Vascularization in the mammary gland in fatty necrosis. Steatonecrosis or fatty necrosis of the mammary glands and nipple-areolar complex. Breast problems

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

general information

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

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

The reasons

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

injury;
surgical intervention;
sampling during a biopsy.

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

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

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

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

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

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

Symptoms

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

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

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

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

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

Diagnostic methods

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

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

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

Possible Complications

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

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

Methods of treatment

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

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

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

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

Forecast and prevention

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

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

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

The mammary glands are a paired organ, which consists mainly of adipose tissue. Fatty necrosis of the mammary gland is the necrosis of certain areas of the adipose tissue of the breast, resulting from an injury. It should be noted that such significant changes are of an exclusively benign nature.

The course and causes of the disease

With necrosis, a seal is formed, which causes deformation of the breast: tissue is retracted and certain changes in the color of the breast occur. At the sight of such a picture, a woman may have thoughts about the formation of a tumor. Most often, fat necrosis affects the fairer sex, who are owners of magnificent forms, less often women with small breasts. Causes of this disease:

. minor blows to the chest (household bruises, falls on the street, inconvenience in transport);
Carrying out radiotherapy procedures;
A sharp decrease in body weight;
Medical manipulations and plastic surgery of the mammary glands;
Physical training.

Manifestations of fatty necrosis of the breast

In most cases, the development of this disease is facilitated by the influence of a traumatic nature on the mammary glands. In the sector of adipose tissue, small vessels are damaged, which leads to a loss of blood supply. At the site of injury, a painful neoplasm occurs, which has the shape of a circle. It combines with the skin, which causes a thickening, after which the damaged part of the breast loses its sensitivity. There is most often redness and retraction of the nipple. Body temperature, unlike mastitis, remains normal. Due to the deformity of the breast, the appearance of lymph nodes and the appearance of dimples, fat necrosis is very similar to breast cancer.

Diagnosis of the disease

Fat necrosis is detected by a mammologist by ordinary finger touch. He easily probes the seal with unclear contours. Ultrasound cannot detect all the characteristic symptoms of fat necrosis. Magnetic resonance imaging () or survey mammography is performed, which can show a picture of a malignant neoplasm, since fat necrosis often looks like it. A biopsy may be required, and if necessary, a sectoral resection is performed. The biopsy is performed under the influence of ultrasound.

Features of the prevention of the disease and its treatment

The course of treatment is prescribed only after a thorough examination by specialists. Fat necrosis is not treated with absolutely no folk remedies. The affected lesion should be removed by performing an operation such as a sector resection. After such a surgical intervention, the collected material is examined histologically.

In order to prevent breast necrosis, it is necessary to avoid various kinds of injuries in the chest area. If there is any damage to the mammary gland, then it must be immediately fixed with a bandage in an elevated position, and then immediately contact a specialist.

You need to be sensitive to your health, especially women to their breasts, since its main function, as you know, is breastfeeding a child.

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.

N60.8 Other benign dysplasias of breast

Causes of breast lipogranuloma

Lipogranuloma is a benign neoplasm, which is characterized by the formation of aseptic inflammatory processes, cysts and foci of necrosis of lipocytes. Lipogranulomas are distinguished by the type of structure, there are diffuse and nodular. The cause of the pathology can be trauma, a sharp decrease in body weight, radiation exposure, and more.

The causes of breast lipogranuloma are varied, but most often the neoplasm appears due to chest injuries. When traumatized, normal blood circulation is disturbed and adipose tissue is damaged. An inflammatory focus is formed inside the gland, from which infiltrate can be isolated with transformation into granulation tissue with a hard capsule. Pathology can appear due to blockage of the ducts of the sebaceous gland, due to a sharp weight loss and exposure to radiation.

The disease accounts for 0.6% of all cases of nodular lesions of the breast. Most often, this pathology appears in women with macromastia than in owners of small breasts. Traumatic factors include bruises, medical manipulations, sports injuries and more. In some cases, radiation therapy leads to the formation of lipogranuloma.

