Herbal treatment of fatty necrosis of the mammary breast. Breast fat necrosis symptoms and treatment. Symptoms. Signs of a disease of varying degrees of development

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.

Fat necrosis of the breast- this is an aseptic focal necrosis of the fatty tissue of the mammary gland with its replacement with scar tissue. This disease has several names - steatogranuloma, lipogranuloma, oleogranuloma. The disease refers to non-enzymatic necrosis, which is usually caused by various injuries of the chest. According to statistics collected by modern doctors, fat necrosis is about half a percent of all other nodular formations of the mammary glands. Most often, fat necrosis occurs in women with large breasts - in women with small breasts, it develops much less frequently.

Causes of fatty necrosis of the breast

Impacts and bruises in transport or at home, sports training, various medical and surgical operations can act as a traumatic factor for the onset of the disease. Slightly less often, the cause of fat necrosis is radiation therapy or sudden and severe weight loss. In rare cases, necrosis can be diagnosed in patients who have undergone reconstructive mammoplasty with their own tissues, that is, their mammary gland was restored using materials from their body.
Even slight damage to the capillaries sometimes leads to disruption of the blood supply to any part of the fatty tissue. This is followed by the development of inflammation, which limits the dead tissue, which does not receive blood. After the inflammation subsides, the necrotic masses are replaced by connective tissue - the process of fibrosis begins. In this case, scar tissue remains in the place where the necrosis was located. After some time, calcium salts begin to be deposited in the necrotic area.

Symptoms of fatty necrosis of the breast

In almost 100% of cases, before the development of necrosis, the chest is injured in one way or another.

A bruise - at the site of this very injury, a swelling that is quite painful to the touch is formed, which is soldered to the skin. It has a dense texture and a rounded shape. Gradually, over time, the area where the fatty necrosis of the mammary gland is located loses sensitivity.
Discoloration of the skin - the skin over the formed tumor sometimes acquires a red or cyanotic color. If fatty necrosis of the mammary gland has formed in the areola, then the nipple is also drawn into the process of dying. Unlike the related mastitis, during fat necrosis of the mammary gland, body temperature usually does not rise above normal.
Deformation of the mammary gland - due to such signs as an increase in lymph nodes, the formation of a dense infiltrate and "dimples" on the skin of the breast, fatty necrosis looks very much like breast cancer. In especially unfavorable cases, fatty necrosis of the mammary gland proceeds with the melting of the focus of necrosis and its subsequent rejection.

Treatment of fatty necrosis of the breast

The only more or less effective measure of treatment for fatty necrosis of the mammary gland is the removal of its part, the dead necrotic sector. This is necessary because, due to the disease, irreversible changes occur in fatty tissue that cannot be eliminated with medication.
An oncological process, due to the similarity of the clinical picture, can be excluded only after a postoperative study of the extracted formation is carried out. Thus, before the operation there is no way to determine whether it is cancer or fat necrosis.

Prevention of fatty necrosis of the breast

In order to avoid fat necrosis of the mammary gland, one should try to avoid injury to the mammary glands. If any, even minor damage still occurred, you need to contact a mammologist as soon as possible. Immediately after the injury, before contacting a doctor, it is necessary to give the mammary gland a slightly elevated position with a bandage.

Complications

If left untreated, necrosis can lead to purulent inflammation of its focus. In addition, the process of forming an area of dead tissue may start. Over time, it is not replaced by its own connective tissue and can freely move to the zone of healthy tissues.

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Fat necrosis of the mammary gland is the process of focal necrosis of the adipose tissue of the breast and its subsequent replacement with scar tissue. Fat necrosis of the mammary gland occurs after various injuries (accidental bruises and blows in transport or at home, during training or medical procedures). Rarely, breast fat necrosis is caused by radiation therapy or rapid weight loss. In some cases, fat necrosis of the mammary gland can form in a patient who has undergone reconstructive mammoplasty.

In all these cases, the integrity of small vessels may be disrupted, and the blood supply to this area may be interrupted. All this leads to the development of fatty necrosis of the mammary gland. The most common fat necrosis of the mammary gland occurs in women with large breasts.

Symptoms of fatty necrosis of the breast

Most often, fat necrosis of the mammary gland is preceded by some kind of trauma to the mammary gland. At the site of injury, a painless tumor of a dense consistency and rounded shape is formed. Sometimes with fatty necrosis of the mammary gland, patients complain of discomfort and pain in some areas of the mammary gland. But most often, fat necrosis of the mammary gland has unexpressed symptoms, and tumors are detected only by palpation.

