Vascularization in the mammary gland with fatty necrosis. What is breast lipogranuloma and how to treat a benign process with the formation of foci of fat necrosis. Forecast and consequences

Fat necrosis of the mammary gland - necrosis of a section of adipose tissue of the mammary gland with its subsequent replacement with scar tissue, arises as a result of impaired blood circulation in this area.

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

The most common reason for the development of fatty necrosis of the mammary gland is trauma, which occurs as a result of impact, compression, fall, excessive massaging. Breast injury is more common in women involved in sports, where the risk of injury is significantly higher than in everyday life, and in women with macromastia (large breasts). In addition, the development of the disease is possible due to the transferred infectious process, surgical intervention, for example, reconstructive mammoplasty, subcutaneous administration of drugs, sudden weight loss, hormonal disorders.

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

Symptoms

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

Diagnostics

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

Treatment

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

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

In the future, you should be more careful about your health and avoid traumatic factors. If injury does occur, it is recommended that the breast be lifted with a bandage. After that, it is necessary to monitor the condition of the injured breast and in case of symptoms characteristic of the disease, immediately consult a doctor for help.

Medicines

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

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

Folk remedies

To prevent the development of fatty necrosis, it is necessary to protect yourself from injuries, since they are considered the most common cause of the development of the disease. In addition, it is extremely important to self-examine the mammary glands. Every woman should be able to perform this procedure, but this does not mean that, subject to regular self-examination, you can neglect a trip to a gynecologist. The specialist will most accurately assess the condition of the mammary glands and, if necessary, prescribe studies to confirm his doubts.

For the survey, you must complete the following steps:

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

All these actions are not difficult to perform, so every woman should find the time and opportunity to examine the mammary glands.

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

Everyone knows that the female breast is a very delicate gland, the tissues of which should not succumb to physical influences (trauma, bruises). Girls should be aware that their breasts should be protected from being squeezed by a bra, that they should cover their breasts with their hands in a crowd of people, and that even the smallest chest trauma should be avoided in every possible way. This is because the mammary gland consists of extremely sensitive tissues, which, with the slightest influence, can change their structure. The mammary glands are very susceptible to such pathological processes as mastopathy, fibroadenoma, mastitis, papilloma. There may also be fatty necrosis of the breast.

Fatty necrosis of the mammary gland. Lipogranuloma reasons

Fatty necrosis of the mammary gland is aseptic focal necrosis of adipose tissue. In this case, the adipose tissue is replaced by scar tissue. Fat necrosis is also called oleogranuloma, lipogranuloma and steatogranuloma. Fat necrosis refers to non-enzymatic necrosis. The main cause of oleogranuloma is chest injury. Patients with large breasts are more susceptible to fatty necrosis of the mammary glands than with small ones.

Traumatic factors that can provoke fatty necrosis of the mammary glands: accidental blows and bruises, for example, in transport, sports training, medical manipulations. Sometimes the cause of oleonecrosis is rapid weight loss or radiation therapy. Sometimes necrosis occurs after breast augmentation or mastectomy.

What happens in the breast tissue during fat necrosis?

In case of trauma to the breast tissue, the small capillaries of the fatty tissue area are damaged. Further, the mammary gland tissues react to this process by the appearance of an inflammatory reaction. A demarcation zone is formed, which limits the dead tissue. After the completion of the inflammatory reaction, the process of fibrosis begins, in which necrotic masses are replaced by connective tissue cells. This is how scar tissue forms. In the future, calcium salts are deposited in such areas of necrosis of the adipose tissue of the mammary gland, and petrification of the foci occurs. In rare cases, ossification processes are observed.

Symptoms of breast fat necrosis

After a chest injury, a painful swelling appears that is adhered to the skin. It has a dense consistency and a rounded shape. Later, the affected area of adipose tissue begins to lose sensitivity. Externally, the gland may change in color - the skin of the gland may acquire a bluish or red tint, the nipple may be somewhat retracted. Such a picture often resembles mastitis and misleads women, but it is very simple to distinguish fat necrosis from mastitis - with mastitis, the body temperature will rise to febrile numbers.

