Tangshan People's Hospital Breast Cancer Department
Nonlactating areola fistula is a local infectious disease of the large duct of the breast that occurs in the areola.Both men and women can get sick.The clinic is characterized by recurrent fistula in the areola area, which is also called non lactating breast abscess, non lactating periareolar abscess, chronic infraareolar abscess, breast fistula, breast ductal granuloma, etc.
alias
Non lactating breast abscess、Non lactating periareolar abscess
Visiting department
Surgery
Common diseases
breast
Common causes
Congenital malformation of main mammary duct
common symptom
Recurrent fistula in areola
Chinese name
Nonlactating areola fistula
Science popularization in China
Committed to authoritative science communication
The certification expert of this term is
Niu Fengling|Chief physician
Tangshan People's Hospital Breast Cancer Departmentto examine
Non lactating breast abscess、Non lactating periareolar abscess
Visiting department
Surgery
Common location
breast
Common causes
Congenital malformation of main mammary duct
common symptom
Recurrent fistula in areola
Chinese name
Nonlactating areola fistula
pathogeny
Announce
edit
The mechanism of infection and fistula formation in the areola area during non lactation is not consistent.It may be related to the congenital malformation of the main mammary duct. Others believe that the external opening of the fistula is near the areola area, because the skin of the areola area is rich in sebaceous glands, sweat glands and multiple areola glands (usually 5-10), and the secretion is strong. If the distal end of the breast feeding duct (namely the areola) is blocked and the drainage due to local skin infection cannot be discharged, it can develop into this disease.
clinical manifestation
Announce
edit
1. Symptoms
(1) Painless massBefore the chronic abscess formed in the areola area is punctured or cut, the local skin usually has no inflammatory manifestations and can only touch the painless mass with a clear boundary.
(2) Inverted nippleMost cases are accompanied by inverted nipples, which are often biased to the affected side, also known as "biased inverted nipples".
(3) Recurrent fistulaAfter the abscess is punctured or cut, sebaceous secretions may be discharged;The ulceration is not healed for a long time or abscess and ulceration occur repeatedly, forming local repeated incision and drainage → healing → ulceration → healing → re ulceration.
2. Physical signs
(1) There are cords at the base of areola or nipple.
(2) Under local anesthesia, probe gently toward the nipple with a metal probe through an ulcer or a punctured abscess, which can be detected through the opening of the breast duct.
inspect
Announce
edit
1. Laboratory inspection
The total number of white blood cells in blood routine test increased slightly, and the proportion of neutrophils increased.
Bacteriological culture and drug sensitivity test: the fistula secretion is reserved or the pus is aspirated through puncture for bacteriological culture and drug sensitivity test, which provides the basis for the selection of antibiotics.
2. Other auxiliary inspection
In the methylene blue injection test, a little methylene blue is injected into the breast tube and massaged toward the nipple. When a fistula is formed, methylene blue overflows from the opening of the breast tube.
diagnosis
Announce
edit
The following clinical characteristics are the basis for diagnosis of this disease:
1. Abscess formation → incision → healing → re ulceration → re healing.
2. Antibiotic treatment is ineffective, incision and drainage or fistulectomy for healing.
3. The probe can be inserted at the site where the abscess breaks, or methylene blue can be injected to protrude or overflow at the breast duct opening.
differential diagnosis
Announce
edit
1. Breast tuberculosis
Tuberculosis of the breast is far away from the areola and the large duct for milk transfusion, so nipple invagination is very rare. Most cases of this disease are accompanied by nipple invagination, and anti tuberculosis treatment is ineffective.
2. Breast cancer
This disease can only touch the painless mass with clear boundary and biased nipple invagination before the chronic abscess breaks through, so it is easy to be confused with breast cancer.The pus can be extracted by local puncture, which is the evidence for excluding cancer.
treatment
Announce
edit
1. Operation principle
Cut off the fistula or cut the fistula for drainage.
2. Operation method and indication
(1) If the course of disease is short, inflammatory infiltration is serious or there is abscess, and the cord like induration in the areola area is not obvious: fistula is cut and scratched.
(2) If the course of the disease is long, the cord like induration in the areola area has obvious tenderness and no obvious nipple invagination: fistulectomy and dressing change.
(3) Fistulectomy plus papilloplasty is recommended for patients with long course of disease, cord like induration in the nipple area, no pain, and severe nipple invagination.If there is no inverted nipple, it can be sutured in one stage.
(4) Long lasting complicated fistula and abscess affecting most of the breast and forming multiple chronic inflammatory induration: simple mastectomy.
prognosis
Announce
edit
The longest follow-up was 10 years, and no nipple re invagination or recurrence was found.The patients got married after recovery. There was no recurrence or difficulty in lactation during the lactation period. The curative effect was good.