With the further development of fatty necrosis of the mammary gland, sensitivity may be lost in this area of \u200b\u200bthe mammary gland. With the formation of fatty necrosis of the gland, the skin, as it were, is soldered to the tumor and acquires a red or cyanotic color. In addition, with fatty necrosis of the mammary gland in the areal area, nipple retraction may occur, which makes the patient think about the development of a tumor. External similarity with cancer to fatty necrosis of the mammary gland gives an increase in lymph nodes and the appearance of irregularities and dimples on the skin. In fact, fat necrosis of the mammary gland is a benign formation, it can only mimic a malignant tumor in the diagnosis.

After the inflammatory process in the mammary gland subsides, the process of replacing necrotic masses with connective tissue begins. As a result, at the site of fatty necrosis of the mammary gland, scar tissue is formed. With the unfavorable development of fatty necrosis of the mammary gland, septic fusion of the focus and rejection of the damaged area from the surrounding tissues can be observed.

Diagnosis of fatty necrosis of the breast

When diagnosing fat necrosis of the breast, it is very important that the patient report breast trauma. During an external examination of the glands, the doctor may note redness or blueness of the skin, as well as the presence of bumps and retractions on the skin. On palpation of the mammary gland, the doctor can easily determine the compaction, sometimes painful. The contours of such a seal in fatty necrosis will be fuzzy. But ultrasound of the mammary gland will not reveal the characteristic signs of fatty necrosis of the mammary gland. When diagnosing a survey mammography or MRI of the breast, it is possible to identify a nodular formation with uneven edges and a heterogeneous structure. Since the picture in breast fat necrosis resembles that in breast cancer, this will require additional research. In the future, when calcium salts are deposited on the site, and calcification of the focus occurs, fatty necrosis of the mammary gland on mammograms will look like a spherical calcification resembling an eggshell. This will allow the diagnosis to exclude the malignancy of the ongoing process in the mammary gland.

Until this happens, fat necrosis of the mammary glands requires a biopsy. A breast biopsy is performed under X-ray or ultrasound control. After that, the obtained samples must be sent for cytological and histological examination. This allows you to differentiate fat necrosis of the breast and exclude the development of cancer.

Treatment and prevention of fatty necrosis of the breast

Since fat necrosis of the mammary gland is characterized by irreversible changes in adipose tissue, drug treatment in this case will not lead to anything. In addition, it is very difficult to completely differentiate breast fat necrosis even when performing a biopsy. Therefore, sectoral resection is used as a treatment for fatty necrosis of the mammary gland. It allows you to remove only part (sector) of the breast.

Further postoperative examination of the macropreparation will completely exclude the oncological process in the breast. Microscopically, fat necrosis is a nodular growth of granulation tissue. One of the components of fatty necrosis will be fatty cysts. Under a microscope, they are thin-walled formations that are filled with an oily liquid.

Fatty necrosis of the mammary glands is a disease that is easier to prevent than to treat later. In order to prevent fat necrosis, trauma to the mammary glands should be avoided. If the injury nevertheless occurred, it is necessary to give the mammary gland an elevated position with a bandage and contact a mammologist.

You should periodically contact a specialist not only in case of injury, but also for prevention in order to avoid fatty necrosis of the mammary glands. Such examinations should become mandatory for every woman, this will allow timely detection of diseases of the mammary glands, diagnostics and elimination of oncological processes in the breast. And, of course, every woman should make an independent examination of the glands at least once a month.

Fatty necrosis of the breast necrosis of an area of adipose tissue of the mammary gland with its subsequent replacement with scar tissue occurs due to impaired blood circulation in this area.

The mammary gland consists of glandular tissue and adipose tissue, there are also layers of dense connective tissue that divide the gland into lobes. Each mammary gland consists of 15 - 20 lobes, which in turn are divided into smaller lobules. The space between the lobules is filled with adipose tissue. In addition, adipose tissue is present at the base of the gland, which forms a kind of cushion. The shape and volume of the mammary glands depend on the amount of adipose tissue. The defeat of adipose tissue leads not only to a cosmetic defect, but is also accompanied by a violation of the functions of the mammary glands.

The most common cause of the development of fatty necrosis of the mammary gland is an injury that occurs as a result of a blow, compression, fall, excessive massaging. Breast injuries are more common in women involved in sports, where the risk of injury is significantly increased compared to everyday life, as well as in women with macromastia (large breast size). In addition, the development of the disease is possible due to the transferred infectious process, surgical intervention, for example, reconstructive mammoplasty, subcutaneous administration of drugs, sudden weight loss, hormonal disorders.

It is important to notice signs of fatty necrosis at an early stage in time and immediately contact a mammologist for a detailed diagnosis. Relapses of the disease do not develop in the case of high-quality removal of dead tissue. A reoccurrence of fat necrosis can only occur with repeated trauma. Tissue necrosis is an irreversible process, therefore, necrotic tissues will never recover. With a favorable outcome, dead tissue is replaced by connective tissue. With an unfavorable outcome, purulent inflammation develops.