With all this, fatty necrosis can be clinically similar to breast cancer. Breast deformity, density of infiltration, the appearance of retracted areas on the skin of the gland, and enlargement of regional lymph nodes can resemble breast cancer. In advanced conditions, fatty necrosis can proceed in the form of tissue sequestration and melting.

Diagnosis of breast fat necrosis

In the diagnosis of fat necrosis, it is of great importance to indicate the patient's history of a chest injury that happened recently. On palpation, the mammologist determines a painful seal that does not have clear contours and can fluctuate.

When carrying out an ultrasound of the mammary glands, CT or MRI, a heterogeneous formation of a nodular nature is revealed, which has heavy uneven contours. With these tests, the results are often very similar to those of breast cancer. But, after a while, when the necrosis focus begins to calcify, during mammography, the fat necrosis focus looks like a spherical calcification of the "eggshell" type. This allows you to exclude the malignancy of the process.

For differential diagnosis, it is advisable to conduct a biopsy of the gland tissue with subsequent histological examination. A breast biopsy is performed under ultrasound guidance.

Treatment and prevention of breast fat necrosis

In the presence of fatty necrosis, only surgical treatment is indicated - organ-preserving sectoral resection of the mammary gland. After that, the material is checked histologically. Microscopically, this material is represented by nodular growths of granulation tissue from epithelioid cells, large lipophages, xanthoma cells around fat inclusions. The main components of lipogranulomas are fatty cysts - cavities with thin walls that are filled with serous and oily fluid.

If the gland is injured, it is necessary to give it a raised position with a bandage and immediately consult a doctor.

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

The mammary gland consists of lobules (producing milk) and lactiferous ducts that carry milk to the nipple. They are surrounded by glandular, fibrous and adipose tissue. Fat necrosis can result from damage to the fatty tissue of the mammary glands, for example, after surgery or radiation therapy.

Damage to adipose tissue can occur from sudden weight loss, severe bruising, breast biopsy, radiation therapy, or any breast surgery, including:

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

When damaged breast tissue is healed, scar tissue usually forms. But not all fat cells have the same ability to repair, so some of them release their contents. During this process, an oil cyst can form.

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

If a formation is found, the specialist will refer you for a mammogram or an ultrasound of the mammary glands. On breast examination and mammography, fat necrosis may be similar to breast cancer. If mammography or ultrasound examinations clearly show that this 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 requires no treatment. Light massage of the area of formation can help resorb 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 can be recommended:

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

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

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

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

The body is made up of numerous cells that work together to participate in many processes. Sometimes, for various reasons, cell death occurs. If this happens in the adipose tissue of the mammary gland, they speak of necrosis. Breast fat necrosis is the formation of dead areas in adipose tissue and their transformation into scars or cysts.

Most often, aseptic necrosis occurs after bruises and injuries and is a benign formation. The disease has many names, one of which is steatonecrosis.

ICD-10 code - N64.1

The disease itself is not dangerous and often does not even require any treatment. All cases are considered individually and must be diagnosed in a timely manner. Only after studying the anamnesis, the doctor prescribes treatment.

The focal area is deprived of blood flow, but this does not mean that the blood supply to the mammary glands will be impaired. Damaged capillaries cease to function, and blood flow continues through the available channels. Due to a lack of blood, dead areas are formed.

Do not hesitate, as fatty necrosis can cause more complex pathologies, such as breast cancer.

The most common cause is damage to the mammary glands. These can be bruises, cuts, squeezing, punctures. Women with large breasts are most susceptible to necrosis, since adipose tissue occupies a significant part of the organ. The disease can occur with sudden changes in weight. When a woman loses weight incorrectly, fat becomes thinner, and some areas do not have time to recover, which leads to necrosis. Treatment of steatonecrosis of the mammary gland depends on the nature of changes in the structure of the organ.

