when necrosis has caused systemic complications.

In order to prevent inflammation with subsequent death of breast tissue, it is recommended to avoid breast injuries. To do this, you should wear comfortable underwear, give up contact sports, and avoid strict diets. Women (especially of reproductive age) need to treat breast diseases and endocrine pathologies in a timely manner. In addition, it is important to regularly (once every six months) be examined by a mammologist and immediately consult a doctor if palpation reveals seals in the chest.

Lipogranuloma of the mammary gland is characterized by the formation of foci of necrosis in adipose tissue. According to external signs, this disease is similar to a malignant neoplasm, but the ongoing examination establishes a benign process. In medicine, lipogranuloma is also referred to by other terms, these are oleogranuloma, steatogranuloma, oleoma, fatty necrosis of the mammary gland.

Causes

Lipogranuloma belongs to the group of benign tumors of the mammary glands.

The disease in most patients develops as a result of trauma and other mechanical external influences.

Damage to small blood vessels leads to impaired blood supply and nutrition in one of the areas of the chest. Gradually, this area of ​​adipose tissue dies, and a zone of reactive inflammation forms around it. Usually, inflammatory changes fade on their own, and a sac with liquid forms in necrotic areas. There is a possibility of infection of this fluid and then suppuration begins. In some women, with a long-term oleogranuloma, calcium salts accumulate in the necrosis zone and calcification occurs.

Areas of necrosis may appear as a result of unsuccessful sports training, after bruises in transport. Rarer causes of oleoma formation include:

The likelihood of developing this type of benign formation is increased in women with large breasts and in old age. After a bruise with hemorrhage, the formation of lipogranuloma occurs quite quickly. In other cases, the process of tumor growth before the appearance of noticeable external changes may take several months.

Symptoms

The process of formation of lipogranuloma in some women is completely asymptomatic. Pay attention to the neoplasm when the breast in one area changes its shape. A neoplasm on palpation is defined as a dense lump of a rounded shape; when probing, its soreness is felt. As the lipogranuloma grows, soreness and discomfort appear. Sometimes the nipple is retracted, and dimples appear on the chest over the localization of the area of ​​necrosis.

In case if
lipogranuloma is preceded by a strong blow, then the symptoms of the disease are much easier to notice. A painful area appears in the area of ​​impact, resembling a rounded lump in shape. The tumor is quite dense and soldered to soft tissues. Sometimes there is a loss of sensitivity in the area of ​​necrosis. You can also pay attention to the change in the skin, the skin acquires a cyanotic or reddish color.

Oleogranuloma of the mammary glands, in addition to the listed signs, leads to deformation of the nipple, to an increase in the nearest lymph nodes, to a change in the shape of the breast, and sometimes to discharge from the chest. Similar signs are similar to cancer (in another material, the symptoms of breast cancer are analyzed in detail). Therefore, it is imperative to be examined, this will help detect breast cancer in the first stage. Lipogranuloma is not a malignant neoplasm, but under the influence of a number of changes it can give impetus to the degeneration of cells into cancerous ones.

Postoperative oleogranuloma occurs as a result of an allergic reaction to the suture material or implants. The tumor is formed in one of the zones of the postoperative suture after its inflammation. In nearby tissues, there is a violation of blood microcirculation, which leads to cell death - the formation of a necrosis zone.

Diagnostics

Establishing the diagnosis begins with examination and palpation of the mammary glands. If a tumor is detected, the doctor will definitely send for an additional examination, mammography or ultrasound is prescribed.

Oleogranuloma on mammography images at the beginning of its formation looks like a cancerous tumor. After the calcification of the granuloma occurs, it can be diagnosed immediately. At the beginning of the formation of lipogranuloma, a biopsy is required - taking biomaterial for histological examination and making a final diagnosis.

Treatment

Since with fat necrosis irreversible changes occur in the mammary gland, an operation is indicated. Most often, an organ-preserving operation is performed - sectoral resection, that is, the desired area with the tumor is removed. Part of the cut off tissues is sent for a histological examination, based on the results of which a further tactic for managing the patient is chosen.

If fluid is detected in the area of ​​necrosis, aspiration may be performed. This procedure consists in introducing a needle into the formation, with the help of which the contents are pumped out. As a result of such an intervention, the walls of the tumor subside, which leads to the disappearance of the neoplasm. It should be borne in mind that such an outcome of the disease does not always occur and depends on the causes of the oleogranuloma and the general health of the patient.

In the video clip, a consultation with a mammologist about the causes and treatment of lipogranuloma:

Postoperative period

In the postoperative period, a woman is prescribed a course of hormonal agents and vitamin complexes. The use of these medicines helps prevent the recurrence of the disease. It is necessary to wear a support bandage and avoid bruises, bumps.

Removal of lipogranuloma is a fairly easy operation in terms of technique, so complications rarely occur. In the postoperative period, a woman is prescribed anti-inflammatory therapy and a daily change of dressings for several days. Be sure to wear a supportive top. Carrying out a sectoral resection (operation) allows you to save a large part of the breast and apply a cosmetic suture. If the formation is small, then its removal practically does not affect the shape of the breast. When a large lipogranuloma is removed, the mammary gland is deformed. Therefore, a woman is offered mammoplasty, during which implants of the necessary shape are inserted or breast reconstruction is carried out by other methods.

