What does breast necrosis look like on ultrasound. Fat necrosis of the breast: causes, symptoms, treatment. Diagnosis of fatty necrosis of the breast

Fatty necrosis of the mammary gland is a focal death of adipose tissue resulting from impaired blood circulation in this area. Pathology develops as a result of trauma, surgery, radiation therapy, or rapid weight loss. Necrosis can arise from a neglected lipogranuloma, a benign tissue change that has not been cured in a timely manner.

Necrosis and oleogranuloma are not malignant changes, but the area with dying tissue can stimulate the growth of a cancerous tumor, therefore, it requires a careful approach to treatment.

Types of pathology and their causes

The disease is classified depending on the size of the necrotic area and there are extensive, medium and small lesions. Often neglected lipogranulomas develop into necrosis - the causes of their formation and symptoms are similar to the factors and signs of the occurrence of necrotic foci.

Oleogranulomas are distinguished depending on the reasons for their appearance:

Artificial or injection - arise as a result of the introduction into the subcutaneous space of various fats and oils, prostheses, suture material.
Post-traumatic - appear after physical damage (blows, squeezing, falls, massaging).
Spontaneous - formations of uncertain etiology.
Para-inflammatory - occur near the source of infection.

All types of lipogranulomas occur at the site of injury; spontaneous formations can be paired (symmetrically located on both sides), but they rarely occur on the mammary glands.

Of the identified causes of breast fat necrosis and lipogranulomas, there are:

injuries (bruise, squeezing, cut);
surgical intervention (reconstructive mammoplasty, remnants of suture material during other operations);
injections (subcutaneous administration of drugs);
hormonal disorders;
transferred infectious diseases;
sudden weight loss.

The main cause is considered to be various injuries - in everyday life, during sports, it is also noted that this problem is more common in women with macromastia (large breast size).

Pathology proceeds in stages: in the initial phase (paranecrosis), nodules form at the site of circulatory disorders - this is a reversible process, cells can restore their structure and functionality completely. Then the node becomes denser, granulation tissues form around it, several foci can grow. Dead areas cannot be restored, they must be removed to prevent extensive necrosis.

Symptoms. Signs of a disease of varying degrees of development

Signs of oleogranuloma or necrosis that has begun are also noticeable to a non-professional, it is unlikely that the patient will be able to ignore them - they bring significant discomfort. Most often, their appearance can be associated with a recent injury - a hematoma remains at the site of the bruise, which does not heal, but changes:

noticeable visually and during palpation, tuberous formations on the chest, if therapy is not applied, then over time they increase in size;
fever, chills;
the place of formation is hot, reddish, hard and painful, ;
often there is a local loss of sensitivity at the site of the necrotic focus;
the nearest lymph nodes become inflamed (in the armpits);
the shape of the breast, nipple changes;
the advanced stage is characterized by the presence of festering ulcers and cracks.

With a careful attitude to your health, it is difficult to miss the pathology at the initial stage; having discovered any visual changes or unusual sensations in the chest, you need to contact a mammologist or surgeon as soon as possible. Diseases of the female breast have many common symptoms and slight discomfort can be caused by both an oleogranuloma and an oncological formation - a differentiated diagnosis can only be made by a specialist after a series of studies.

Diagnostics. Methods for determining pathology

To diagnose the pathology, you need to contact a mammologist. If there is no such narrow specialist in the nearest medical facility, you can contact an oncologist or surgeon.

To establish a diagnosis, it will be necessary to collect information about the possible causes of the development of pathology - injuries, operations and the time of their occurrence. Then an initial examination is carried out and a series of instrumental and laboratory tests are prescribed to confirm the diagnosis, determine the degree of development of the disease and exclude pathologies with similar symptoms.

The following types of examinations are prescribed:

Treatment. Is it possible to do without surgery?

Drug therapy for oleogranuloma and fat necrosis will not give any positive effect, the problem can be dealt with only through surgical intervention.

With fat necrosis, a sectoral resection is performed. Dead tissue (chest sector) is surgically excised, the rest of the gland is preserved. In the case of a serious neglect of the disease and a large proliferation of necrosis, the breast can be completely removed. The removed material is sent for examination to exclude malignant cells in the focus of inflammation.

After the operation, drug therapy is prescribed to prevent the inflammatory process. A recovery course of physiotherapy is also shown, which will help speed up the rehabilitation process.