The dead zone can differ in the nature of the course of the disease, size and other signs. The disease can be called oleogranuloma or steatonecrosis and is:

artificial
post-traumatic
near-inflammatory nature
incomprehensible character

Causes

Often, adipose tissue necrosis appears after various breast augmentation surgeries. The introduction of foreign bodies can cause the formation of necrosis. After a severe chest injury, dead areas often appear. Sometimes the force of the bruise can be minimal, but regular - this will be enough for the onset of pathology. For example, an improperly done massage can lead to necrosis. If any inflammation is detected in the mammary gland, tissue deformation will occur. In this case, blood circulation is disturbed, and individual areas of adipose tissue may die.

Steatonecrosis can occur due to:

chest injuries
surgical intervention
hormonal disruption
infectious diseases
weight loss
radiation therapy
injections and foreign bodies in the mammary gland

In the first couples, the process is reversible if treatment is started on time. If no treatment is followed, nodules form at the site of cell death. They harden and become overgrown with connective tissue, which tries to repair damage. Thus, an increase in necrosis occurs. If the affected areas continue to grow, they must be removed. A more severe and dangerous course of the disease is liponecrosis.

Necrosis can also affect superficial areas. Areola necrosis is an uncommon manifestation of necrosis. It can be complete or partial. The disease is characterized by a violation of the blood supply in the area of the nipple and areola, which leads to the necrosis of the areas. Sometimes rejection of dead cells occurs, and the areola is separated from the rest of the tissue. Most often, areolar necrosis occurs as a result of improperly performed breast surgery. When improving an organ, women often go under the knife to look their best. An example is mammoplasty - changing the shape of the breast. However, the consequences can be corrected for a lifetime. With complete necrosis, there is also nipple necrosis. After the diagnosis is made, surgery is required.

Symptoms of necrosis

Symptoms of breast fat necrosis can vary. Depending on the type of disease, the symptom may appear as pain. In this case, the patient may not suspect the presence of the disease. This course of the disease is characterized by an indefinite reason for the appearance.

If the manifestation of the disease appears after a bruise, the affected area will hurt for a long time. Deformation and asymmetrical breasts can be seen. At first, the painful area may increase in size. The skin is thickened, tuberosity can be detected to the touch. Another sign is that the affected area is often warmer than the surrounding tissue. Depressions may appear at the site of the lesion. If this occurs at the site of the areola of the nipple, the nipple is often pulled inward. When adipose tissue dies off, the place loses its sensitivity, and the skin becomes reddish. Discharge from the nipple is noted.

Symptoms may not show clear signs of illness. Lymph nodes can often be enlarged, but the general condition of the body remains normal. The body temperature does not rise. Necrosis usually develops gradually and is characterized by slow dynamics. The affected area of the skin grows together with nearby tissues. The peculiarity of severe cases is that the dead area is not destroyed. The rejection process begins and sepsis may occur. The entire cavity is filled with pus, with prolonged stages ulcers and cracks appear.

Diagnosis of the disease

If necrosis is suspected, it is necessary to identify the nature of the disease and the size of the affected area. For this, the following studies are assigned:

mammography
x-ray
tomography

The complex of research results shows blurred contours, heterogeneous structure, calcifications or oncology. If necessary, the study of the tissues of the affected area - the sampling is carried out using a biopsy. Histological examination is performed by trepanobiopsy or fine-needle puncture. A biopsy is needed to rule out breast cancer.

Based on the results, the specialist prescribes the most optimal treatment. An important role is played by the duration of necrosis and its size.

Treatment and prevention

The main treatment for breast fat necrosis is surgery. In some cases, when it comes to minor injuries, surgery is not required - treatment can only be medication. It is prescribed when the affected area is minimal, does not increase in size, and tissues can be restored.

