Galactocele is a cyst of the mammary gland, the contents of which is a milky liquid. Cysts of small size are asymptomatic, and only with their increase there is discomfort in the chest and its deformation, signs of intoxication are added to infection. When diagnosing galactocele, the data of anamnesis, complaints and objective examination of the mammary glands are taken into account. Ultrasound, MRI, mammography and ductography are used among the instrumental methods of research. Small cysts do not require treatment, large diameter formations are surgically removed (using puncture sclerosis or breast resection).
Meaning
Galactocele (fatty breast cyst) is a typical retention formation of a benign nature. Unlike other retention cysts, the contents of which are serous fluid, the fatty cyst is filled with milk, pure or modified (raw, oily or saponified mass). The disease has a direct connection with breastfeeding and is more often diagnosed in women who are breastfeeding. Often, a fatty cyst occurs in pregnant women and in women who completed lactation 8-10 months ago. It is extremely rare for such a cyst to develop in men and girls of puberty. In mammology, the incidence of fatty cyst among all breast tumors in women is 0.5%.
Causes
The disease occurs due to incomplete patency of the milk ducts, which leads to a violation of the outflow of milk or to its stagnation. The causes of galactocele are diverse, and in each case of the disease it is quite difficult to establish the etiology. The main factors causing a violation of the patency of the ducts of the breast include:
- Congenital anomalies of the duct structure. They may be represented by too small a diameter of the ducts, their curvature or pronounced tortuosity. These defects lead to a violation of the outflow of milk and provoke its stagnation.
- Lactostasis. It is formed due to refusal of breastfeeding, violation of feeding rules (untimely pumping or incorrect application of the baby to the breast), hyperlactation or abrupt termination of breastfeeding.
- Breast injuries. Chest bruises in the past provoke the formation of scar adhesions and duct stenosis.
- Inflammation of the breast. The penetration of infection through the cracks of the nipples causes swelling of the walls of the milky duct and narrowing of its lumen. Compression of the duct by nearby inflamed tissues is possible.
- Hormonal failures. They lead to changes in the composition of milk, which contributes to its coagulation in the mammary glands, the formation of milk clots and blockage of the duct.
Pathogenesis
The disease develops for a long time, as a result of which the size of the formation gradually increases and can reach 8-10 cm in diameter. The effect of the etiological factor leads to a violation of the outflow of milk, which is the main trigger in the mechanism of galactocele development. Due to the violation of the output of milk from the breast, the duct expands, where milk accumulates. The walls of the fatty cyst are the walls of the duct lined with epithelium. Epithelial cells, in turn, flatten, and the distance between them is reduced. This disrupts the exchange between cells and extracellular fluid. The secret accumulated in the duct is not able to be absorbed into the interstitial fluid, and the latter cannot penetrate into the enlarged duct. These processes increase the coagulability of milk, which further blocks its outflow and leads to the formation of galactocele.
Classification
Cysts can be single and multiple, located in one mammary gland or formed in both. According to the presence / absence of complications, uncomplicated cysts and complicated (suppurated fatty cyst of the breast) are distinguished. Depending on the content of the formation, the composition of which changes with the duration of the galactocele’s existence, there are:
- Oil cyst – contain pure milk;
- Cheese-like cyst – filled with cheese-like mass;
- Soap-like cyst – accumulate a secret in the form of a saponified mass.
Symptoms
The disease is asymptomatic, especially at the initial stage of development. Women with galactocele of small size feel absolutely healthy, and the disease can be detected accidentally when undergoing ultrasound of the mammary glands. Since the process progresses slowly, the cyst does not cause even minimal discomfort in the chest for a long time. It is possible to suspect the presence of pathology during feeding, when the difficulties of the child when sucking the breast become noticeable, his hunger when feeding with one mammary gland, given that there is enough milk left in it. Galactocele of significant size changes the shape of the breast, and wearing squeezing clothes (bra) causes pain. The cyst is especially clearly defined on the eve of menstruation, when its size increases under the influence of hormones. In uncomplicated cases, the general condition of the woman does not suffer.
