Shelley,
I've been reading extensively on embryology, histology, breast
ultrasound, and breast surgery of all kinds including cancer and plastic
for a special project.
You said:
< This is her third child and she has never had any unusual circumstances
before.>
That indicates to me that it is unlikely to be supernumerary breast
tissue, which develops when some accident of early embryologic
development prevents the usual regression of the major part of the milk
line.
If vestiges of that tissue remain, they respond to the hormones of
menstruation and pregnancy in relation to how much or little tissue there
actually is. (Beller)
In my opinion, if this were the problem, it would have shown up long
before this and would not have recently developed as you described:
<I feel that her right areola
involves supernumerary tissue that was previously dormant. With the
aggressive nursing of the new baby it has been stimulated to produce
milk.>
Montgomery glands, emerging as Morgagni tubercles on the surface of the
inner, more central area of the areola, represent an intermediate stage
between sweat and mammary glands, and are capable of secreting milk.
(Beller).
I have seen many mothers in whom manual extraction tried in the usual way
elicits some drops from a few Montgomery glands. I always reassure them
that this is entirely normal for many mothers.
It may be associated with the swelling you describe, but then again, it
may just be a normal, coexisting thing with no actual connection to the
problem.
<They drained 2 1/2 ounces from the site and were never informed that she
leaks from the areola leaving them with only with the thought that this
is a
galactocele.>
I think a galactocele is more on target. It is "a cystic dilatation of
one of the major ducts at the areola, often occurring as the result of
obstruction during lactation. . .Secondary infection is accompanied by an
inflammatory exudate in the lumen and in the surrounding tissues."
(Ramzy)
"If the characteristic milky fluid is withdrawn, no further treatment is
required. Since galactocele is a rather infrequent lesion, surgeons often
fail to keep this possibility in mind, and operate unnecessarily."
(Haagenson)
The patient has the right to request a copy of the lab report from the
analysis of the fluid that was drained, especially since she is traveling
and may need ongoing care.
Certainly the microscopic view ought to confirm the character of the
fluid and help dispel the fears of a cancerous process at this point in
time.
Ultrasound is also helpful in differentiation of a galactocele from a
tumor. (Cardenosa).
Certainly, the less trauma from a breast pump the better. Gentle massage
to empty it, plus supporting it with gentle compression with her thumb
before MER may reduce the repetitive filling.
Anti-inflammatory medication and an icebag for 30 minutes every 3-4 hours
for a day may help the inflammation. Remember though that along with this
problem, the stress of international travel with children, interruptions
in nursing, etc. may increase her risk of mastitis.
If no spectacular improvement occurs, before leaving for her trip, she
may want to discuss prophylactic antibiotic therapy with her physician.
This might also reduce or eliminate any indication for surgery later.
Beller, F. "Development and Anatomy of the Breast" in "The Female Breast
and Its Disorders", ed. by Mitchell, G. W. Jr. and Bassett, L.W.,
Williams and Wilkins, Baltimore, 1990, p. 4-10.
Cardenosa, G. "Breast Imaging Companion", 1997, Lippincott-Raven
Publishers, Philadelphia, p. 239.
Haagensen, C.M., "Diseases of the Breast", third edition, 1986, W.B.
Saunders Co., Philadelphia, p. 63.
Ramzy, I. "Pathology of Benign Breast Disease" in
"The Female Breast and Its Disorders" op. cit., p. 91.
I hope this helps provide both of you "some serious reassurance" before
she returns to France next week.
Jean
********************
K. Jean Cotterman RNC, IBCLC
Dayton, Oh, USA
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