Reconstructive mammoplasty with own tissues after mastectomy is another cause of a benign tumor. Due to damage to the capillaries, there is a loss of blood circulation. As soon as the inflammatory process subsides, tissue fibrosis begins in the mammary gland. In some cases, scar tissue appears at the site of necrosis. Subsequently, calcium salts are deposited in such areas of the breast, which leads to petrification of the focus of necrosis or ossification processes.

Symptoms of lipogranuloma of the breast

Most often, the disease appears in women with large breasts. The tumor is characterized by a long formation, which at first does not manifest itself. The first symptom of pathology is post-traumatic formations with hematomas and hemorrhages. If necrosis of fatty elements occurs in the mammary gland, then a cyst with liquid forms in the lipogranuloma. In some cases, the contents of the capsule are infected, which leads to suppuration. If lipogranuloma progresses over a long period of time without proper treatment, then this leads to its calcification.

Women who have been diagnosed with this pathology feel discomfort and pain in certain areas of the mammary glands. When trying to palpation, a painful, dense and bumpy formation is clearly defined. If the neoplasm is pronounced, then this leads to retraction of the nipple and deformation of the mammary gland. But in some cases, the disease is asymptomatic. Quite often, a tumor in its course resembles a malignant process, so the correct diagnosis of lipogranuloma and differential methods of study are very important.

Symptoms of breast lipogranuloma largely depend on the causes that caused the pathology. Microscopically, the pathology is nodular growths of granulation tissue from epithelial cells, xanthoma and lipophages with giant nuclei around adipose tissue. Diffuse lipogranuloma is surrounded by adipose tissue of the mammary gland, and nodular capsules. Thin-walled cavities filled with serous or oily fluid are one of the components of lipogranuloma.

If fat necrosis has arisen as a result of an injury, then a painful round-shaped tumor with a dense consistency and soldered to the skin appears at the site of the lesion. As the disease progresses, the mammary gland may lose its sensitivity.

Red or cyanotic color of the skin of the gland is another symptom of lipogranuloma. If the neoplasm occurs in the areola, then this leads to retraction of the nipple and deformation of the breast. Lipogranuloma is not accompanied by high body temperature, as is the case with mastitis.
Symptoms of lipogranuloma are outwardly similar to breast cancer. Dimples appear on the skin, breast deformity, dense infiltrate and enlarged lymph nodes occur.

Lipogranuloma is characterized by painful sensations that are aggravated by palpation of the mammary gland. Pain occurs even when probing, it is possible to enlarge the lymph nodes and the appearance of small dimples on the skin. Please note that lipogranuloma does not degenerate into a malignant tumor, but can simulate it. Therefore, it is very important to use differential diagnosis. If fat necrosis is recognized by ultrasound or mammography, then the tumor can be defined as a malignant neoplasm.

Diagnosis of lipogranuloma of the breast

Diagnosis of breast lipogranuloma is a very important process. The final diagnosis (the nature of the tumor) and the choice of treatment method depend on the results of the studies. In the diagnosis of fat necrosis, recent trauma to the gland is important, as they can be the cause of the pathology. Initially, the mammologist conducts an examination of the breast and palpation. In the process of palpation, fluctuation and painful seals with fuzzy contours can be detected.

In addition to the initial examination and palpation, a woman is given a survey mammography, computed and magnetic resonance imaging of the mammary glands. In this case, lipogranuloma looks like a nodular seal with uneven contours and a heterogeneous structure. With radiography, tomography and echography, fat necrosis has a picture similar to breast cancer. In the later stages, when the calcification of the tumor occurs, the focus of the pathology looks like a spherical calcification (like an eggshell), which makes it possible to exclude the malignant nature of the tumor.

Mandatory is the differential diagnosis of lipogranuloma. The woman undergoes a biopsy, cytological and histological examination of the obtained samples. The biopsy is performed under x-ray or ultrasound control. Sometimes sonography is used for a more accurate diagnosis.