After surgery for the removal of lipogranuloma of the breast, a woman should be periodically checked by a doctor. Control mammography once a year is necessary for timely detection of recurrence of the disease.

Forecast and prevention

Lipogranuloma of the mammary glands is a fairly rare neoplasm, but it is treated quite successfully. Timely operation allows you to remove all the changed tissues at a time, which completely eliminates the risk of re-formation of the tumor.

To prevent the appearance of lipogranuloma, it is necessary to avoid bruises, falls on the chest, and blows. Caution must be exercised during sports, and in case of injury, it is always desirable to be examined. Treatment prescribed after a bruise, a course of physiotherapy can prevent the formation of a necrosis site.

Every woman should always have a breast exam by a doctor at least once a year. Self-examination of the breast is carried out on the 5th day of the menstrual cycle. Identification of various in shape and size seals or areas of pain should not be ignored and consult a doctor.

The video shows the method of self-examination of the breast:

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Everyone knows that the female breast is a very delicate gland, the tissues of which should not succumb to physical influences (injuries, bruises). Girls should be aware that their breasts should be protected from squeezing with a bra, cover their breasts with their hands during a massive crowd of people, and in every possible way avoid even the most minimal chest injuries. This is because the mammary gland consists of extremely sensitive tissues, which, at the slightest impact, can change their structure. The mammary glands are very susceptible to such pathological processes as mastopathy, fibroadenoma, mastitis, papillomas. There may also be fat necrosis of the breast.

Fatty necrosis of the mammary gland. Causes of lipogranuloma

Fatty necrosis of the mammary gland is an aseptic focal necrosis of fatty tissue. In this case, adipose tissue is replaced by scar tissue. Fat necrosis is also called oleogranuloma, lipogranuloma and steatogranuloma. Fat necrosis refers to non-enzymatic necrosis. The main cause of oleogranuloma is chest trauma. Fat necrosis of the mammary glands is more susceptible to patients with large breasts than with small ones.

Traumatic factors that can provoke fatty necrosis of the mammary glands: accidental bumps and bruises, for example, in transport, sports training, medical manipulations. Sometimes the cause of oleonecrosis is rapid weight loss or radiation therapy. Sometimes necrosis occurs after breast augmentation or mastectomy.

What happens in breast tissue during fat necrosis?

With injuries to the breast tissue, small capillaries of the fatty tissue area are damaged. Further, breast tissues react to this process by the appearance of an inflammatory reaction. A demarcation zone is formed, which limits the dead tissue. After the completion of the inflammatory reaction, the process of fibrosis begins, in which necrotic masses are replaced by connective tissue cells. This is how scar tissue is formed. In the future, calcium salts are deposited in such areas of necrosis of the adipose tissue of the mammary gland, and petrification of the foci occurs. In rare cases, ossification processes are observed.

Symptoms of fatty necrosis of the breast

After a chest injury, a painful swelling appears, which is soldered to the skin. It has a dense texture and a rounded shape. Later, the affected area of ​​adipose tissue begins to lose sensitivity. Outwardly, the gland may change in color - the skin of the gland may acquire a bluish or red tint, the nipple may be somewhat retracted. Such a picture often resembles mastitis and misleads women, but it is very easy to distinguish fatty necrosis from mastitis - with mastitis, there will be an increase in body temperature to febrile numbers.

With all this, fat necrosis can be clinically similar to breast cancer. Deformation of the mammary gland, the density of the infiltrate, the appearance of retracted areas on the skin of the gland and an increase in regional lymph nodes may resemble breast cancer. In neglected states, fat necrosis can occur in the form of sequestration and tissue melting.

Diagnosis of fatty necrosis of the breast

In the diagnosis of fatty necrosis, it is of great importance to indicate the patient's history of a chest injury that has occurred recently. On palpation, a mammologist determines a painful induration that does not have clear contours and can fluctuate.

When conducting ultrasound of the mammary glands, CT or MRI, a heterogeneous formation of a nodular nature is detected, which has stringy uneven contours. With these tests, the results are often very similar to breast cancer. But, after some time, when the focus of necrosis begins to calcify, on mammography, the focus of fat necrosis looks like a spherical calcification of the "eggshell" type. This allows you to exclude the malignancy of the process.

For differential diagnosis, it is advisable to conduct a biopsy of the gland tissues with subsequent histological examination. Breast biopsy is performed under ultrasound guidance.

Treatment and prevention of fatty necrosis of the breast

In the presence of fat necrosis, only surgical treatment is indicated - organ-preserving sectoral resection of the mammary gland. After that, the material is checked histologically. Microscopically, this material is represented by nodular growths of granulation tissue from epithelioid cells, large lipophages, and xanthoma cells around fatty inclusions. The main components of lipogranulomas are fatty cysts - cavities with thin walls that are filled with a serous and oily fluid.

If the gland is injured, it is necessary to give it an elevated position with a bandage and immediately consult a doctor.