I'll tell you mine long story, maybe it will be useful to someone. For the reason that when this affected me, and I was looking for any information, I could find practically nothing. I breastfed my daughter, my lactation made me happy. I always wanted to feed, for the reason that it is an unrealistic connection with a child! My mother told me from the very beginning - express the remaining milk after feeding until the last drop... Although modern breastfeeding consultants say otherwise: there is no need to express, you need to give breastfeeding to the baby more often, as soon as he goes crazy - apply it. I did, let’s say, this way and that, and expressed the leftovers, which I didn’t fully understand, because they can be expressed forever, and often gave the breast to the baby. When pumping after feeding, I was able to express a maximum of 15-20 grams. After each feeding, I kneaded my breasts with my hands so that milk would flow better during pumping and the remaining milk would come out better. My mother told me: you don’t have enough milk to express, or you don’t express well, or you have so little of it and your daughter doesn’t get enough... Which I categorically disagree with because my daughter was gaining weight well, she often peed, pooped, just like typical for a child undergoing breastfeeding. I didn’t express milk after feeding in cases where I had absolutely no time and I felt with my hands that the breasts were very light and there was nothing there except a few incoming drops. At first glance, it was an ideal picture: I was glad that my lactation had improved, my breasts did not swell much, did not hurt, the child was eating enough and gaining weight. And then one of these days my wisdom tooth starts to hurt, well, naturally, I didn’t run to the doctor on the first day, for the reason that firstly it’s a wisdom tooth, and from time to time it hurt me, there wasn’t enough room for it to come out before end, secondly, teeth are the weak point of women who have recently given birth, and thirdly, it’s a problem with whom to leave infant and get to the doctor. I suffered for about 4 days, my cheek began to swell... then I already made an appointment with the dentist and went to treat him. The dentist, knowing that I was breastfeeding the child, did not start using antibiotics, she said let’s try to remove the pus, if that doesn’t work, then we’ll add them. Naturally, I agreed, knowing that with any antibiotics, feeding must be stopped during their use. Although they say that there are antibiotics compatible with hepatitis B, I don’t believe it. There are many acquaintances, including my mother, when she was breastfeeding my brother, who thus gave their child dysbacteriosis. Everything seemed to work out, the pus came out of the tooth. In addition to this, the weather outside was wonderful, at first glance, but there was a breeze... I put on a sweater and a light jacket, but in the car, while I was running out of the car to the doctor, I still thought: “the main thing is not to catch a cold in your chest.” By evening the temperature rose to 38.2. Which is basically obvious in connection with the situation with the tooth. The next day, the doctor washed my tooth again, the swelling visibly subsided, and it became easier. But then another problem arose: in the evening a lump appeared in the chest... thinking of ordinary lactostasis, she tried in every possible way to knead it, strain it, put her daughter more often to this breast, with her chin to the lump. I did it at night folk recipes, which supposedly help everyone: alternating chalk cakes with cabbage leaves... and, in between, adding a daughter. The next day the lump did not shrink, I continued to try to remove it using these methods. It was Sunday. On Monday I called a breastfeeding consultant to my house, she told me a lot useful information, showed several comfortable positions for feeding, and proceeded to the main thing, for which I actually called her - to express my sore breast. She strained it for a long time and skillfully, but did not strain the lump. After she left, I continued to do it myself, but nothing came out of the part where the lump was... it already hurt like hell... but I endured it, realizing that everything had to be done to prevent mastitis. In the evening, my mother came and helped me pump, at the same time my daughter was pumping, and I had to involve my husband... The lump didn’t soften, and on Tuesday I ran to the hospital for an ultrasound, where the ultrasound specialist immediately told me: honey, you have purulent mastitis???? I fainted at this news... I came to my senses and they immediately told me, let’s call an ambulance and go to the hospital for surgery. I went home, packed my things, fed my daughter. healthy breasts, realizing that I might be feeding her for the last time, and my husband took me to the hospital. There the surgeon on duty looked at me and said, this is not yet purulent mastitis, but acute lactostasis, it’s still possible to strain it out, we will always have time to cut you. Moreover, lactation must be suppressed there. I showed my husband how to strain, and I went home happy, realizing that not everything was lost, and I would do everything to avoid surgery. We bought the mixture for our daughter, I hoped that it would not be forever, but for this period. They started injecting me with antibiotics. And then the most terrible days of my life began... every 2-3 hours my mother pumped my breasts, I couldn’t do it myself, the pain was hellish, it got to the point that my husband was holding me by the arms and legs, because I was weeping from pain them in different sides! And so for 4 days, for days, we dealt only with my breasts, we got to the pus, it came out well, but the lump did not shrink at all. They brought in a surgeon we knew, he also came once a day and helped me express, preparing me for the fact that there was a chance of doing without surgery, but it was very small... I started taking pills to suppress lactation: dostinex. But I really hoped