Prevention of oleogranulomas and fatty necrosis of the breast

Specific prevention of these diseases does not exist. The main cause of necrosis and lipogranuloma is various injuries, and they can not always be avoided even with caution. Insignificant squeezing, jolts received in everyday life (in a crowd, public transport) can cause inflammation and tissue death. Therefore, it is important to be attentive to your body, namely, periodically examine and palpate the breast yourself and at least once every 6 months visit a mammologist for a preventive examination.

If any breast surgery has been performed, it is necessary to follow the doctor's recommendations regarding the recovery period - it is during this short period of time that pathology can develop.

When deciding on breast plastic surgery, it is necessary to take the choice of a clinic and a specialist with all responsibility - it is better to give preference to a surgeon with many years of experience using high-quality certified materials in his work. Strict adherence to the advice of a specialist will minimize the risks of complications in the form of necrosis or oleogranuloma.

Any noticed changes in the chest should not be ignored. Even if the detected seal, the stain does not bring any discomfort, a thorough examination and a number of studies are still needed: it is impossible to determine the disease without this and, as a result, prescribe the right treatment. It is important to remember that almost all changes in the mammary gland can cause the development of cancer cells. That is why any disease must be diagnosed and treated at an early stage of its occurrence.

Fat necrosis of the mammary gland (lipogranuloma) is a benign formation resulting from the replacement of fatty tissues with connective ones. Fat necrosis can form anywhere in the breast and occurs at any age. The disease is more common in women with large breasts. Fat necrosis can also occur in men, but this is very rare.

The mammary gland is made up of lobules (which produce milk) and lactiferous ducts that carry milk to the nipple. They are surrounded by glandular, fibrous and adipose tissue. Fat necrosis can form as a result of damage to the adipose tissue of the mammary glands, for example, after surgery or radiation therapy.

Fatty tissue damage can occur due to sudden weight loss, severe bruising, breast biopsy, radiation therapy, or any breast surgery, including:

plastic surgery
Breast reduction (reduction mammoplasty)
Lipomodelling (introduction into the breast of fat taken from another part of the body for aesthetic purposes)

When damaged breast tissues are repaired, scar tissue usually forms. But not all fat cells have the same ability to regenerate, so some of them release their contents. During this process, an oil cyst may form.

Diagnostics
Oil cysts and fat necrosis are tumor-like or lumpy formations that are usually not accompanied by pain. In some cases, the skin around the lesion may be red, tender, and sometimes dimpled. The nipple with fatty necrosis may be retracted.

If a mass is detected, the specialist will refer you to a mammogram or ultrasound of the mammary glands. On breast examination and mammography, fat necrosis may be similar to breast cancer. If a mammogram or ultrasound clearly shows that it is fat necrosis, then there will be no reason for a biopsy. In case of doubt about the origin of the neoplasm, a biopsy will be performed.

Treatment
Fat necrosis is safe and does not require treatment. A light massage of the area of education can help dissolve the seal. As a rule, necrosis disappears over time. Doctors usually try to avoid surgery because it can cause further fat necrosis. However, in some cases, surgery to remove fat necrosis may be recommended:

In case the biopsy did not give enough information to confirm the diagnosis;
If fat necrosis causes discomfort;
If the formation does not go away or becomes larger in size.

If an operation is necessary, the focus of fat necrosis will be removed by sectoral resection of the mammary gland. The operation will leave a small scar, which usually disappears with time.

An oil cyst can be removed by fine needle aspiration and pumping out its contents.

Risk of developing breast cancer
Fat necrosis is not a precancerous condition and does not increase the risk of developing breast cancer.

Tumor necrosis is the process of necrosis of a malignant or benign neoplasm, in which the metabolism in pathological tissues is completely stopped. Necrotic changes go through four successive phases:

Reversible phase or paranecrosis.
Irreversible cytological stage - necrobiosis.
Death of tumor cell structures.

Reasons for the development of tumor necrosis

The following factors contribute to the formation of irreversible destruction of neoplasm tissues:

Mechanical injury to mutated cells.
Exposure to high or extremely low temperatures.
Irradiation of the tumor with highly active ionizing radiation.
Chemical factors of necrosis.