Symptoms

Trauma is a common cause of breast fat necrosis. A painful induration appears at the site of impact. This formation is soldered to the skin, has a dense texture, has no clear boundaries. The skin over the altered area becomes hot to the touch, the color becomes bluish or red. With the spread of the process, the deformation of the mammary gland occurs, retractions appear. In the case of a long course of the disease, the necrotic adipose tissue is replaced by scar tissue (connective tissue). This process is accompanied by a decrease in soreness, as well as a pronounced persistent deformation of the mammary gland. In rare cases, axillary lymph nodes increase due to the development of an inflammatory process in them. The general condition of a woman usually does not suffer, only in severe cases of the disease, when septic melting of the foci occurs, there is an increase in body temperature, chills, and the appearance of general weakness. In the advanced stage, the formation of cracks and ulcers with purulent discharge is possible.

Diagnostics

Every woman should be examined by a gynecologist twice a year. At the appointment, the doctor feels the mammary glands for prophylactic purposes. If a suspicious formation is found in the mammary gland, the gynecologist writes a referral to the mammologist for further examination. With fatty necrosis, a formation with fuzzy contours is palpated, bringing pain to the patient. In the future, it is possible to prescribe ultrasound of the mammary glands, however, it should be noted that this research method will not help in verifying the diagnosis, so the rationality of its use remains in question. In addition, the doctor may prescribe the following studies: review mammography, CT, MRI. These studies will also not show specific features that are unique to fat necrosis. Considering that a nodular formation with a heterogeneous structure raises suspicions not only regarding the disease in question, but also such a formidable one as breast cancer, a breast biopsy is indicated. A biopsy is necessary for further cytological and histological examination, which will help in establishing the diagnosis. The study is recommended to be carried out under X-ray or ultrasound control.

Treatment

Unfortunately, it is impossible to get rid of the problem with the help of drugs, since they are not able to save a woman from the most altered area of \u200b\u200bthe breast. Therefore, the treatment uses surgical intervention, which consists in a sectoral resection of the mammary gland, that is, the area of \u200b\u200bthe mammary gland that is affected by fatty necrosis is removed. After removal, this area is sent for histological examination to exclude malignant cells. When the process is sufficiently started, it is necessary to resort to the removal of the entire mammary gland. Currently, this phenomenon is rare, since every year women undergo preventive examinations, during which it is possible to detect the process at an early stage. A running process is observed if a woman ignored trips to a gynecologist, and also did not seek help from a doctor after she discovered symptoms characteristic of this disease.

Given that the disease proceeds with pain, it is possible to use painkillers to eliminate this phenomenon.

In the future, you should be more careful about your health and avoid traumatic factors. If, nevertheless, an injury has occurred, it is recommended to give the mammary gland an elevated position with a bandage. After that, it is necessary to monitor the condition of the injured mammary gland and, in case of symptoms characteristic of the disease, immediately consult a doctor for help.

Medications

In the treatment of fatty necrosis of the mammary gland, drugs are practically not used, since they are not able to eliminate the problem of the disease itself. And they are appointed to relieve pain, which is a frequent companion of the disease. Of the painkillers, you can use analgin, nimesulide, ketorolac. These drugs are prescribed mainly in the form of tablets, with severe pain that does not go away after taking an anesthetic tablet, injections are prescribed. The most effective drug from this group, which has the most pronounced analgesic effect, is ketorolac. It is important to know that these funds are not recommended for long-term use. In most cases, they are used no more than 5 days.

In the clinic of the disease, there may be an increase in temperature. In such cases, drugs with antipyretic effect, such as ibuprofen, are prescribed. It is worth noting that medicines should be used only when the temperature rises above 38 ° C, until this period our body is able to cope with its condition itself.

Folk remedies

To prevent the development of fat necrosis, it is necessary to protect yourself from injuries, since they are considered the most common cause of the development of the disease. In addition, it is extremely important to conduct an independent examination of the mammary glands. Every woman should be able to perform this procedure, but this does not mean that if you follow a regular self-examination, you can neglect going to a gynecologist. The specialist will assess the condition of the mammary glands with the greatest accuracy and, if necessary, appoint studies to confirm his doubts.

The following steps must be followed for the survey:

Stand in front of a mirror with your arms extended along your torso. Check if both mammary glands are the same in size, shape, appearance, if there are any differences among them. Any changes, for example, redness of the skin, the presence of retractions or wrinkling, discharge from the nipple should alert and become a reason to go to the doctor;
Repeat the same steps, but with your arms raised above your head.
Put your hands on your belt, then alternately tighten and relax the muscles of the anterior chest several times. With these actions, continue to monitor the condition of the mammary glands;
Alternately, on both mammary glands, pinch the nipples between the thumb and forefinger. During these actions, attention should be paid to the presence of discharge from the nipple, if any, it is necessary to note the nature of the discharge;
Lie on your back and relax. With the pads of 2-4 fingers brought together, alternately feel the right and left glands. The right gland is felt with the left hand and vice versa. Feeling is done in a circle. Identification of areas of compaction or vice versa softening, pain when palpated indicates the development of a process that is not characteristic of the normal state of the mammary gland;
Repeat the feeling in a standing position.