for a miracle, and was ready to endure a lot more pain, just to avoid surgery, and then I would try to restore lactation. As a result, Saturday, the lump did not soften up, I was very exhausted these days, because all day long we were only with wild ones I was expressing my breasts in pain. I come to the hospital to see the surgeon, with my things, realizing that the operation can no longer be avoided. He confirms my fears, and I go to the hospital, and they operate on me that same day. The operation took place under general anesthesia, did not last long. When I woke up, I felt a tingling sensation in my chest. The next day I had to undergo the first dressing change, I was very afraid. I gave her a painkiller, it hurt a lot but didn’t last long. They shoved bandages in some kind of solution inside my holey tit, poured levomekol. And so every day, for a week. It was still scary to lie in such a department: purulent surgery... every second person there is either missing a leg or an arm... I got off easy with my tit. It was very scary to catch some other infection there. It was very bad being separated from my daughter, they immediately warned me that you would lie there for at least 12 days... On the 6th day they sewed up the hole for me, under general anesthesia. They installed a drainage and the ichor came out for 2 days. Then it was removed and all that remained was to treat it with alcohol and apply a cosmophor compress. Discharged. All I have to do is remove the stitches, I'll be back in a week. Mentally I feel terrible that I won’t be able to feed my daughter anymore... there is an opinion that even after surgery you can return lactation, but to be honest I can’t imagine how it will be, how the ducts will grow together, how milk will flow through them, and whether my daughter will now take the breast. There will obviously be a shortage of milk, there will obviously be SV, and is there any point... until it heals right now, while I pump it, I torture my daughter... I don’t know, for now I’m inclined to think that I won’t return it. But when I give birth to my second child, I will try to feed! We feed our daughter with the Nutrilak mixture, to my great surprise, as soon as we switched her to the formula, her flowering went away, and naturally her pooping became better) In the end, I still don’t know what the reason is, either there is still milk left, or a dental infection has reached the chest, the wind blew... I think more like a tooth... It’s very hard and sad. Thank you for reading to the end of my story. I hope it will help someone, and in such a situation you should immediately run to the doctor, and not treat with strange things yourself traditional methods. Although I didn’t do this for long, it turned out that every minute counted.
Despite the many real successes and significant achievements that she was able to achieve modern medicine in the treatment and prevention of inflammatory infectious problems in general, a disease such as purulent mastitis today continues to remain a more than urgent medical (and in particular surgical) problem of our time. Moreover, both in women and in children, and even in newborns.
What today, as before, accompanies this incredibly common pathology in women? The answer, quite sadly, is:
- And extremely long terms necessary hospitalization during surgery.
- And an incredibly high percentage of relapses of the disease, and as a result, the need for repeated surgical actions (corrections).
- And of course, there are cases of emergency conditions, even severe sepsis, the treatment of which must be immediate.
- And of course, the cosmetic results of surgical treatment are not the best.
Today, this type of mastitis, such as purulent, among doctors is usually divided into two, quite large groups. This is, first of all:
- Purulent lactation mastitis. This form differs primarily in the cause of its occurrence. pathological process(since it occurs after the formation of milk in a woman’s breast), as well as some features in the clinic and diagnosis, and sometimes, methods surgical treatment(operations). Symptoms of this form of the disease are usually more pronounced, and patients feel worse.
- And, accordingly, purulent non-lactation mastitis.
It must be understood that lactation purulent mastitis in modern world occurs quite often (in almost 6.0% of all women giving birth).
Moreover, in more than 50% of all primiparous women, such lactation mastitis (in various forms, serous or infiltrative, purulent or non-purulent) occurs in the first two or three weeks, immediately after childbirth.
You should know that most often purulent lactation mastitis develops after long-term unresolved lactostasis.
For example, statistics say that when lactostasis is not resolved in the first three or five days, after that, in 99% of cases one of the many clinical forms mastitis.
Let us note that the bacteriological picture of such a disease as acute and even purulent mastitis has been studied excellently by doctors. So in 95.0% of cases, mastitis is acute, and purulent develops after entering the woman’s mammary gland Staphylococcus aureus, which is easily detected in monoculture.
Why does the condition of purulent inflammation of the mammary gland occur?
It should be immediately noted that the non-lactational version of purulent mastitis today occurs almost four times less frequently than acute mastitis during lactation. Moreover, most often, non-lactation mastitis passes without reaching its purulent forms. It could be:
- Physiological or pathological non-lactational mastitis in newborns. Moreover, inflammation mammary gland Newborns can be observed in both girls and boys, there is plenty of photo evidence of this. Despite the fact that this condition most frightens mothers of newborns, the problem often goes away on its own (no treatment is required). Moreover, in newborns themselves, such a physiological state may not cause much concern.
- Physiological or pathological non-lactational mastitis in children and adolescents during periods hormonal changes body.
