Parametrium is a common malformation of breast development in women. It is often an underdeveloped tissue, mostly like a baby’s breast, or only a little skin pigmentation is seen, and there can be a little skin increase in the center afterwards, similar to a tiny nipple. Some have only mammary glands and some have only nipples, but there are also complete breast bodies (nipples, areolas, and glands) that are visible in the axillae and are larger.
If mammary gland hyperplasia occurs, the parametrium will be swollen and painful before menstruation, and it will be significantly enlarged when expecting, and there will be nipples and even secretion of milk during the prolapse. The incidence is 1 to 6 percent. It can occur in both men and women, more women than men (5U1), and is often hereditary. The parametrium can occur anywhere in the breast line between the upper and lower extremities, and the parametrium occurs mostly in the lower part of the breast and around the axilla, generally near the normal breast, but also in the face, neck, buttocks and other parts of the vulva of the groin.
In the sixth week of embryonic life, when the embryo is only a little more than 1 cm, the ectodermal cells on both sides of the ventral surface of the trunk thicken to form ridges, equivalent to the curved line from the axilla to the groin. Since people generally have only one or two children, they do not need many mammary glands, so only the pair of mammary primordia on the chest continue to develop and form nipple buds. By the third month of embryonic life, the mammary ducts are formed. The rest of the mammary primordia usually gradually regress after the ninth week of embryonic life.
If the regression is incomplete, an extra breast is formed after birth, which is medically known as paramecium or polymecium. It may also be the result of external forces that deform the breast. Due to the wrong perception, in the choice of underwear prefer to choose a smaller size, hoping to achieve the effect of squeezing out the cleavage.
Because of the small bra, the steel ring and cups are relatively insufficient to cover, long time squeezing, like sharpening tight tops, or wearing too small, poorly covered underwear, over time the breast fat around the breast outward, the mammary gland will not cover the development of the armpit, the secondary breast out, so long-term incorrect underwear wearing habits is the biggest factor causing the formation of the secondary breast.
First, the location of the side breast
They are mostly located on the lower inner side of the normal breast, or above the normal breast near the armpit, and a few are found on the abdomen, groin, inner thighs, and occasionally on the cheeks, ears, neck, upper limbs, shoulders, hips, back, vulva, etc. They are easily mistaken for subcutaneous nodes, lymph nodes or tumors. Most of the parametrial breasts appear in pairs and are symmetrically distributed, and most patients have only one pair, but there are also single or more than one pair.
Second, the classification of parametrial breast
(1) There is breast tissue without nipple.
(2) Nipple without nipple.
(3) With nipple and mammary tissue. All parametrial breasts with glandular tissue are affected by sex hormones, just like normal breasts.
They are subject to cyclical changes, premenstrual swelling and pain, and can also suffer from the same common diseases as the normal breast, such as hyperplasia, cysts, and adenocarcinoma of the parametrium
Third, diagnosis of parametrial breast
1. A localized bulge or subcutaneous swelling near the axilla or around the normal breast;
2.The swelling and soreness of the mass, especially if it is obvious before menstruation;
3.There is a tough tissue that can be pinched up with fingers during palpation, with soft texture and unclear borders, and a sense of glandular lobe within touch;
4.After pinching up with fingers, a fat-like lobulated mass can be seen under the taut skin;
5, the lump has grayscale images of the breast on NIR scan.
The above mentioned masses should be thought of as fibroids if there are movable hard nodes. If there are hard nodes or hard masses in the parametrial lump, if they are adherent to the skin or the base, or if there are orange peel-like skin changes on the surface, the possibility of cancer should be considered. Parametrial breast should be differentiated from lipoma and sebaceous cyst.
Fourth, surgical treatment
1.Usually under continuous epidural anesthesia or intravenous anesthesia, and only a few under local anesthesia. Local anesthesia is not conducive to freeing the flap with the electric knife and distinguishing between fat and parametrial glandular tissue.
2. The selection of incision will take into account the aesthetics and concealment.
3.Side breast has no envelope, so the flap should be free to the edge of the lump and the resection area should be sufficient to ensure the surgical treatment effect.
4.For the treatment of parametrial cancer, the excision range should be at least 5cm from the edge of the lump, and the muscle tissue should be removed at the same time, and the axillary lymph nodes on the same side should be cleared.
5.Rubber drainage tube and negative pressure absorption are placed on the trauma surface to facilitate the growth of skin flap, and the drainage tube is removed after 72 hours according to the drainage flow. If the tube is removed too early, subcutaneous fluid and blood will accumulate.
6, there is obvious pain disease; pain disease affects the patient’s life. Surgery should be performed for those with parametrial fibroids or nipple overflow.
7.Parametrial breast as a multiple breast deformity, affecting the appearance; on the larger axillary parametrial breast affects the beauty, dress, patients with urgent surgical requests, can bear the surgical treatment.
8, there are obvious hard nodes; there are parametrial fibroids, nipple overflow, lump obvious swelling and pain, there is a certain possibility of malignant change; lump recently increased significantly, you can consider surgery.
9.If the diagnosis is unclear and other tumors cannot be excluded.