All these actions do not cause difficulties in performing, so every woman should find the time and opportunity to examine the mammary glands.

The information is for reference only and is not a guide to action. Do not self-medicate. At the first symptoms of the disease, consult a doctor.

Fatty necrosis of the mammary gland is the necrosis of its fatty tissue, followed by replacement with scar tissue. Such necrosis develops in the form of foci.

For this pathology, a dense painful formation, retraction of the skin and a change in its color are characteristic - such signs make one suspect the presence of a tumor process.

When fatty necrosis occurs, there is a need for a sectoral resection (removal of a section) of the mammary gland.

Table of contents: 1. General data 2. Causes 3. Development of pathology 4. Symptoms of breast fat necrosis 5. Diagnosis 6. Differential diagnosis 7. Complications 8. Treatment of breast fat necrosis 9. Prevention 10. Prognosis

common data

Fatty necrosis of the mammary gland belongs to a number of so-called non-enzymatic necrosis. In mammology, of all nodular formations of the mammary gland, 0.6% of all diagnosed clinical cases fall on it.

When this pathology is mentioned, the disease in women is meant. With the defeat of the male representatives, the diagnosis sounds like “Fatty necrosis of the breast” (mammary glands are only in women). In men, this disease occurs very rarely - due to the scarcity of fatty tissue of the mammary glands. An exception may be gynecomastia - the development in male patients of the mammary glands according to the female type.

note

Fatty necrosis of the mammary glands is more often diagnosed in patients with large breasts (macromastia) than in women with small breasts.

Mostly women of the childbearing period get sick - the age category from 25 to 35 years is mainly affected.

Pathology has other names - it is oleogranuloma, lipogranuloma and steatogranuloma.

The reasons

The occurrence of fatty necrosis of the mammary gland can provoke fundamentally different reasons - for convenience, they are divided into groups:

traumatic lesions;
rapid weight loss;
radiation exposure to breast tissue.

A traumatic lesion that can lead to the development of this pathology can be observed:

when performing medical manipulations (in this case it is also called iatrogenic);
outside of the healing process.

Medical procedures, during which the integrity of breast tissue may be violated, with a subsequent risk of developing fat necrosis, can be:

diagnostic;
actually curative.

Such diagnostic manipulations include a biopsy - the collection of breast tissue for examination under a microscope. She happens:

puncture - the skin and underlying tissues of the mammary gland are pierced, suspicious contents are sucked out with a syringe;
sectional - cut off a section of suspicious tissues. Most often, such a biopsy is performed during surgery on the mammary gland for cancer.

Cases have been described when a biopsy was performed in case of suspected development of breast fat necrosis, which did not confirm the diagnosis - however, fatty necrosis developed later as a result of the biopsy.

Medical manipulations that can provoke the development of the described pathology include any invasive therapeutic actions. It can be:

suction of purulent contents from a breast abscess (recently practiced very rarely as a controversial and ineffective method of treatment);
opening and emptying the purulent focus of this organ;
removal of a fragment of the mammary gland due to a particular disease - necrosis, benign or malignant tumor, tuberculous focus, and so on;
plastic surgery. Fat necrosis of the mammary gland can occur in women who, after mastectomy (radical removal of the affected breast), underwent reconstructive mammoplasty (breast restoration) with their own tissues.

The development of iatrogenic fat necrosis is associated with:

forced intraoperative traumatization of gland tissues - for example, when removing large sections of it, stopping bleeding with the help of diathermocoagulation (“cauterization” of the destroyed walls of blood vessels with electric current);
gross inaccurate diagnostic or therapeutic manipulations, which is fraught with damage to the glandular tissue of the mammary gland, as well as its blood vessels and nerve endings.

Traumatic injury, not associated with medical procedures, is one of the most common causes of breast fat necrosis. According to the mechanism of development, such injuries are:

torn;
bruised;
bitten;
chipped;
chopped;
firearms.

By origin, such injuries that can lead to the development of fatty necrosis of the mammary gland are:

household;
production;
sports.

Domestic injuries that can lead to the occurrence of the described disease can be facts of traumatization:

unintentional;
deliberate.

The most common form of injury to the mammary gland, which can lead to fatty necrosis of the mammary gland, is its bruises:

received due to domestic inconveniences (sharp corners of furniture, cramped living quarters, and so on);
caused by hyperactive or unruly children;
received in transport (in public transport, this is mainly a bruise from the handrail of the front seat, in personal transport, a blow by the steering wheel to the mammary gland during sudden braking of the car);
related to domestic violence.