- Purulent mastitis in men. There are a lot of photos of such men on the Internet.
There can be many reasons for the occurrence of purulent mastitis, but most often the disease develops:
- After certain hormonal surges in the body of patients.
- After some breast injuries.
- After suffering (or at the time of development) acute purulent-inflammatory and allergic diseases skin and most subcutaneous tissue of the breast. (After boils, carbuncles, after microbial eczema etc.).
- After primary development a disease such as fibrocystic breast disease or mastopathy. Or other benign tumors mammary gland (say, after fibroadenoma).
- After poor-quality implantation of foreign (often synthetic) materials directly into the breast tissue.
- If you have suffered specific infectious diseases mammary gland (for example, with actinomycosis, tuberculosis, syphilis, etc.).
Note that the bacteriological picture (and symptoms) of non-lactation forms of purulent mastitis is much more diverse. Thus, the disease can be caused (in 20% of all cases) by streptococcus, enterobacteria, and other anaerobic infections.
Classification of purulent forms of mastitis
Probably the most accurate and most noteworthy classification of purulent mastitis (whether it is a disease observed in newborns, children or adults) can be considered the classification according to N.N. Kanshin (created back in 1981). So, according to the classification, mastitis occurs:
- Acute form, (extremely rarely chronic) serous mastitis.
- Acute infiltrative form (in isolated cases chronic).
- Abscessing purulent form of mastitis, which in turn can be Apostematous (limited or diffuse), Breast Abscess (solitary or multi-cavitary), and mixed abscessing purulent inflammation.
- Phlegmonous form of purulent mastitis.
- And necrotic gangrenous form of the disease.
How can purulent forms of mastitis manifest?
In the vast majority of cases, lactation forms of purulent mastitis begin extremely acutely. Symptoms are constantly increasing. Typically, this type of disease goes through its stages of serous and even infiltrative forms incredibly quickly. Symptoms of this disease differ in their intensity.
The affected mammary gland may become enlarged. Symptoms of intoxication are also always observed. Visually, significant hyperemia usually appears skin above the affected area of the chest, which is clearly visible even in the photo.
Unrelatedly, careful palpation of the breast usually reveals a dense, sharply painful, mobile infiltrate that has no clear boundaries.
The symptoms of this form of the disease are also different in that the well-being of such nursing women suffers the most.
Severe weakness may appear, noticeable sleep disturbances, loss of appetite, and of course an increase in body temperature.
Non-lactation forms of purulent mastitis can be chronic and have a more subtle clinical picture (symptoms). However, it can be more difficult to treat such forms unless, of course, we are talking about physiological variants of the problem.
As a rule, on initial stages The disease picture is determined only by the clinical picture of the underlying disease (symptoms of the primary disease are observed), which may be accompanied by purulent inflammation of the breast tissue.
It is important to note that non-lactation forms of the disease in newborns can manifest with minimal symptoms and practically return to normal (if we are talking about physiological mastitis in newborns).
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However pathological forms diseases in newborns may have the same symptoms as described above for adults.
How are purulent types of mastitis treated?
It should be noted right away that it is strictly forbidden to treat purulent variants of inflammation of the mammary gland on your own, without consulting a doctor (and regardless of whether the problem develops in newborns or in adults).
And above all because this disease can incredibly quickly transform into more global complications and emergency conditions. It is important to understand that recovery after treatment running forms the illness will be much more complex and prolonged.
By the way, treatment folk remedies as the main therapeutic direction is strictly prohibited. Purulent forms of mastitis are always (even with surgical intervention) treated using certain antibiotics.
Treatment with folk remedies can be justified and logical only in one case - if it is prescribed in combination with therapy using antibiotics. And if this treatment is prescribed to a woman by a doctor.
And here comprehensive options therapy, when treatment includes both antibiotics and effects on the affected mammary gland with folk remedies, is becoming increasingly common in traditional medical circles.
Unfortunately, there are also forms of purulent inflammation of the mammary gland that even the strongest antibiotics cannot cope with, and then patients may require surgery.
As a rule, the choice of surgical approach (and, as a consequence, the type of operation) directly depends on the specific location and the main volume of tissue affected by the disease.
For example, surgical treatment for subareolar or central intramammary location of the focus of purulent mastitis involves performing a paraareolar incision.
But, when the purulent focus of inflammation is localized exclusively in the lower parts of the gland (with retromammary or with total purulent inflammation) surgical treatment involves making an incision using the Gennig approach.
In any case, the surgical treatment of purulent forms of mastitis is based on the principles of maximum preservation of healthy tissue.
However, the volume of excision of severely affected gland tissue, today, can be decided ambiguously by many surgeons. However, most authors prefer to use exclusively gentle surgical techniques to prevent the development of breast deformities and disfigurement.
Such techniques involve opening a specific lesion and its subsequent drainage.