In other cases, especially when difficulties arise in an accurate diagnosis, a sectoral resection of the mammary gland is performed. The surgeon decides to operate only on the dead area while preserving the adjacent tissue. The taken sample is sent for repeated histological examination to be checked for oncology.

If the affected area is very large, the only remedy is complete removal of the organ. After the operation, a rehabilitation course is prescribed. It consists in drug treatment: anti-inflammatory, antibiotics, pain relievers and other drugs. Physiotherapy will have a good therapeutic effect.

No folk method can get rid of the disease. It is necessary to resort only to traditional medicine.

As a preventive measure, it is recommended to undergo more examinations and be treated by a doctor. Self-examination can also become a good habit. Even minor concerns in the thoracic region may indicate incipient problems that need to be treated on time. What is hidden from the eyes - diagnostic studies will show. It is necessary to treat the sensitive organ with caution, avoid injuries and bruises that can lead to necrosis. If the mammary gland has already been operated on, the risk of necrosis is significantly increased. To avoid this, you need to follow the doctor's recommendations and do not treat your health carelessly.

Timely referral to a specialist and high-quality treatment gives a good result. If the disease has no complications, the prognosis for a cure is positive.

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

This pathology is characterized by a dense painful formation, retraction of the skin and a change in its color - such signs make one suspect the presence of a tumor process.

When fatty necrosis occurs, it becomes necessary for a sectoral resection (removal of a site) of the mammary gland.

Table of contents: 1. General data 2. Reasons 3. Development of pathology 4. Symptoms of fatty necrosis of the mammary gland 5. Diagnostics 6. Differential diagnosis 7. Complications 8. Treatment of fatty necrosis of the mammary gland 9. Prevention 10. Prognosis

general information

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

When mentioning this pathology, we mean a disease in women. With the defeat of males, the diagnosis sounds like "Fatty necrosis of the breast" (only women have mammary glands). In men, this disease occurs very rarely - due to the scarcity of fatty tissue in the mammary glands. An exception may be gynecomastia - the development of female-type mammary glands in male patients.

note

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

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

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

Causes

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

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

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

when performing medical procedures (in this case, it is also called iatrogenic);
outside the treatment process.

Medical procedures, during which the integrity of the breast tissue may be compromised, with the subsequent risk of developing fatty necrosis, can be:

diagnostic;
actually medicinal.

Such diagnostic manipulations include biopsy - sampling of breast tissue for their examination under a microscope. It happens:

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

Cases are described when a biopsy was performed with suspicion of breast fat necrosis, which did not confirm the diagnosis - nevertheless, fat necrosis developed later as a result of biopsy.

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

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

The development of iatrogenic fat necrosis is associated with:

forced intraoperative trauma to the tissues of the gland - for example, when removing large areas of it, stopping bleeding with the help of diathermocoagulation ("cauterization" of the destroyed walls of blood vessels with an electric current);
gross inaccurate carrying out of 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 fatty necrosis of the mammary gland. 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.

Household injuries that can lead to the occurrence of the described disease may be facts of trauma:

unintentional;
deliberate.

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

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

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

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

Also, prolonged squeezing of the mammary glands can be observed in road 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.

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

Sports injury is most often seen in women who choose strength sports or those that carry the risk of falls. This is:

women's boxing;
all types of struggle;
women's football;
volleyball;
basketball;
tennis;
running with obstacles

and others.

Rapid weight loss, against the background of which fatty necrosis of the breast can develop, can be observed with:

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

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

rapidly progressing oncological diseases (in particular, their defeat by especially aggressive forms);
pulmonary tuberculosis - an infectious lesion caused by mycobacterium tuberculosis (Koch's bacillus);
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 on the part of the psychoemotional 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 breast;
frequent passage of diagnostic procedures fraught with radiation exposure (radiography, fluoroscopy, and others);
contact with radioactive substances due to professional activities. Is fraught with pronounced radiation exposure to the body in case of violation of labor protection rules or ignoring safety measures (personal protective equipment);
unauthorized access to radioactive substances.

