A 36-year-old woman with no relevant medical history and mother of a 5-year-old child, who consulted for bilateral breast enlargement.
Very rare: breast moderate with ptosis.
The skin is good quality, hydrated and without striations.
No breast nodules were found and the patient reported no relevant pathological breast history.
In recent mammograms no pathology was detected.
After consultation and clinical examination, it was decided to perform a bilateral breast augmentation surgery via the lower periareolar route, with dissection of the subpectoral pocket and placement of an anatomical prosthesis of Style 140 MMGhan®.
The surgery was performed under general anesthesia and was uneventful; the patient was discharged the following day.
Seven days after surgery the patient is well, the appearance of the breasts is normal, symmetry is adequate and the discomforts are of little relevance.
The patient reported tension in the breast, but without pain due to palpation.
Healing is correct.
1.
Fifteen days after surgery, the patient presented a symmetrical increase in breast volume and spontaneous drainage of white colored liquid material through a small right periarecine acular wound.
She had no fever and the breasts showed no inflammatory signs.
On the lateral margin of the scar, a small 2 mm defect can be seen. This drains material, which increases its flow when expressing the breast.
A retroareolar abscess and spontaneous dilation of the defect are observed using a hemostasis clamp.
When expressing the breast, it is also observed that the material drains through the nipple and when performing the same maneuver on the left breast, this drainage is also observed through the nipple.
We took samples for culture, the result being negative.
These findings suggest that swelling of the breasts is due to milk production.
1.
We recommend the patient to perform an analytical test to study prolactin levels (PRL) and consult with specialists who recommend bilateral breast ultrasound, cranial CT scan and analysis of thyroid and adrenal hormones.
The results of all these tests showed no pathological signs.
Breast ultrasound revealed an increase in breast tissue density and no liquid was seen in the pocket housing the prosthesis.
Nevertheless, it was decided to empirically start bromocriptine treatment at an initial dose of 1.25 mg, 3 times a day.
After one week of treatment and after no response, the dose was increased to 2.5 mg 3 times daily.
Treatment should be continued for up to 2 weeks after cessation of secretion.
In spite of the treatment, the evolution was torpid and the picture of hypersensitivity did not stop, continuing the drainage of milk through the wound of the right breast.
Both breasts were still turgent.
The patient is maintained with moderately compressive bandages, considering that the continuous drainage of milk by the wound fistula can be a stimulus maintained for breastfeeding, as well as to seal possible dead spaces in the breast tissue.
After 2 months in which the patient underwent weekly revisions and dressings, she stopped draining milk through the wound and decreased turgidity in both cases.
However, two weeks later, the patient returns to the hospital with an increase in right unilateral breast volume.
A new breast ultrasound revealed the existence of an intrafamilial seroma.
Drainage is performed under asepsis conditions and it resolves within 7 days; however, the morphology of the breast begins to be affected in such a way that the pathway through which the milk drains is collected.
It was also found that the breast develops an incipient degree of contracture.
We chose to perform a surgical review mainly due to the deformity caused by the areolar fistula.
1.
The patient underwent surgery, obtaining a review of the pocket in which the existence of no liquid collection was observed. There were only few deposits bleaching of the stent and an intact resurfacing were analyzed.
The pathology report of white deposits found describes the existence of hyalinized with chronic granulomatous fibrosis and histiocyte infiltrate.
1.
During this second post-operative period, the patient did not develop persistent fever and recovered without incident.
However, after 1 year the right breast developed total contracture affecting grade III tissues, so it was decided to reoperate again, performing partial capsulectomy due to the fact that the integuments were considered to have thinned the capsule area.
We change the prosthesis for another of identical characteristics.
In the postoperative period of this new intervention we detected as the only complication a Mondor syndrome in the right breast.
1.
Two years after surgery, the patient presented new signs of recurrent contracture in the right breast, with marked aesthetic involvement and slower appearance in the left breast.
The surgical treatment that could be raised on this occasion would be: in the right breast new capsulectomy, if the integuments allow it, may require reinforcement by mesh of synthetic or biological material in the inferior region of capsule.
The need to add mastopexy procedures to correct the position of the teloareolar complex is not ruled out.