Let us consider in more detail the complex of diagnostic procedures performed to recognize lipogranuloma:

Mammography - diagnostics uses low levels of radiation to get a picture of the breast on paper. The method allows you to determine the nature of the neoplasm (benign, malignant). Mammography makes it possible to identify lipogranuloma before it is determined by palpation.
Aspiration is a diagnostic method that allows you to find out about the contents of the tumor (liquid, solid). The procedure is carried out in a clinic, and it does not require anesthesia. A needle is inserted into the neoplasm, if it is a cyst, then the fluid is removed until the tumor subsides. If the neoplasm contains dense masses, then the doctor receives a small amount of cells that are examined in the laboratory using a microscope.
A biopsy is one of the final studies that allows you to make a final diagnosis. The procedure is carried out under local or general anesthesia, in a clinic. If the neoplasm is small, then the surgeon removes it completely, if it is large, then only a part is removed. The resulting tissues are sent for further microscopic examination.
Ultrasound - high-frequency waves are used to identify the tumor. With the help of electronics, the waves are converted into a visual image of the state of the mammary glands.
Translumination - light rays are passed through the mammary glands. So, different types of fabrics transmit and retain light in different ways.
Thermography - temperature indicators are recorded in different parts of the chest. The temperature difference indicates the presence of pathology.

In the process of diagnosis, none of the last three methods are used to make a definitive diagnosis. These techniques are more often used to clarify the diagnosis, since sometimes seals in the mammary glands indicate hormonal changes in the body. For the timely detection of pathological processes in the chest, it is recommended to be examined by a doctor twice a year.

Treatment of lipogranuloma of the breast

Treatment of breast lipogranuloma depends on the results of the diagnosis, the age of the woman and other characteristics of the patient's body. Benign seals, which include lipogranuloma, are treated with medication, aspiration, or surgery. With the help of a puncture, fluid is sucked out of the tumor, which leads to the collapse of its walls. If, after aspiration and puncture, the neoplasm has not disappeared, then surgical removal is performed.

Given the focal changes in fatty tissue of an irreversible nature and the difficulty of differential diagnosis, often with lipogranuloma, women undergo an organ-preserving sectoral resection (removal of a sector or part of the breast). After such treatment, a woman is waiting for a course of vitamin therapy and hormonal preparations to restore the normal functioning of the body.

After the operation, tissue samples are sent for further research. Postoperative histological examination makes it possible to exclude oncology. During the period of treatment, a woman should protect herself as much as possible from possible injury to the mammary glands, hormonal disruptions and other causes that can lead to relapse of the neoplasm.

Prevention

Prevention of lipogranuloma of the mammary gland is aimed at regular examinations by a mammologist and avoiding trauma to the mammary glands. After the treatment, a woman is recommended to wear a special bandage top, which maintains the normal position of the breast and prevents injury during sports.

Since fat necrosis does not turn into a malignant tumor, but can simulate it, the woman's task is to exclude all possible causes of the formation of lipogranuloma. This will save you from surgery and further drug therapy.

Particular attention in the prevention of benign tumors of the mammary glands should be paid to the level of hormones. To maintain the normal functioning of the body, you should have regular sex life with a regular partner, as this has a positive effect on emotional and physical health. Do not forget about nutrition, food should be healthy and natural. You should also refrain from sunbathing topless, play sports and strengthen the immune system.

Forecast

The prognosis of breast lipogranuloma is positive. This is due to the fact that the tumor is benign, and surgical treatment completely removes the affected tissue, which prevents possible recurrence of the neoplasm.

Lipogranuloma of the mammary gland occurs very rarely, but, despite this, it has every chance of a full recovery. The task of a woman is to regularly undergo examinations by a gynecologist and a mammologist, independently examine the mammary glands and seek medical help in a timely manner.

- focal aseptic necrosis of breast fat with its subsequent replacement with scar tissue. Fat necrosis is characterized by the appearance of a dense painful formation that deforms the mammary gland; retraction of the skin and a change in its color, which in the first place makes you think about tumor processes. Diagnosis includes palpation of the breast, ultrasound, mammography, fine needle biopsy. Treatment of fat necrosis requires sectoral resection of the mammary gland.