A group of factors was also identified that are not direct provocateurs of the development of fatty necrosis of the mammary gland, but can contribute to the necrosis of its tissues. 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 the tissues of the mammary glands are disturbed;
blood diseases - the consequences are the same as with vascular pathology;
wearing tight clothing regularly.

Development of pathology

At the heart of the maximum majority of disorders that lead to necrosis of breast tissue and the formation of areas of fat 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 disruption of the blood supply to a separate area of the 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 on the damaged area with the formation of the so-called demarcation line around it - it separates the affected tissues from healthy ones.

The dead tissue decays after a while, the decay products are excreted from the mammary gland with the blood stream. If there are many necrotic foci in the mammary gland or they are large, the abundance of decay products can provoke the onset of intoxication syndrome.

Since defense mechanisms are turned on, the 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 the 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 site of bone tissue.

In unfavorable 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 breast fat necrosis

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

Symptoms of breast fat necrosis 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 the influence of a pathogenic factor on the breast tissue. Its characteristics:

in shape - rounded or ovoid (ovoid);
by consistency - dense, at the same time elastic;
for mobility - soldered to the skin, therefore, its mobility is limited;
on sensitivity - painful. In the future, with the formation of fatty necrosis, pain sensations may fade away, and loss of sensitivity of soft tissues may also increase. Both processes are associated with the fact that in the process of necrosis, nerve endings also die;
according to the characteristics of the integument - the skin over the tumor becomes cyanotic (cyanotic) or red, sometimes a combination of these two shades is possible.

The retraction of the nipple is observed if the focus of fatty necrosis is formed in the thickness of the breast in the area of the areola.

Pain syndrome characteristics:

by 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 - pains are often aching, when an infectious agent is attached with subsequent suppuration - twitching, "tearing";
in intensity - as necrosis forms, they increase, then weaken;
by occurrence - observed almost from the very onset of the disease.

Signs of a 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 of the general condition, feeling of malaise;
general weakness and lethargy;
worsening 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 cyanotic or red;
on palpation (palpation) - swelling is confirmed, breast tenderness is also determined. One or more foci of compaction are determined in the tissues.

note

In some cases, there may be changes similar to signs of breast cancer - its deformation, the formation of "dimples" on the skin, dense infiltration, 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 condition of the mammary gland;
breast biopsy - tissue is taken, followed by examination under a microscope.

During mammography, the following are used:

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

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

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

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 the breast tissue;
abscess - a limited abscess of the mammary gland. Especially careful differential diagnosis should be carried out in the case of the development of several abscesses;
phlegmon - a diffuse purulent lesion of the breast tissue;
syphilis of the mammary gland - a pathological process caused by treponema pallidum;
tuberculosis of the mammary gland - a pathological process in it, provoked by mycobacterium tuberculosis (Koch's bacillus);
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:

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 death, accompanied by the processes of decay. It develops when a putrefactive infection is attached.

Treatment of fatty necrosis of the breast (lipogranulomas)

The main method in the treatment of fatty necrosis of the mammary gland is the surgical method. The operation is advisable for reasons such 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 tissue is sent for histological examination - only it allows you 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. The appointments are based on:

antibacterial drugs - for the prevention of infectious complications;
vitamin therapy - to improve the processes of tissue repair (restoration).

Prophylaxis

The prevention of fatty necrosis of the mammary gland is based on the following measures:

avoiding injury to the mammary gland in everyday life and at work;
accurate execution of medical procedures;
avoiding rigid diets that lead to rapid weight loss;
compliance with safety measures when working with radioactive substances;
avoiding strength 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 constriction of the mammary glands;
regular preventive examinations by a mammologist (a doctor who deals with breast problems) - even in the absence of any complaints.