Prolonged compression of the gland is considered to be a special type of trauma to the tissues of the mammary gland, against which its fatty necrosis may develop. Most often it occurs during disasters:

natural - these are soil collapses in the mountains, snow avalanches, suction in bogs, staying under fragments of buildings during earthquakes;
man-made - mainly collapses due to powerful industrial explosions.

Also, prolonged compression of the mammary glands can be observed in traffic accidents, when people are trapped in a vehicle before the arrival of rescuers and doctors. Basically, this type of trauma is observed during:

car or bus accident;
train wreck.

Occupational injuries of the mammary gland, contributing to the development of its fatty necrosis, are less common than domestic ones. They are mainly associated with violation of labor protection rules (falling on slippery steps that lead to the office space) or ignoring safety regulations (improper care of large farm animals that can hit the mammary gland with a hoof or horn).

Sports injuries are most often observed in women who have chosen strength sports or those that are associated with the risk of falls. It:

women's boxing;
all kinds of wrestling;
women's football;
volleyball;
basketball;
tennis;
running with obstacles

and others.

Rapid weight loss, against the background of which fat necrosis of the mammary gland can develop, can be observed with:

severe diseases and pathological conditions;
deliberate adherence to a strict diet aimed at quickly losing weight before any important event - a wedding, a beauty contest, sports competitions (especially of a high rank, where a certain weight is an important condition for participation).

Severe diseases and pathological conditions, against which rapid weight loss can occur, contributing to the development of fatty necrosis of the mammary gland, are:

rapidly progressing oncological diseases (in particular, the defeat of their especially aggressive forms);
pulmonary tuberculosis - an infectious lesion caused by Mycobacterium tuberculosis (Koch's wand);
diabetes mellitus - a violation of the metabolism of carbohydrates, provoked by a lack of insulin in the body;
thyrotoxicosis - intoxication (poisoning) of the body with hormones produced by its own thyroid gland;
gross violation of the psycho-emotional sphere;
insufficiency of the adrenal cortex (other names - Addison's syndrome, hypocorticism);
Alzheimer's disease - senile dementia;
lymphoma (Hodgkin's disease) - a malignant lesion of the lymphoid tissue;
drug addiction;
any chronic intoxication, in which vomiting and diarrhea are regularly observed.

Radiation exposure to breast tissue, which can lead to the development of fatty necrosis, is observed in such cases as:

radiation therapy - in particular, the effect on malignant neoplasms of the mammary gland;
frequent passage of diagnostic procedures fraught with radiation exposure (radiography, fluoroscopy, and others);
contact with radioactive substances due to professional activity. It is fraught with pronounced radiation effects on the body in case of violation of labor protection rules or ignoring safety precautions (individual protective equipment);
unauthorized access to radioactive substances.

A group of factors that are not direct provocateurs of the development of fatty necrosis of the mammary gland, but can contribute to the necrosis of its tissues, has also been identified. It does not mean that under the influence of such factors, the described pathology develops without fail - nevertheless, the risks should be taken into account. These are diseases and conditions such as:

vascular pathology - because of it, microcirculation and nutrition of mammary gland tissues are disturbed;
blood diseases - the consequences are the same as with vascular pathology;
regular wearing of tight clothing.

Development of pathology

At the heart of the maximum majority of disorders that lead to the necrosis of breast tissue and the formation of areas of fatty necrosis is a violation of blood supply and, as a result, a sharp deterioration in the nutrition of these tissues.

The mechanism of development of pathology is as follows. Damage to the capillaries (traumatic or against the background of a particular disease) leads to a sharp violation of the blood supply to a separate area of fatty tissue (therefore, fatty necrosis develops in the form of foci). The body reacts to such a process with reactive inflammation - at the initial stage it is aseptic (non-infectious). The mentioned inflammation develops in the damaged area with the formation of the so-called demarcation line around it - it separates the affected tissues from healthy ones.

After some time, dead tissues disintegrate, the decay products are removed from the mammary gland with the bloodstream. If there are many or large necrotic foci in the mammary gland, an abundance of decay products can provoke the onset of an intoxication syndrome.

Since defense mechanisms are activated, inflammation stops after a while. In the location where it arose, the process of fibrosis starts - connective tissue cells begin to develop, which finally displace dead foci and form a connective tissue scar.

note

Sometimes necrotic areas do not have time to disintegrate, and calcium salts are deposited in them - foci of petrification (calcification) appear. In some cases, this process is so intense that the processes of ossification (ossification) are triggered - a focus is formed in the mammary gland, similar in structure and physical characteristics (density) to a piece of bone tissue.