In addition, it is believed that after operations to excise the affected breast tissue, full treatment should be carried out, including antibiotics. And only in the postoperative period can doctors prescribe non-traditional treatment.
Do you still think that it is completely impossible to heal your body?
How can you identify them?
- nervousness, sleep and appetite disturbances;
- allergies (watery eyes, rashes, runny nose);
- frequent headaches, constipation or diarrhea;
- frequent colds, sore throat, nasal congestion;
- pain in joints and muscles;
- chronic fatigue (you get tired quickly, no matter what you do);
- dark circles, bags under the eyes.
If a woman needs surgery for mastitis, it means her mammary glands are in poor condition. After all surgical intervention with such a disease, this is an extreme measure, because doctors are aware of the aesthetic and physiological importance of the female breast. How is the operation performed, and is it possible to regain femininity and self-confidence after it?
Reasons for the development of mastitis
Mastitis (from the Greek mastos - nipple, breast) is called inflammatory process, developing in the mammary glands. In the old days, the disease was called breastfeeding. Inflammation is caused by pathogenic microflora (usually staphylococcal infection) and is more common in nursing mothers. If the baby is not placed correctly at the breast, the sucking process will be difficult. And due to strong tension, cracks form on the nipples. Through them, the infection easily enters the mammary glands.
But breast mastitis can also develop in experienced mothers who feed their babies with proper technique. The fact is that breastfeeding women actively open their milk ducts. And if any infection appears in the body (for example, E. coli), then through the network of blood vessels it can reach the chest.
Another one possible reason development of mastitis - stagnation of milk. If the baby does not suckle well, the milk begins to linger in the breast and fester. Firstly, it is dangerous for the baby. Secondly, for the mother herself. Lactostasis creates an ideal environment for the proliferation of bacteria that cause mastitis.
By the way! There is also non-lactation mastitis, which develops in non-lactating women. This may be due to hormonal disorders and decreased immunity due to other diseases.
How mastitis manifests itself at different stages
The first signs of mastitis begin to appear almost immediately after infection. It is impossible not to feel discomfort or pain in the mammary gland (or both at once). Unpleasant sensations intensify during feeding, when raising hands, or when a woman tries to examine herself by palpation. But mothers often attribute such pain to the regular application of the baby to the breast.
Mastitis is rarely diagnosed at the earliest stage, when mild discomfort is present. The woman begins to feel alarmed when new symptoms appear, which indicate the onset of the next stage of the disease. Each stage is simultaneously considered an independent form of mastitis.
Serous stage
At first general state the patient is not affected: she has no fever, milk comes out freely, but pumping can cause discomfort. A distinctive symptom of the onset of the serous form of mastitis is compaction in the areola area of the nipple. It is painful, but tolerable, with clearly palpable boundaries.
This compaction is caused by stagnation of milk. And if you don’t get rid of it within two days (with the help of a breast pump), inflammation will begin. The temperature will rise, pumping will become sharply painful, and weakness will appear. The breast tissue will begin to become saturated with pathological serous fluid. The density of the nipple areola will increase.
Treatment of mastitis at this stage is carried out with antibiotics. But many mothers prefer to continue feeding and hope that the disease will subside. This is possible if a woman strong immunity: Then the high temperature will kill the bacteria and the seal will resolve. But this happens extremely rarely, and after 5-7 days of the serous stage, the next one begins.
Attention! Feeding the child should be stopped at the first signs of mastitis and not resumed until the attending physician gives the go-ahead.
Infiltrative stage
The painful lump spreads throughout the chest and no longer has clear boundaries - an infiltrate forms. The affected mammary gland noticeably increases in size compared to the healthy one.
The infiltrative stage of mastitis lasts approximately 5 days, during which the temperature is maintained at 37-38 degrees, so the woman feels unwell all this time.
Destructive stage
Or purulent mastitis. An advanced process that manifests itself as a sharp deterioration in a woman’s well-being. This is explained by intoxication of the body caused by the release of toxins from the source of infection into the blood. The fever begins, the patient becomes drowsy, but she cannot sleep because of the fever; no appetite.
Redness and local hyperthermia are added to breast swelling: the mammary gland becomes clearly red or burgundy color, but it is hot to the touch. The nipples may ooze pus or bloody milk. The pain is present all the time, not just when touched. Also, painful spasms sometimes radiate to the armpits, which indicates damage to the lymph nodes.
Today, purulent mastitis is rare, because most women, fearing for the condition of their breasts, consult a doctor at the first signs of inflammation. This allows you to immediately stop the disease and not lead to critical conditions when surgery is required.
Indications for surgery for mastitis
As long as possible, treatment of mastitis is carried out conservatively. The patient is prescribed antibiotics, immunomodulators and anti-inflammatory ointments. Of course, breastfeeding must be stopped during therapy.