Forecast

The prognosis for fatty necrosis of the mammary gland is complex. On the one hand, the rapid detection of pathology and surgical correction allows you to get rid of the pathology, on the other hand, you have to remove part of the breast.

The prognosis worsens with:

late treatment and progression of pathology;
the occurrence of complications.

Oksana Vladimirovna Kovtonyuk, medical commentator, surgeon, consultant physician

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

This pathology is called fatty 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 cancer, since the symptomatic indicators are similar.

Accordingly, there is a need to contact a medical institution for examination and the required diagnostic procedures.

A pathological disorder called fatty necrosis of breast tissue refers to necrotic processes of the non-fermented type, which can be caused by traumatic injuries.

According to statistics, which are based on the clinical frequency of cases in mammology, fat necrosis occurs in 0.6% of women with identified nodular 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 breast tissue - bruises, squeezing, penetrating injuries, etc.
The consequences of medical manipulations are excessive pressure during palpation, minimally invasive diagnostics, etc.
Exercise injuries - bruises, sprains in the chest, etc.
As a result of rapid weight loss.
Reactive tissue inflammation in violation of the blood flow of the local area.
Passage of procedures related to radiation exposure.
Impaired regeneration after reconstructive mammoplasty with own tissues.

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

Symptoms of the necrotic process

The emergence of a focus of necrosis of adipose tissues is characterized by the formation of a painful compaction, which, on palpation, is defined as an object of rounded shape and dense structure welded to adjacent tissues.

In addition, the following signs are observed:

discoloration of the skin 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.

Temperature indicators of the body rarely exceed the norm, which distinguishes fatty necrosis from mastitis.

The outward appearance of such a process is very similar to the signs of a malignant neoplasm, which requires careful diagnosis.

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

Diagnostic techniques for fatty necrosis of the mammary glands

In the process of diagnosis, the patient's history 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 specialist mammologist has a seal that has fuzzy boundaries and increased soreness.

In the future, for the diagnosis, it is required to conduct such instrumental 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 area.

With the development of the process to calcification, calcification deposits with spherical outlines are found in the images, which make it possible to accurately determine the non-malignancy of the disease.

Differential diagnosis

To differentiate the diagnosis, a mammologist may prescribe a biopsy sample for further histological and cytological laboratory research.

This procedure is carried out under fluoroscopic or ultrasound control 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 an organ-preserving resection of the affected area - sectoral.

In the process of 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 breast injury. If you receive an injury to 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.

Typically this is wearing a breast lift, 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 benign changes in the tissues of the mammary gland. With various damaging factors, as a result of 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 strike during sports training or a bruise on a doorframe.

Often, necrosis can be observed as a result of radiation therapy and with a sharp decrease in weight. Usually, painful symptoms of fat necrosis are either absent, and changes in adipose tissue are detected only during a physical examination by traditional palpation, or are manifested by painful sensations, and a visual examination of the breast 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, sectoral resection. Fatty necrosis of the mammary gland, also called oleogranuloma, lipogranuloma and steatogranuloma, refers to non-enzymatic necrosis.

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

Symptoms and diagnosis of fatty necrosis of the breast

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

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

In the process of contact determination, the doctor-mammologist reveals the degree of density, the clarity of the contours of fat necrosis, the symptoms of the presence of fluid (pus, blood). Plain mammography and MRI of the mammary glands help to detect structural heterogeneity, heavy 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 calcinate of the "eggshell" type, this circumstance completely excludes the presence of a malignant tumor. Differential diagnosis involves a biopsy of the mammary gland, i.e. puncture fine-needle or trepanobiopsy, which makes it possible for subsequent cytological and histological examination of the fragments obtained.

The biopsy is always done under ultrasound or X-ray guidance. Treatment and prevention of fatty necrosis of the breast has its own specifics and some difficulties. It is good when patients go to the doctor at the beginning of detecting 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 examinations after surgery can completely exclude or confirm the process of cancer. Under the microscope, fat necrosis is 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 respectful 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 consult a specialist.