What to do if breast ducts expand

Etiology Editor

Causes

There is no consensus on the cause, which may be related to factors such as duct excretion disorders, abnormal hormone stimulation, and infection.

The cause of this disease is unclear, but because this disease is common in middle-aged and elderly people, it may be a degenerative change, related to the invagination or deformity of the nipple, and the squamous epithelium extending into the inner wall of the duct, causing angulation. It is related to the obstruction of scales or the irritation of the duct wall by lipid secretions, causing inflammation, scar hyperplasia and secondary infection. Autoimmune diseases are also possible, because in the later stages of this disease, it is often complicated by plasma cell mastitis. In the pathology, a large number of plasma cells are often infiltrated, and the lesions recur, so some people think that it is an autoimmune disease.

Pathogenesis

Dilation of breast ducts is accompanied by inflammation

The pathogenesis of breast duct ectasia is still controversial in the academic community. Generally speaking, there are the following opinions :

1. Duct excretion disorders:

(1) Such as congenital nipple deformity, depression, uncleanness, or foreign hair, fibers, etc. causing blocked nipple pores, abnormal duct development, and mammary gland Poor structure leads to epithelial proliferation, inflammation, injury, etc., causing duct stenosis, interruption, or occlusion. Poor ductal drainage is often the main reason why the galactorrhea stage develops into the lump stage.

(2) Secretions accumulate in the duct, causing duct dilation.

(3) In some middle-aged and elderly women, due to reduced ovarian function, the breast ducts undergo degeneration, the duct walls are relaxed, and the contractility of myoepithelial cells decreases, resulting in the accumulation of secretions in the ducts and the expansion of the lumen, causing this disease. sick.

2. Abnormal hormone stimulation:

Abnormal sex hormone stimulation can cause the duct epithelium to produce abnormal secretion and the ducts to expand significantly.

Generally speaking, the presence of obstruction alone without abnormal hormone stimulation to promote epithelial secretion will not cause ductal dilatation.

3. Infection:

It may be related to anaerobic bacterial infection or areolar infection.

Adai (1933) found after a more detailed study that in the later stages of the disease, breast duct secretions not only stimulate the expansion of the ducts, but also can overflow outside the ducts and produce chemical substances after decomposition, causing surrounding Chemical stimulation and antigenic reaction of the tissue cause an inflammatory reaction dominated by plasma cell infiltration around the tubes, which is named "plasma cell mastitis".

2 Clinical Characteristics Editor

This disease is more common in non-lactating or menopausal women over 40 years old, who often have a history of breastfeeding disorders. The lesions are often limited to one side, but there are cases where both breasts are affected simultaneously. Nipple discharge is sometimes the first and only symptom of the disease. Compression of the breast glands from multiple locations can cause secretions to overflow from the nipples. The lesions often involve a large number of milk ducts and can also occupy more than half of the areola. Nipple discharge is often intermittent and comes and goes.

Not all patients will develop the above clinical manifestations according to their development rules. That is, the first symptom may not be nipple discharge or acute inflammation. It may be a subareolar mass first, or it may be a long-lasting symptom. Non-healing paraareolar fistula.

In addition, according to the pathological changes and course of the disease, the clinical manifestations can be divided into three stages.

Acute phase

(1) Early stage:

The symptoms are not obvious, and there may be spontaneous or intermittent nipple discharge, which only occurs when squeezing. The discharge is brownish-yellow or bloody or purulent secretions, and this symptom can last for many years.

(2) Development:

The skin within the areola is red, swollen, hot and tender. Enlarged lymph nodes can be palpated and tender in the armpit. There may be chills, high fever and other symptoms throughout the body.

This acute inflammation-like symptom will subside soon.

Subacute stage

A lump with mild pain and tenderness forms in the areola area. The edge of the mass is unclear, like a breast abscess, and the mass varies in size. Pus can often be extracted by puncture of the tumor. Sometimes the tumor naturally ruptures and forms a abscess fistula. After the abscess is ulcerated or cut, it does not heal for a long time, or new small abscesses form again after healing, causing the inflammation to continue to develop.

Chronic phase

The duration of this phase varies, from months to years or longer. When the condition relapses, one or more indurations with ill-defined borders may appear, mostly located within the areola. The texture is solid and adheres to the surrounding tissue, causing the ducts to shorten and the nipple to retract. Sometimes due to local skin edema, it will show "orange peel-like" changes, and in severe cases, breast deformation may occur.

Discharge from a single hole or multiple holes can be seen, and its nature can be serous or bloody. Axillary lymph nodes are palpable.

3 Related examination editor

X-ray breast ductography, needle aspiration cytology of the tumor, and pathological examination after tumor resection can be used to confirm the diagnosis.

4 Notes Editor

Prevention

1. Women should have regular breast examinations every year to achieve early detection, early diagnosis, and early treatment.

2. Pay attention to personal hygiene, especially the hygiene of the vagina during menstruation and puerperium. Pay attention to keeping the nipple and areola area clean, properly help remove secretions, and avoid wearing tight tops and bras.

3. Enhance your physical fitness and improve your own immunity: Pay attention to the balance between work and rest, participate in more physical exercises, and eat more fresh fruits and vegetables rich in vitamins.

Preoperative preparation

You should have a detailed understanding of the symptoms and related contraindications of the disease.

Correct diagnosis of minor lesions in the milk ducts before surgery can clarify the surgical indications for breast disease patients with nipple discharge but no lumps, and provide guidance for distinguishing normal ducts or ductal ectasia from breast cancer. favorable conditions.

5 How to care for editors

Prognosis:

Breast duct ectasia is a benign disease with a slow course and easy recurrence, and has no obvious relationship with breast cancer.