In addition, inflammatory breast lesions can be malignant, and most of these types of breast cancer are advanced and difficult to cure, so people should be highly alert. Here are some of the most common inflammatory breast diseases.
1. Acute mastitis.
Acute mastitis occurs mostly during lactation and can easily develop into septic in early stage if not well controlled. It is most common in first-time mothers and usually occurs 3 to 4 weeks after delivery. Mastitis during lactation has a rapid onset and changes rapidly, affecting normal breastfeeding, causing great physical discomfort and psychological stress to the mother, and in severe cases often leading to discontinuation of breastfeeding, affecting the health of both mother and child. All patients have varying degrees of breast pain, skin redness, breast lumps, breast swelling, and some patients have chills, fever, and malaise at the beginning of the illness.
The etiology is usually.
(1) milk stasis: milk is a good culture medium for bacteria, and the causes of milk stasis are.
(1) Small nipples or nipple invagination prevent breastfeeding. Many pregnant women fail to correct nipple invagination in time before delivery, which makes it difficult for babies to suckle.
(2) Too much milk, resulting in incomplete emptying of milk. Many mothers do not understand the situation of their own milk secretion, and the excess milk cannot be eliminated in time and retained in the breast.
(2) Bacterial invasion: Babies with inverted nipples have difficulty suckling, which can easily cause breakage around the nipple, and bacteria can invade the breast along these “breaks”.
(3) Lack of good breastfeeding habits: Babies often sleep with their nipples in their mouths, and bacteria from the baby’s mouth can directly invade and spread to the milk ducts, leading to breast inflammation.
Treatment of early onset abscesses is mainly non-surgical conservative treatment.
(1) Promote breast drainage: use a towel soaked in a 20% magnesium sulfate solution in warm water and apply a continuous local hot compress to the breast mass for 30 min each time, replacing the towel after it cools, 4-6 times a day, and pass the milk after each hot compress to drain the milk. Massage the breast as follows: apply a small amount of Vaseline to the sore breast, hold up the breast with one hand, separate the five fingers with the other hand, and massage the breast from the root of the breast to the nipple with five fingers in the direction of the nipple in a combing grip, with a lighter and heavier grip, not squeezing or rotating pressure, but in the direction of the milk ducts, applying downward pressure to slowly drain the stagnant milk, about 10 times. Then use the right hand to pull the nipple upward with the thumb and the 2 fingers to extend the milk ducts in the areola area. Then the 4 fingers hold the breast and squeeze the nipple with a little force from the root of the breast with the two thumbs, so that the milk is drained.
(2) Anti-inflammatory treatment: If the body temperature is elevated and the blood count is high, antibiotics and antipyretics should be used under the guidance of the doctor. When the abscess is not formed, breastfeeding can be done normally.
When the lesion forms an abscess, surgical treatment is usually required, and the main way is abscess incision and drainage. At this time, breastfeeding should generally be stopped, and patients can take oral milk-reducing Chinese and Western medicines to avoid the occurrence of milk fistulas that keep the wound from healing for a long time.
To prevent the occurrence of acute mastitis during breastfeeding, in addition to increasing the resistance of the pregnant woman herself, the most important thing is to prevent the accumulation of milk; secondly, to actively prevent and treat oral inflammation in infants; to prevent nipple breakage, to develop good breastfeeding habits, not to sleep with the nipple in the baby; to clean the nipple before and after breastfeeding.
2. Chronic mastitis.
Previously once a rare disease in the last decade the incidence has increased significantly, and is now a common disease among young and middle-aged women. The common types are: plasmacytoid mastitis, granulomatous mastitis.
(1) Plasmacytoid mastitis.
Plasmacytoid mastitis, abbreviated as plasmacytosis, predisposes non-lactating, young, unmarried women to this type of disease. Most patients have nipple dysplasia or nipple deformities, such as nipple entropion, split nipples, and flat nipples. The disease starts with localized redness, swelling and pain next to the areola, with recurrent episodes. When the breast is broken or incised, bacterial infection can easily develop secondary to fistulae, which can be difficult to heal. Multiple incisions and ruptures of the breast can result in scarring, nipple distortion, and breast deformation. If repeated incomplete surgery is done, breast disfigurement becomes more serious.
The rate of misdiagnosis is extremely high because of the variety of clinical manifestations and the complexity of the condition of pulpy breast. Some surgeons do not understand the disease and misdiagnose it as a general small abscess in the acute stage, believing that incision and drug change will cure it. Since the diseased ducts cannot be completely removed, fistulas can be formed that are difficult to cure; multiple fistulas can be misdiagnosed as breast tuberculosis because of the constant pus; chronic inflammatory masses can easily cause skin adhesions, and the whole breast can be removed due to misdiagnosis as breast cancer.