Complications
In addition to the cosmetic defect – pronounced breast deformity – it is possible to develop more serious complications. If infectious agents enter the cystic cavity, suppuration of the galactocele occurs and the formation of a gland abscess or purulent mastitis. Suppuration of cystic formation is accompanied by signs of intoxication: fever, deterioration of the general condition (weakness, lethargy), redness of the skin at the site of inflammation and throbbing pain in the chest, an increase in axillary lymph nodes.
The formation of a purulent process in the mammary gland requires surgical intervention, the appointment of antibiotics and the weaning of the baby from the breast. Galactocele rupture is possible, which leads to the formation of a fistula. A long-existing fatty cyst may become malignized, but the frequency of transition to cancer is very low (up to 1.5%).
Diagnostics
Diagnosis of the disease is not particularly difficult. The detection of galactocele is carried out by a mammologist who conducts the following diagnostic measures:
- Collection of anamnesis and complaints, physical examination. The connection of education with breast-feeding, the duration of galactocele existence, the presence/absence of pain, and so on is being clarified. An objective examination establishes the localization of a fatty cyst: it usually forms in the periarticular area or directly under the nipple, but can develop in any quadrant of the gland. During palpation, a painless or slightly painful rounded or oval formation of a tight elastic consistency is determined, not soldered to the surrounding tissues (it easily rolls under the skin).
- Ultrasound of the mammary glands . Allows you to confirm the diagnosis, evaluate the secret of the cystic cavity and identify the structural features of the cystic wall. The diagnosis is confirmed by visualization of an anechoic rounded or oval formation with clear boundaries. The method is not informative when examining lactating women – the formation may be closed by lobules of the gland filled with milk.
- Mammography. Uncomplicated formation on X-rays look like a rounded enlightenment with clear contours. Galactocele calcification is also excluded or confirmed.
- Ductography. It is performed when unsatisfactory mammography results are obtained. It helps to identify the problem area of the duct, to clarify the number and location of cystic formations. It is not carried out during lactation and acute inflammatory process in the breast.
- MRI of the breast. It is used in difficult cases. Allows you to accurately determine the location and nature of the tumor, identify stretched ducts, evaluate regional lymph nodes.
- Puncture of education. The resulting contents have a thick creamy consistency, brownish or greenish color. The aspirate is sent for bacteriological and cytological examination. The sterility of the secret confirms the absence of infectious agents in the cyst cavity.
Differential diagnosis of this disease is carried out with benign (fibroadenoma, lipoma) and malignant (breast cancer) formations. The examination of the patient by a surgeon and oncologist helps to exclude these diseases.
Treatment
In the presence of formations of small size (less than 10 mm), therapy is not prescribed, only dynamic observation is required. Treatment of galactocele is necessary if its size is more than 10 mm and if complications occur (suppuration or rupture of cystic formation). Treatment includes three directions:
- Drug therapy. It is indicated for galactocele that has arisen against the background of hormonal imbalance. Includes the appointment of hormonal drugs.
- Sclerosis of the cyst. Puncture aspiration of the contents of the formation is performed and the introduction of air into its cavity (pneumosclerosis) or a sclerosing substance (alcohol). The advantages of this method include simplicity, cheapness and the absence of a postoperative scar. The disadvantages are a high probability of recurrence of the formation and a new accumulation of secretions in the cystic cavity.
- Radical surgical intervention. A reliable and effective way to treat the disease. It is performed with significant galactocele sizes. The operation consists in excision of the affected lobule of the gland together with the formation. The recurrence rate is extremely low. The disadvantages of this method include traumatism, the need for intravenous anesthesia and a cosmetic defect (postoperative scar). With the development of a purulent process (abscess, mastitis), the abscess is opened, pus is removed, the postoperative wound is treated with antiseptics and drains are installed. At the second stage (after the inflammation subsides), the galactocele capsule is excised, the wound is sutured tightly with secondary sutures.
Prognosis and prevention
With timely treatment, the prognosis for recovery and life is favorable. Prevention includes regular breast self-examination and doctor visits, organization and compliance with the rules of breastfeeding, prevention of hypothermia and infection with ARI, hygiene of the mammary glands (daily change of underwear, breast washing before and after each feeding), pumping milk after each feeding. It is also necessary to prevent the occurrence of cracks in the nipples, eliminate stress, normalize the drinking regime and nutrition. The correct selection of a bra, air baths for the chest and the performance of special exercises will help prevent the development of galactocele.