ICD-10

N64.1

General information

Fatty necrosis of the mammary gland (oleogranuloma, lipogranuloma, steatogranuloma) refers to non-enzymatic necrosis, most often caused by various breast injuries. According to clinical observations carried out by modern mammology, fat necrosis accounts for 0.6% of all nodular formations of the mammary glands. Breast fat necrosis is more common in patients with macromastia than in women with small breasts.

Traumatic factors can be accidental bruises and blows in everyday life or transport, medical manipulations, sports training. Rarely, fat necrosis of the breast is caused by rapid weight loss or radiation therapy. In some cases, the formation of fat necrosis is noted in patients who underwent reconstructive mammoplasty with their own tissues after mastectomy.

Damage to the capillaries can lead to loss of blood supply to a local area of fatty tissue. Further changes are characterized by the development of reactive inflammation in the damaged area with the formation of a demarcation zone that delimits dead tissue. After the inflammation subsides, the process of fibrosis begins - the replacement of necrotic masses with connective tissue cells. In these cases, scar tissue forms at the site of necrosis. In the future, calcium salts can be deposited at the site of fatty necrosis of the mammary gland, causing calcification (petrification) of the focus of necrosis; in some cases, ossification processes are noted.

Symptoms of fatty necrosis of the breast

The development of fat necrosis in most cases is preceded by a traumatic effect on the mammary gland. At the site of the injury, a painful swelling appears, soldered to the skin, having a rounded shape and a dense texture. In the future, the area of fatty necrosis of the mammary gland may lose sensitivity.

The skin over the breast tumor may be cyanotic or red in color. With the formation of fatty necrosis of the mammary gland in the areola, nipple retraction is possible. Unlike mastitis, with fatty necrosis of the mammary gland, body temperature usually remains normal.

Dense infiltrate, deformation of the mammary gland, the appearance of "dimples" on the skin, an increase in lymph nodes gives fatty necrosis an external similarity with the clinical picture of breast cancer. In unfavorable cases, the development of fatty necrosis of the mammary gland can proceed with septic fusion of the focus and sequestration.

Diagnosis of fatty necrosis of the breast

When diagnosing fatty necrosis of the breast, it is important to indicate the patient to a recent chest injury. In the process of palpation of the mammary gland, a mammologist easily determines a painful induration with fuzzy contours, sometimes fluctuation. Ultrasound of the breast does not reveal the characteristic hallmarks of fat necrosis.

Plain mammography, CT or MRI of the mammary glands reveals a nodular formation with a heterogeneous structure, heavy uneven contours. The radiological, tomographic and echographic picture in fatty necrosis often resembles that in breast cancer. Later, when calcification occurs, the focus of fatty necrosis of the mammary gland appears on mammograms as a spherical calcification of the “eggshell” type, which makes it possible to exclude the malignancy of the process.

For differential diagnosis, a biopsy of the mammary gland (puncture fine-needle or trepanobiopsy) is indicated, followed by cytological and histological examination of the obtained samples. Breast biopsy is recommended under ultrasound or X-ray guidance.

Treatment and prevention of fatty necrosis of the breast

Given the irreversible focal changes in adipose tissue, as well as the difficulties of differential diagnosis in fatty necrosis, an organ-preserving sectoral resection is indicated - removal of a part (sector) of the mammary gland.

Only a postoperative histological examination of the macropreparation makes it possible to exclude an oncological process. Microscopically, fat necrosis of the mammary gland is represented by nodular growths of granulation tissue from epithelioid cells, multinucleated giant lipophages and xanthoma cells around fat inclusions. One of the components of lipogranulomas are fatty cysts - thin-walled cavities filled with oily and serous fluid.

To prevent fat necrosis, it is necessary to avoid injuries to the mammary glands, and also contact a mammologist in a timely manner if damage does occur. In case of trauma to the mammary gland, it is necessary to give it an elevated position with a bandage.