In adverse cases, the progression of the described pathology of the mammary gland can take place with:

with septic fusion of the focus;
sequestration - the formation of cavities in place of dead tissue.

Symptoms of fatty necrosis of the breast

Since the formation of fat necrosis is preceded by a traumatic effect, the clinical picture begins to develop even before the formation of full-fledged necrotic foci.

Symptoms of fatty necrosis of the breast are:

tumor formation;
retraction of the nipple;
pain syndrome;
signs of a violation of the general condition of the body.

A tumor-like formation appears at the site of exposure of the pathogenic factor to the breast tissue. Its characteristics:

in shape - round or ovoid (egg-shaped);
by consistency - dense, at the same time elastic;
by mobility - soldered to the skin, so its mobility is limited;
by sensitivity - painful. In the future, with the formation of fat necrosis, pain may fade, and loss of sensitivity of soft tissues may also increase. Both processes are connected with the fact that in the process of necrosis the nerve endings also become dead;
according to the characteristics of the integument - the skin over the tumor becomes cyanotic (bluish) or red, sometimes a combination of these two shades is possible.

Retraction of the nipple is observed if the focus of fatty necrosis is formed in the thickness of the mammary gland in the area of the areola.

Characteristics of the pain syndrome:

according to localization - in the area of formation of a necrotic focus;
by distribution - sometimes there may be a feeling that the entire mammary gland hurts;
by nature - the pains are often aching, when an infectious agent is attached, followed by suppuration - twitching, "tearing";
in intensity - as necrosis forms, they increase, then weaken;
by occurrence - are observed almost from the very beginning of the disease.

Signs of deterioration in the general condition are associated with the ingress of necrotic elements into the bloodstream. These are the symptoms of the classic intoxication syndrome, namely:

deterioration in general condition, feeling unwell;
general weakness and lethargy;
deterioration of sleep up to insomnia;
deterioration of appetite, with the progression of pathology - its complete absence.

With fatty necrosis of the mammary gland, the temperature is usually normal and rises only in the presence of large foci of necrosis.

Diagnostics

The diagnosis of fatty necrosis of the mammary gland is made on the basis of complaints, anamnesis and the results of additional examination methods.

The physical examination determines the following:

on examination - the affected mammary gland is enlarged, the tissues are swollen, the skin over the lesion is bluish or red;
on palpation (palpation) - the swelling is confirmed, the soreness of the mammary gland is also determined. In the tissues, one or more foci of compaction are determined.

note

In some cases, there may be changes similar to signs of breast cancer - its deformation, the formation of "dimples" on the skin, a dense infiltrate, as well as an increase in peripheral lymph nodes.

In the diagnosis of fatty necrosis of the mammary gland, such research methods are used as:

mammography - a set of methods that are used specifically to study the state of the mammary gland;
breast biopsy - tissue is taken and then examined under a microscope.

During a mammogram, the following are used:

x-ray mammography;
ultrasound mammography - helps to identify areas of necrosis, assess their size, quantity, as well as the condition of surrounding tissues;
tomosynthesis is the creation of a two-dimensional image of the mammary gland with all the changes in its tissues;
MRI mammography is a high-tech method for obtaining a tomographic image of the breast;
optical mammography - when it is carried out, optical equipment is used.

Informative in the diagnosis of fatty necrosis of the mammary gland are the following laboratory research methods:

cytological examination - a biopsy specimen is examined under a microscope, its cellular composition is evaluated. First of all, the method is important for the detection of atypical cells;
histological examination - a biopsy is examined for the structure of tissues;
a general blood test - when an infectious agent is attached and the inflammatory process develops, the number of leukocytes increases (a phenomenon called leukocytosis) and ESR.

Differential Diagnosis

Differential (distinctive) diagnosis of fatty necrosis of the mammary gland is most often carried out with such diseases and pathological conditions as:

acute mastitis - an acute inflammatory lesion of breast tissue;
abscess - a limited abscess of the mammary gland. Particularly careful differential diagnosis should be carried out in the case of the development of several abscesses;
phlegmon - a diffuse purulent lesion of breast tissue;
syphilis of the mammary gland - a pathological process caused by pale treponema;
tuberculosis of the mammary gland - a pathological process in it, provoked by Mycobacterium tuberculosis (Koch's wand);
actinomycosis is an infectious disease of the gland caused by actinomycetes (radiant fungi).

Complications

Complications that most often accompany fatty necrosis of the mammary gland are:

the attachment of an infectious agent with the formation of infectious and inflammatory pathologies - mastitis, abscess, phlegmon;
fistulas (fistulas) - pathological passages that pass inside the tissues from the purulent area to the surface of the mammary gland;
sepsis - the spread of infection throughout the body;
gangrene of the mammary gland - its necrosis, accompanied by the processes of decay. It develops with the addition of a putrefactive infection.