Surgery for mastitis is performed in the following cases:
- lack of positive changes from therapeutic treatment;
- rapid deterioration of the patient’s mammary glands;
- diagnosing destructive form mastitis (purulent, abscessing, gangrenous);
- chronic mastitis (if the disease develops repeatedly).
Technique of the operation
Surgical treatment of mastitis involves opening and draining the purulent cavity. It is performed under general anesthesia. The technique of performing the operation depends on the location of the accumulation of pus.
Superficial mastitis
The purulent formation is located directly under the skin and is easily palpated. The pus is enclosed in a capsule that is in contact with the lobes of the mammary gland. To access this capsule, the doctor makes two radial incisions (from the areola of the nipple to the edges of the breast). If there are several lesions, then there will be more incisions. The capsules are opened and washed.
Intrathoracic mastitis
Purulent accumulations are located directly between the lobes of the mammary gland. You can also get to them through radial cuts. Then the doctor uses his finger, so as not to injure the lobes, to spread them apart and form a cavity to remove pus. After the contents have drained, the breast cavity is washed antiseptic solution and checked for the presence of necrotic tissue to remove them.
Substernal mastitis
If the abscess has developed between the outer lobe of the breast and the pectoral fascia, it will be more difficult to remove the pus. To get to the depths of the breast, you have to make a Bardenheyer incision - under the mammary gland in its natural fold. Then the mammary gland is pulled upward, almost completely separating it from the fascia of the pectoral muscle. The discovered abscess is opened and washed; necrotic tissue is excised. The breast is returned “to its place.”
Wound drainage
Purulent mastitis will not go away if after the operation you do not install a drainage tube that will remove the pus that accumulates at first to the outside to avoid relapse. Sometimes the drainage system is made through (double or triple) so that the chest cavity can be washed with immediate removal of the solution. In mild cases, surgery without incisions is possible, and then the operation is performed by draining the abscess (if there is only one, and its location is clearly defined).
Features of the rehabilitation period
The actions of doctors and the patient herself after mastitis should be aimed not only at healing the wound and preventing infection of the sutures, but also at the rapid restoration of feeding function. To do this, it is necessary to stop lactostasis, which persists after the operation. This will not only prevent recurrent abscess, but also improve metabolic processes in the chest.
Expressing milk in postoperative period should be carried out under the supervision of a doctor so as not to damage the sutures. This is a painful process, so at first it is carried out using painkillers.
Possible complications after surgery
Any intervention to open an abscess is associated with the risk of infection of nearby tissues. Therefore, doctors try to work as much as possible with blunt instruments or fingers, for example, to move the lobes of the mammary gland or to bring the capsule out.
The main complications after surgery for mastitis are:
- milk fistula (formation of inflammatory nature);
- phlegmon or gangrene (a developing purulent inflammatory process that spreads over the entire affected surface - without clear boundaries);
- aesthetic defect (scars and scars on the chest);
- risk of relapse.
Even if acute mastitis was cured by surgery, it is possible that the disease will return and become chronic. This can happen either after another birth during lactation, or simply due to hormonal imbalance.
Cosmetic defects in the form of scars can subsequently be eliminated with laser. If an operation was performed with a Bardenheier incision, the scar will be hidden in a natural fold. Also, breasts affected by mastitis may change slightly in size after surgery. This problem can be solved by mammoplasty (if the woman no longer plans to give birth).
How to prevent mastitis
Breasts are given to a woman not only for beauty, but also to fulfill its main purpose - feeding a child. Therefore, you need to monitor the health of your mammary glands, shower regularly and not wear tight underwear.
During lactation, a woman should wash her breasts before and after feeding her baby. It is advisable to change your bra every day, and it should not be synthetic. If cracks have formed on one mammary gland, you should consult a doctor, but in the meantime, feed with a healthy breast.
If there is a lot of milk, you should express it to avoid stagnation. This can be taught by a visiting nurse, an instructor at courses for young mothers, or a more experienced woman (friend, mother, mother-in-law). At the slightest symptoms beginning mastitis or lactostasis, you should immediately consult a doctor so that you can stop the problem on early stage and avoid surgery and complications.
Mastitis - a fairly common inflammatory disease of the mammary gland. The most common is lactation mastitis, less common is neonatal mastitis, which complicates the course of physiological sexual crises in newborns, and juvenile mastitis. There are 4 main forms of mastitis: serous, infiltrative, purulent (abscessing and phlegmonous) and gangrenous. Purulent mastitis can develop both with the progression of serous and infiltrative mastitis, and de novo.
By localization, phlegmonous mastitis can be superficial [located between the subcutaneous fascia and the anterior layer of the gland capsule, can be located peripherally (premammary mastitis) or subareolar], intramammary (interstitial and parenchymal), ductal (in the gland tissue within one lobule), retromammary (in fiber of the same name) (Fig. 17.1).