How to treat pulpy breast? What are its methods and characteristics? The first thing is to master the timing of surgery and promote the timing of surgery with the combination of Chinese and Western medicine. In the early inflammation period, we can control the infection, clear the heat and detoxify the toxin; in the rupture period, we can use the method of chemotherapy to clear the wound and promote the wound healing. If the wound cannot heal completely, surgery can also be performed as long as the acute inflammation subsides, the redness and swelling are not obvious, and the wound is superficial. It is also believed that some of the disease is related to Mycobacterium rotundum infection, and the application of anti-tuberculosis drugs is effective. The next step is complete excision of the lesion, and it is imperative that all inflammatory necrotic tissue be removed surgically. Further, nipple reconstruction is done immediately after excision of the lesion, and some of the breast glands are displaced for internal reconstruction, so that destruction and reconstruction are done at once. In this way, the complete excision of the inflammatory lesion is ensured, and the breast shape is fully maintained.
(2) Granulomatous mastitis.
Granulomatous mastitis is a nonspecific inflammatory disease of unknown etiologic evidence that occurs in women during the nonlactating period. Because of the disease’s tendency to recur, many patients have had their breasts removed as a result, severely affecting the patient’s quality of life and causing harm to the woman’s physical and mental health.
Granulomatous mastitis should be highly guarded when several breast-related problems occur, such as
①Lumps in the breast, especially in non-lactating women with redness, swelling, abscesses and ulcers;
(2) Imaging features such as elevated white blood cells and rapid blood sedimentation are also present;
(3) Biopsies suggesting characteristic changes of granulomatous mastitis and exclusion of breast tuberculosis and inflammatory breast cancer.
How can granulomatous mastitis be treated? Because the cause of this type of chronic breast inflammation is not clear, it is not as clear-cut as appendectomy or cholecystitis, so there are advantages and disadvantages to various methods of treating the disease, and there is no absolute advantage. The treatment methods applied now are roughly as follows.
① Surgery to completely remove the diseased tissue, part of the breast gland displaced to do internal plastic surgery, and strive for a one-step process.
② Long-term conservative treatment with traditional Chinese medicine. However, some patients persist for a long time with poor results and eventually require surgery.
③Some foreign experts consider this disease as an autoimmune disease and often apply corticosteroids and immunosuppressant treatment. Meanwhile, there are many cases with better results after treatment with corticosteroids and immunosuppressants. However, immunosuppressive drugs are sometimes used to treat malignant tumors, so many patients often refuse to receive “hormones” and “chemotherapy drugs” to treat the disease.
Our view is that the treatment of granulomatous mastitis is not static, and that after the principles are defined, we will develop an individualized and refined treatment plan based on the patient’s specific situation. The choice of treatment plan should be based on a thorough evaluation of the condition. Steroid hormone therapy is the basic and most important part of the treatment of granulomatous mastitis, while surgery is recommended for those who are not satisfied with drug therapy. Treatment of granulomatous mastitis is a long-term process, and patients must have confidence.
3.Inflammatory breast cancer.
Inflammatory breast cancer it is a kind of breast cancer with reddened skin. A large area of the skin of the affected breast is congested and sometimes red or purplish, with a typical violet color. Why does this phenomenon occur? It is mainly because the cancer cells infiltrate into the lymphatic vessels of the skin and cause inflammatory changes secondary to the blockage of the lymphatic vessels. The incidence of breast cancer accounts for 1% to 2% of all breast cancers, which is a kind of breast cancer with low incidence but high malignancy. The affected breast has fever and tenderness, similar to acute mastitis, and the whole breast is edematous, hard and tough like rubber.
Patients with inflammatory breast cancer are often misdiagnosed as mastitis and lose the best time for treatment. In fact, there is a clear difference in the diagnosis of these two diseases. First, in acute mastitis, the lesion may be limited or extensive, with bright red color and sunken edema; while in inflammatory breast cancer, the skin changes are extensive, often involving the whole breast, with dark red or purplish red color and orange peel-like skin edema. Secondly, acute mastitis has a short duration and can appear septic symptoms, which can be improved by anti-inflammatory treatment; while inflammatory breast cancer is not effective with antibiotic treatment. Therefore, if your breasts are red, swollen, hot and painful and antibiotics are not effective, you should go to the hospital to see a specialist in time to rule out the possibility of breast cancer even during breastfeeding. Because of the high malignancy and rapid development of inflammatory breast cancer, early diagnosis is especially important. Especially during pregnancy and lactation, it is difficult to distinguish breast cancer from acute mastitis, so if you find any change in breast skin, you should consult a doctor in time.
Inflammatory breast cancer is generally not suitable for immediate surgery, but after the diagnosis is confirmed by puncture, systemic chemotherapy or radiotherapy should be administered first to create conditions for surgery. After surgery, appropriate comprehensive treatment can be given according to the pathology and laboratory results and patient’s condition, including endocrine therapy, targeted therapy, interventional therapy, biological immunotherapy, Chinese medicine treatment, etc.