Treatment of fatty necrosis of the mammary gland (lipogranuloma)

The main method in the treatment of fatty necrosis of the mammary gland is the surgical method. The operation is advisable for such reasons as:

irreversibility of focal tissues in adipose tissue (tissues are not restored);
difficulty in differential diagnosis with a tumor process.

An organ-preserving operation is performed - a sectoral resection of the mammary gland. The removed tissues are sent for histological examination - only it allows to exclude the presence of a tumor in the mammary gland.

Conservative therapy is also used in the treatment of fatty necrosis of the mammary gland - it is prescribed in the postoperative period. Appointments are based on:

antibacterial drugs - for the prevention of infectious complications;
vitamin therapy - to improve the processes of reparation (recovery) of tissues.

Prevention

The basis for the prevention of fatty necrosis of the mammary gland is the following measures:

avoidance of injury to the mammary gland at home and at work;
careful performance of medical procedures;
avoiding strict diets that lead to rapid weight loss;
compliance with safety regulations when working with radioactive substances;
avoidance of power sports;
prevention, timely detection and treatment of pathologies that can contribute to the development of fatty necrosis of the mammary gland - endocrine disorders, oncological processes, tuberculosis, drug addiction, chronic intoxication;
wearing clothes (including underwear) that do not lead to compression of the mammary glands;
regular preventive examinations by a mammologist (a doctor who deals with problems of the mammary glands) - even in the absence of any complaints.

Forecast

The prognosis for fatty necrosis of the mammary gland is difficult. On the one hand, the rapid detection of pathology and surgical correction make it possible to get rid of the pathology, on the other hand, it is necessary to remove part of the breast.

The prognosis worsens with:

late treatment and progression of pathology;
occurrence of complications.

Kovtonyuk Oksana Vladimirovna, medical commentator, surgeon, medical consultant

Focal death of fatty tissues in the area of the mammary gland is characterized by the appearance of a certain seal in the tissues, which has increased pain on palpation.

This pathology is called fat necrosis of the mammary gland. During the development of the disease, dead cells are replaced by connective tissue, which in turn is also a violation.

Usually, the appearance of such an object suggests a cancerous tumor, since the symptomatic indicators are similar.

Accordingly, there is a need to go to a medical institution to undergo an examination and carry out the required diagnostic procedures.

A pathological disorder called fat necrosis of breast tissues is referred to as necrotic processes of an unfermented type, which can be caused by traumatic injuries.

According to statistics, which are compiled according to the clinical incidence in mammology, fat necrosis occurs in 0.6% of women with identified nodular-type formations.

For reference!

Experts note that in women with small breasts, this pathology is much less common.

Among the reasons for the development of necrosis, in particular, there are:

Household damage to the tissues of the chest - bruises, compression, penetrating injuries, etc.
The consequences of medical manipulations are excessive pressure during palpation, minimally invasive diagnostics, etc.
Injuries during physical exertion - bruises, sprains in the chest area, etc.
As a result of rapid weight loss.
Reactive inflammation of tissues in violation of the blood flow of the local area.
Passage of procedures related to radiation exposure.
Violation of regeneration after reconstructive mammoplasty with own tissues.

After healed areas in the area of necrotic lesions, the development of ossification and petrification processes is possible.

Symptoms of the necrotic process

The occurrence of a focus of necrosis of fatty tissues is characterized by the formation of a painful compaction, which, upon palpation, is defined as an object of rounded outlines and a dense structure soldered to neighboring tissues.

In addition, the following symptoms are observed:

change in skin color over the area (redness or cyanosis);
the appearance of depressions on the skin of the chest;
retraction of the nipple with alveolar localization;
lymph nodes are defined as enlarged.

Body temperature rarely exceeds the norm, which distinguishes fat necrosis from mastitis.

The external data of such a process are very similar to the signs of a malignant neoplasm, which requires careful diagnosis.

With an unfavorable development of necrosis, a septic expansion of the area of necrotic damage is possible.

Diagnostic methods for fatty necrosis of the mammary glands

In the process of diagnosing, the patient's anamnesis is important, since an indication of a recent traumatic injury more clearly indicates a necrotic form of formation.

The use of an ultrasound examination to determine necrosis is not sufficient, since this technique does not allow revealing characteristic signs.

In the process of palpation examination, a mammologist specialist has a seal that has fuzzy boundaries and increased pain.

In the future, for diagnosis, it is required to carry out such hardware studies, depending on the existing clinical picture, the doctor may omit some of them:

The data obtained at the initial stages of the disease have a similar picture with malignant neoplasms of the region.

With the development of the process to calcification, the images show calcified deposits that have spherical outlines, which make it possible to accurately determine the non-malignancy of the disease.

Differential Diagnosis

To differentiate the diagnosis, a mammologist may prescribe a sampling of biopsy material for further histological and cytological laboratory testing.