In different situations, during operations on the mammary gland, different incisions are used (Fig. 17.2): when opening superficial abscesses or removing benign formations, radial incisions are made that do not reach the areola. This direction of skin incisions reduces the risk of damage to large areas.
Figure 17.1. Localization of purulent formations in the mammary gland: 1 - subareolar abscess; 2 - galactophorite; 3 - intramammary abscess; 4 - retromammary abscess
Figure 17.2. Incisions used for purulent mastitis:
a: 1 - radial cuts; 2 - Bardenheier section; 3 - paraareolar incision; b - flow-aspiration drainage of retromammary abscess
milk ducts and the intersection of muscle fibers located in the skin of the areola and closing the milk tanks;
To expand the accessibility zone, subareolar incisions are made, which are radial incisions with a semicircular notch around the areola, so that the incision takes on a T-shaped appearance
To access retromammary tissue and the posterior surface of the mammary gland, the Bardenheier or Gaillard-Thomas approach is used. The skin incision is made under the mammary gland along the transitional fold. The subcutaneous tissue and superficial fascia are dissected. Find the junction of the anterior and posterior layers of the gland capsule. Next, you can go between the posterior layer and the gland tissue or retromammary;
To remove the mammary gland and skin, wide incisions surrounding the gland are used. The most convenient is the Halsted incision, used in oncological operations.
To remove gland tissue while preserving the skin (the so-called subcutaneous mastectomy), a circular incision is used around the areola. The gland is removed through the resulting hole.
a colored tattoo imitating an areola is applied. Regardless of the type of skin incision, the parenchyma of the gland is pushed apart bluntly. In modern breast surgery, cosmetic techniques and prosthetics of remote areas are widely used.
17.1.2. Surgeries for breast tumors
Sectoral resection (quadrantectomy) consists of removing a sector of the mammary gland in one block with the lymph nodes of the subclavian-axillary zone. It is possible with limited nodular forms of tumors localized in the upper outer quadrant of the mammary gland. The diameter of the tumor should not exceed 2.5 cm. The operation consists of excision from the breast tissue of a sector that includes the tumor node and unchanged gland tissue at a distance of 3-5 cm from the edge of the tumor in each direction. In this case, excision of the sector (quadrant) is performed taking into account the location of the interlobular fascial septa, observing the principle of sheathing. Together with the resected sector, the subscapularis-subclavian-axillary block of tissue and lymph nodes is isolated, preserving the pectoralis major and minor muscles. The isolated tissue with the subclavian and axillary lymph nodes is removed en bloc with the mammary gland sector. When the tumor is localized in the medial and central departments glands, such operations are not justified both due to technical difficulties and due to the predominant metastasis of such tumors to the parasternal lymph nodes.
Tumorectomy with axillary lymphadenectomy consists in removing gland tissue and axillary lymph nodes not as a single block, but separately. In modern conditions, an endoscopic version of axillary lymphadenectomy after axillary lymphography is used. Adjuvant chemoradiotherapy is mandatory. The method is used in patients with stages I and II of breast cancer. In patients with locally advanced breast cancer (stage III), this operation can be performed after neoadjuvant preoperative chemoradiotherapy if the tumor size has been reduced to 3 cm.
Radical mastectomy- mastectomy with simultaneous removal of the pectoralis minor and major muscles, lymph nodes and tissue of the axillary, subclavian and subscapular areas.
Are you sure of the diagnosis?1. Very often nursing mothers call mastitis LACTOSTASIS. What does lactostasis look like?
Painful lumpiness and often redness of the skin above the lump. The occurrence of such lumpiness or compaction is associated with blockage of one of the ducts, presumably by a fatty droplet, and a violation of the outflow of milk from the gland lobe.
If lactostasis is accompanied by an increase in body temperature, chills, and deterioration in general well-being, then American authors prefer to call it NON-INFECTED MASTITIS (in contrast to INFECTED or SERIOUS mastitis, the signs of which see below in paragraph 3), therefore, both in the literature and in nursing mothers confusion occurs, you can say “mastitis” and mean completely different things.
The main cause of lactostasis is poor drainage of the entire breast or part of it. Poor drainage is most often associated with the baby feeding in the same position. For example, with a standard “sitting” position, the axillary lobe, the largest and with convoluted ducts, is emptied worst of all (the areas closest to the lower jaw child - in in this case the lower-central ones, and the upper-lateral ones are the worst).
The simplest action to prevent stagnation of milk in the axillary lobes is to sometimes put the baby “from under the arm” - the mother, for example, sits (you can also lie down), the baby lies on a pillow with his head at the chest, and the bottom and legs are behind the mother’s back, The baby lies on his side, under his arm. Very often, when congestion occurs under the arm, it is enough to place the child in this position several times in a row and he will suck everything out perfectly.
