Massive necrosis of breast tissue

Introduction Severe acute mastitis can lead to massive necrosis of the breast tissue, and even complicated sepsis. Acute mastitis is localized, that is, an acute breast abscess is formed. At this time, the swelling of the mass was fluctuating, and the superficial abscess was relatively fluctuating. The abscess can be ruptured outwards, or it can be broken into the milk duct and drained from the nipple. After the abscess breaks into the breast and reaches the loose tissue in the front of the pectoralis major, a post-abdominal abscess is formed. Strengthening prenatal and postnatal hygiene publicity, guiding maternal protection of nipples, and helping lactating women to master normal breastfeeding methods are effective measures to prevent acute mastitis during lactation.

Cause

Invasion of bacteria

Most of the pathogenic bacteria of this disease are Staphylococcus aureus, and a few are Streptococcus. Bacteria enter from the rupture of the nipple skin or the areola cleft, spread along the lymphatic vessels to the fat and fibrous tissues of the interlobular lobe and glandular lobules, causing acute suppurative cellulitis of the breast. There are also a few cases of complications of infection in other parts of the postpartum period, and the bacteria spread to the breast through the blood circulation.

2. Milk deposition

Milk is beneficial for the invasion of bacteria. The reasons for milk deposition are: 1 the nipple is too small or invaginated and failed to correct in time before birth, making it difficult for the baby to suck breast, or even breastfeeding. 2 too much milk, emptying is not complete. The mother does not understand the secretion of milk, and the excess milk cannot be discharged in time and remains in the milk. 3 mammary duct obstruction makes breast drainage difficult, such as inflammation of the milk duct itself, tumor and external compression, can affect normal breastfeeding.

3. nipple splitting

After giving birth, the mother fails to master the correct breastfeeding skills, or the baby's sputum is abnormal, or excessive use of irritants such as soap or ethanol desiccant on the nipple and the disorder of the baby's oral movement function cause the nipple to split and the bacteria along The small nipple invades and forms an infection through the lymphatic vessels to the subcutaneous and interlobular tissues. When the nipple is cleft, the breastfeeding pain is not enough to make the milk fully sucked out, causing the milk to accumulate and creating breeding conditions for the invading bacteria.

an examination

Related inspection

Blood routine chest B ultra-molybdenum target X-ray examination breast ultrasound examination

1. Medical history: lactating women have milk deposition or nipple splitting, bad breastfeeding habits.

2. Clinical manifestations: lactating women have a partial breast pain, red, swollen, hot or lumps, tenderness, and even chills, high fever, fatigue, weakness, local fluctuations in the formation of abscesses.

Differential diagnosis

Differential diagnosis of massive necrosis of breast tissue:

1, breast hyperplasia: breast lobular hyperplasia.

Also known as cystic breast disease, it is one of the most common diseases in women, usually between 25 and 40 years old. The occurrence of this disease is closely related to endocrine dysfunction, especially ovarian dysfunction.

2, acute breast cancer (inflammatory breast cancer)

The disease is a special type of breast cancer. It occurs mostly in young women, especially during pregnancy or breastfeeding. As cancer cells rapidly infiltrate the entire breast, they rapidly spread in the lymphatic net of the breast skin, causing signs of inflammation. However, inflammatory breast cancer has a wide range of skin lesions, often involving 1/3 or more of the entire breast, especially in the lower half of the breast. Its skin color is a special dark red or purple red. The skin is swollen and is "orange peel-like". The patient's mammary glands generally have no obvious pain and tenderness, mild systemic symptoms, increased white blood cell counts, and mild or no symptoms of infection. Conversely, mastitis can sometimes touch a lump that is not specifically tender, especially in the ipsilateral armpits where lymph nodes are often enlarged.

3, advanced breast cancer

Superficial breast cancer may have skin edema due to obstruction of the subcutaneous lymphatic vessels by cancer cells. When the cancer tissue necrosis is nearly ruptured, the surface skin is often red and swollen, and sometimes it may be misdiagnosed as a low-infected breast abscess. However, advanced breast cancer generally does not occur during lactation, except for skin redness and subcutaneous induration, there is no other local inflammation, especially no systemic reaction of mastitis. The local manifestations of advanced breast cancer are often very prominent, such as skin adhesions, nipple depression and direction changes, axillary lymph node enlargement, more prominent than the axillary lymph node inflammation of acute mastitis. A puncture cytology examination or cutting of small pieces of tissue and abscess wall for pathological biopsy can confirm the diagnosis.

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