General concept of tumor necrosis factor

The necrosis factor or cachectin is synthesized by t-lymphocytes and macrophages. This substance causes hemorrhagic necrosis of certain cancer cells. Until recently, experts believed that it has a toxic effect only on oncological tissues. Recent studies have revealed the participation of cachectin in many physiological and pathological reactions of the human body. The action of TNF directly depends on its concentration in the circulatory system. Thus, an increased amount of cachectin provokes the development of septic shock and reduces the absorption of fats, which thereby contributes to the progression of cancer cachexia. An insufficient amount of cachectin, in turn, stimulates the concentration of neutrophils in the blood walls during the inflammatory process.

Discovery of tumor necrosis factor in oncology

Tumor necrosis factor was first isolated in 1975 in the city of Kakhektin, from which, as a result, the second name of this substance came. Studies were conducted on mice that were injected with BCG and endotoxin. In the blood serum of these animals, scientists have identified cachectin. In the course of laboratory tests, experts also established the antitumor activity of the blood cells of experimental mice.

The main properties of the necrosis factor

Under normal physiological conditions, cachectin is an important mediator of the inflammatory process and an active participant in the body's immune defense. Dysfunction of this system can lead to allergic reactions in the form of immediate hypersensitivity.

In the course of numerous studies, scientists have identified a direct link between an increase in cachectin in the blood of experimental animals and the development of endoscopic shock.

It is also known to science that the necrosis factor for some structural elements of human tissues is a growth factor that stimulates wound healing, restoration of blood flow and the formation of cell abscesses.

But still, the key function of cachectin is its ability to cause tumor necrosis in cancer. In modern oncology, these abilities of the necrotic factor are widely used. It should be noted that extensive necrosis of mutated cells can be life-threatening for a cancer patient.

Acute tumor necrosis syndrome

The syndrome of active destruction of tumor tissues develops after the introduction of active anticancer drugs and chemotherapy. In such cases, a large number of cancer cells die and a large amount of decay products and cytotoxins enter the patient's circulatory system. COOH can be fatal. To prevent such negative consequences, the patient during therapy should be under constant medical supervision for the timely provision of emergency care.

Mechanism of occurrence of acute tumor necrosis syndrome

According to statistical data, the development of this syndrome is mainly observed in patients and. Experts attribute this fact to an increased concentration of phosphates in mutated cells of the circulatory and lymphoid systems. Predisposing factors for this pathology are also considered to be:

The large size of the malignant neoplasm.
Multiple tumors.
Rapid growth of neoplasm.
Germination of a cancerous tumor in the internal organs.
Reducing the volume of circulating blood.

During the active destruction of mutated cells, an increased amount of potassium and phosphate is dumped into the patient's body. It is the symptoms of hyperkalemia, hyperphosphatemia that cause the clinical manifestations of acute tumor necrosis syndrome.

Tumor necrosis in oncology: diagnosis and tests

First of all, I would like to note that a patient receiving intensive anticancer treatment should be under the constant supervision of doctors. Upon detection of the first signs of intoxication in the form of diarrhea, nausea and vomiting, the following diagnostic procedures are carried out:

A biochemical blood test, which pays special attention to the concentration of potassium and phosphate ions.
Electrocardiogram. An increase in the concentration of potassium in the circulatory system can provoke bradycardia.
Analysis of urine. Cancer intoxication is often accompanied by an increase in creatinine and acetone in the patient's urine.

Methods of treatment of acute tumor necrosis syndrome

Emergency medical care in such cases is intravenous administration of a solution of sodium chloride, which normalizes the level of potassium and phosphate. Patients individually determine the level of the necessary fluid, which is also administered parenterally, which contributes to the detoxification of the body. With a secondary increase in the concentration of potassium, the introduction of drugs based on calcium ions is indicated.

According to modern oncology standards, it is necessary to control at all stages of anti-tank therapy, from specific diagnostics to the stage of patient rehabilitation. Prevention of such a complication consists only in the most accurate determination of the size and localization of a malignant neoplasm.

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 isolated cases, necrosis can be diagnosed in patients who have undergone reconstructive mammoplasty with their own tissues, that is, their mammary gland has been 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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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 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 manipulations, 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 a 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 an 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 frequency of cases 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.

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 education.

The use of an ultrasound study to determine necrosis is not sufficient, since this technique does not allow identifying 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 site (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., a fine-needle puncture or trephine biopsy, which makes it possible for 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.