The location of lactostasis on top “in the center” is typical for those cases when the mother holds the breast with “scissors” during feeding - the nipple between the index and middle finger, forefinger pressed into the chest. (You can neither support nor feed your breasts this way - but in most maternity hospitals this is how they advise giving breasts; in some courses on preparation for childbirth they literally advise the following: “Hold your breasts like a cigarette.”) The breasts must be supported with your whole hand - thumb on top, the rest under the chest. In the vast majority of cases, the breast does not need to be supported throughout the entire feeding - it must be held by the child himself.
Very often there are recommendations to constantly wear a bra so that it supports the breasts higher and then they would fill evenly both above and below, they even suggest sleeping in a bra. All this is called the prevention of lactostasis. But by nature female breast It is designed so that more milk accumulates in the lower lobes, and from any position it is the lower lobes of the gland that are best emptied. So why do we need to achieve uniform accumulation of milk in all lobes of the gland? Probably, so that it would be more convenient for lactostasis to form up there... If a bra is worn, it should be loose. It is convenient when your boobs are leaky, your milk is leaking and you need to use pads...
If a woman has large and heavy breasts, one of the reasons for the formation of lactostasis is night sleep in an awkward position. Try to sleep more often on your stomach with a comfortable pillow - then during strong hot flashes, the milk will simply flow out and not stagnate.
Lactostasis is much less common with properly organized breastfeeding, when there is no accumulation of large portions of milk for feeding, and the mother knows how to feed the baby from different positions.
However, lactostasis is a mysterious thing, sometimes it occurs out of nowhere and with active sucking on the affected breast it goes away within 1-2 days without special measures. (And the mother begins to say that it was the cabbage leaf that helped her. If you come across a mother who does not understand at all what is happening to her, and when she begins to develop lactostasis, she stops putting the baby to the sore breast and stops touching it altogether, she no cabbage leaf helps. Then disaster usually happens.)
The tendency to form lactostasis in women is usually the same and does not go away with age and the birth of other children. If a woman with her first child did not have lactostasis - and at the same time she followed all the rules of feeding - she fed for a long time, without restrictions at the request of the child, without supplements and supplements, and lactation persisted for at least a year - then the likelihood of lactostasis occurring when feeding subsequent children is low. . If, under the same conditions when feeding the first child, there were still lactostases, then perhaps they will be regularly repeated at the same time when feeding subsequent children, and as a rule, the mother herself learns to treat them calmly, cope quickly and not turn it into into the problem.
It is impossible to say anything similar about a woman who does not follow the rules of feeding, because she does not have the most important weapon in the fight against lactostasis - the self-regulating system - “mother-child”.
There are often cases when a mother who fed her first child regularly suffered from lactostasis, and when feeding her second and subsequent children, fed freely and was surprised to note that she did not have any lactostasis.
If lactostasis appears in the breast, you need to put the baby on it as often as possible. Sometimes it is necessary to express the breast BEFORE feeding and attach a baby who actively wants to suckle to the breast, in which only lactostasis remains... Sometimes it is necessary to PRE-HEAT and MASSAGE the SEGMENT with lactostasis and express it (contact SPECIALISTS AT YOUR PLACE OF RESIDENCE). The easiest way to warm up, which a mother can safely use, is to place a hot, wet napkin (towel) on the affected segment 5-10 minutes before pumping (or a warm shower).
The severity of the situation does not depend on the degree of soreness or redness of the breast, but on the woman’s ability to express with such soreness. It is pain that prevents the mother from pumping effectively. Therefore, it is better to seek the help of a specialist who can cope with this complication in 30 minutes. Most mothers are afraid to express and massage this area because they think something might burst there. Something may burst if you massage and pump as follows: put your boob on a stone and hit it with a hammer on top.
Lactostasis in itself is not a dangerous thing; illiterate actions to overcome it are dangerous. You cannot STOP feeding the affected breast, even if you have a very high fever. Can't LEAVE painful lump without attention during the night break. If there is no guarantee that the baby will wake up on his own in 2-3 hours, it is better for the mother to use an alarm clock to provoke the baby to suck every 2 hours. By the way, the mother discovers most lactostasis after the child has “slept well” for the first time at night.
2. Women often call mastitis a physiological phenomenon - the ARRIVAL OF MILK or a CHANGE IN THE COMPOSITION OF MILK.
The arrival of transitional milk most often occurs 3-4 days after birth and may be accompanied by swelling of the mammary gland, soreness and increased body temperature. (In this case, the so-called chest temperature: when measuring temperature at three points, such as under the armpit, mouth and groin, highest temperature will be under the armpit, the difference with other points may be a degree or more.) The arrival of mature milk usually occurs 10-18 days after birth and can also be accompanied by swelling of the mammary gland, soreness, and increased body temperature. All this is not yet mastitis, but if done incorrectly it can lead to UNINFECTED MASTITIS.