This procedure is performed under fluoroscopic or ultrasound guidance to determine the exact disposition of the necrotic object.

Treatment and preventive measures

Taking into account the irreversibility of the pathological disorder and the difficulties of accurately differentiating the necrotic process of the adipose tissue of the mammary glands, treatment requires surgical intervention.

The main focus of such an operation is organ-preserving resection of the affected area - sectoral.

During such an operation, the entire affected area (sector) of the mammary gland is excised with the maximum possible preservation of healthy tissues.

The excised part must be sent to the laboratory for additional histology. This measure allows you to accurately determine the origin of the neoplasm and exclude the malignancy of the process.

As a preventive measure, it is necessary to reduce the likelihood of injury to the breast. If you get an injury in this area, you need to contact a mammologist as soon as possible.

He will prescribe the necessary treatment to reduce the likelihood of necrotic changes to a minimum.

Usually this is wearing a bandage that lifts the chest, healing ointments and anti-inflammatory drugs.

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Fat necrosis of the mammary gland is a focal necrosis of adipose tissue that occurs after various injuries. This pathology is a benign change in the tissues of the mammary gland. With various damaging factors, as a result of a violation of the integrity of small vessels, the blood supply to the tissue site stops, after which necrosis develops. Injuries can be very different, for example, an elbow during sports training or a bruise on a door frame.

Often, necrosis can occur as a result of radiation therapy and with a sharp decrease in weight. Usually, pain symptoms of fat necrosis are either absent, and changes in adipose tissue are detected only during a medical examination by traditional palpation or are painful, and a visual examination of the chest shows enlarged lymph nodes and irregularities in the form of dimples on the skin.

Fat necrosis does not degenerate into a malignant tumor, but can only simulate it. On mammography or ultrasound, fat necrosis is defined as a malignant tumor, which requires the use of a biopsy, and in some cases, a sectoral resection. Fat necrosis of the mammary gland, also called oleogranuloma, lipogranuloma and steatogranuloma, refers to non-enzymatic necrosis.

Changes in the tissue structure are characterized by the development of reactive inflammation with the formation of a demarcation zone that separates dead tissue. The subsidence of inflammation is accompanied by the process of fibrosis, i.e., the replacement of necrotic masses with connective tissue. In places of necrosis, scar tissue is formed. Possible deposits in the area of fat necrosis of calcium salts, calcification of the focus of necrosis.

Symptoms and diagnosis of fatty necrosis of the breast

The development of fat necrosis is preceded by a traumatic effect on any part of the mammary gland. If the blow is strong, then a painful swelling quickly forms at the site of the injury, cyanotic or red in color, round in shape and dense in consistency. It is soldered to the skin, sensitivity is lost.

Fat necrosis entails retraction of the nipple, proceeds without an increase in body temperature. With an unfavorable development of the disease, septic fusion of the focus and the process of rejection of the necrotic area (sequestrum) from the surrounding living tissues can occur. Diagnosis of fatty necrosis of the mammary gland necessarily begins with a survey of the patient, the doctor must know the nature of the traumatic effect, the timing of the development of necrosis.

The doctor-mammologist in the process of contact determination reveals the degree of density, the clarity of the contours of fat necrosis, the symptoms of the presence of fluid (pus, blood). Panoramic mammography and MRI of the mammary glands help to detect heterogeneity of the structure, stranded uneven contours.

X-ray, tomographic and echographic studies of fat necrosis often show symptoms of breast cancer. After calcification occurs, the focus of fatty necrosis of the mammary gland resembles a spherical calcification of the “eggshell” type, this circumstance completely excludes the presence of a malignant tumor. Differential diagnosis involves a biopsy of the mammary gland, i.e., puncture fine-needle or trephine biopsy, which allows subsequent cytological and histological examination of the obtained fragments.

The biopsy is always performed under ultrasound or X-ray guidance. Treatment and prevention of fatty necrosis of the mammary gland has its own specifics and some difficulties. It is good when patients go to the doctor at the beginning of discomfort. Since focal changes in adipose tissue are irreversible, and there are also difficulties in differential diagnosis, an organ-preserving operation with the removal of a part of the mammary gland is indicated.

Repeated histological studies after surgery can completely exclude or confirm the process of cancer. Under the microscope, fat necrosis presents as nodular growths of granulation tissue from epithelioid cells, multinucleated giant phagocytic fats and lipoids, and cholesterol ester-laden macrophages around fat inclusions.

Lipogranulomas contain fatty cysts in the form of thin-walled cavities filled with oily and serous fluid. The best prevention of breast necrosis is to be careful and take care of your body parts. If, nevertheless, it was not possible to avoid injury, it is recommended to take independent first aid measures, namely, to lift the injured chest with a bandage and urgently contact a specialist.