In this situation, it is necessary to continue to feed the child on demand, and the concept “on demand” includes demands from both sides: both mother and child. Sometimes a baby cannot latch onto the breast well and suck out milk because the areola becomes hard. In this case, before feeding, it is necessary to slightly pump the breast so that the baby can successfully latch onto it and begin sucking.
Often a mother has a desire to completely express her breasts to alleviate her condition. However, when milk comes in and the composition of the milk changes, pumping should be carried out according to certain rules. If mom has painful sensations, “stone breasts” - then she can express her breasts until she feels relief, NO EARLIER than a day after the milk starts coming. You have to wait about a day because the substance that curtails excess lactation appears in the full breast after about 24 hours. If you express your breasts before this time, the same amount of milk will come, and hyperlactation may “start” with all the troubles that accompany it, the main one of which is the need for regular pumping.
It should be noted that when mother and child stay together in the same room, as well as at home, and following feeding rules, big problems with the arrival of milk is not observed.
If mother and child are kept separately and the child is only brought in for feeding, the mother quite often experiences engorgement with severe swelling, redness of the entire mammary gland, and difficulty in the outflow of milk. If there are abrasions or cracks on the nipples, such engorgement may result in INFECTED MASTITIS.
To cope with engorgement, it is necessary to establish pumping for 2-3 days during the daytime (from 9.00 to 21.00), as well as frequent and prolonged breastfeeding by the child. You should not pump at night, so as not to provoke an additional flow of milk.
To facilitate the outflow of milk, a light massage, warming with a hot towel, or using a high-quality breast pump before feeding or pumping is possible. This is the very case when feeding the child at the request of the mother is extremely important.
3. REAL MASTITIS is an infected inflammation of the breast tissue.
Most often it develops against the background of engorgement or lactostasis. If milk is not removed in a timely manner during lactostasis, inflammatory changes in the breast tissue begin, occurring against the background of swelling and changes in blood circulation in the lobe of the gland with lactostasis. This condition is often called NON-INFECTED mastitis.
If a woman has abrasions or cracks in her nipples, the inflammatory focus quickly becomes infected. It should be noted that the infection can get there not only from cracks, but also from any other source chronic infection in a woman’s body (for example: carious tooth, chronic tonsillitis, pyelonephritis, etc.) There are often cases when, when a woman has a common sore throat, cold, or flu, on the 2-3rd day a woman suddenly develops pain, sharp tingling pain, even redness on the chest without prior formation of compactions in this place. All these are signs of INFECTED mastitis.
With any mastitis, your health worsens, your overall body temperature rises, part of the breast becomes red and hot, painful when touched.
Treatment of mastitis is carried out according to the same principles as the treatment of lactostasis. It is necessary to free the lobe from milk by pumping, massage and latching on the baby. With mastitis, feeding a child is not prohibited, but necessary, since no one better than a baby can empty the lobes of the mammary gland. The infection that caused the inflammation got to the child several days before the mother showed the first visible signs of this infection. Now he already receives with milk not only pathogenic organisms, but also active immune protection against this infection. As a rule, when such a child is weaned from the breast, he gets sick 2 times more often than when breastfeeding continues.
To speed up the process in this case, expressing with a suitable breast pump and using warming and absorbable compresses are used. Any compresses prescribed by your doctor will do, except alcohol or vodka. Alcohol is an antagonist of oxytocin, a hormone that stimulates milk flow. When using alcohol-containing compresses on the breast, it is well absorbed and disrupts the outflow of milk from the affected lobule. Regular use of alcohol compresses can easily “curtail” lactation completely.
For INFECTED mastitis, antibiotic therapy is necessary. Exists a large number of modern antibiotics compatible with breastfeeding. If a doctor prescribes antibiotics, you must inform him about this, because very often doctors do not consider it necessary to continue breastfeeding during antibiotic therapy and do not bother choosing a treatment that is compatible with breastfeeding. As a rule, it is necessary to regularly take medications prescribed by a doctor for at least 5 days and take care to “save” your intestinal flora during the period of antibiotic treatment. Now there are many combination drugs, which are prescribed simultaneously with antibiotics. If your doctor has not prescribed anything like this, consult your pharmacist.
4. BREAST ABSCESS is a condition that develops against the background of mastitis IN THE LACK OF TREATMENT.
Never forms from scratch in 1 day! With an abscess, in place of what was once lactostasis, a cavity is formed filled with purulent contents. An abscess, as a rule, opens into the milk duct and its treatment consists of regular pumping of the sore breast and a course of antibacterial therapy. Self-medication for an abscess is dangerous - you MUST consult a specialist. In case of an abscess, while pus is released from the milk duct, it is recommended to continue feeding the child only from a healthy breast.
When preparing the material, the book “Breastfeeding Counseling”, author Zh.V. Tsaregradskaya, was used.
Liliya Kazakova and Maria Mayorskaya http://www.detki.de/index.asp?sid=157233581&id=d99
