How is surgery for purulent mastitis performed. Mastitis

15.03.2020 -

How is the operation

During the operation to remove purulent mastitis, the chest cavity is drained. Manipulation is carried out by experienced surgeons in a hospital under general anesthesia. The execution technique depends on the nature of the disease and its localization. In any case, the following stages of the operation can be distinguished:

the choice of the most convenient access to the focus of inflammation is carried out, while experienced physicians try to preserve the functions and beautiful appearance of the mammary gland as much as possible;
then surgical treatment of the selected intervention site is carried out;
drainage of a purulent focus of mastitis, washing the cavity with special solutions;
closure of the wound with a suture, in some cases skin grafting is used to preserve the aesthetics of the breast;
in the postoperative period, drip irrigation of the wound with antiseptic solutions is performed to consolidate the result.

In some cases, during the postoperative period, drainage is installed for instant washing and removal of the pus that accumulates the first time after the operation. This is done in order to completely avoid the recurrence of the disease. After graduation rehabilitation period drain is removed.

rehabilitation period

The rehabilitation period after surgery for the treatment of purulent mastitis is under the supervision of a doctor. To avoid recurrence of the disease and prevent infection of the sutures, drip irrigation of the wound with an aqueous solution of chlorhexidine through a pre-installed drainage system is carried out. Also, during the first 5 days after the operation, the wound is dressed daily. The subsidence of inflammatory processes in the chest after purulent mastitis occurs gradually. After their complete elimination, the drainage tubes are removed, usually this happens 5-12 days after the operation.

Cosmetic defects in the form of scars and scars that may remain after surgery for the treatment of purulent mastitis can subsequently be removed with a laser or with the help of plastic surgery.

In the postoperative period, breastfeeding is excluded, this also applies to a healthy mammary gland. Expression of milk during the rehabilitation process should be under the supervision of a doctor. The process of decanting from the operated gland can be painful, in which case painkillers are preliminarily used. The process itself is carried out as carefully as possible so as not to damage the seams. After the complete elimination of foci of inflammation of purulent mastitis, natural feeding can be continued.

Where to apply?

The operation to remove purulent mastitis is effective if all sanitary rules are observed, the qualifications of the doctors performing the operation are also very important. If the technology of the operation is violated, relapses may occur, the disease can develop into a chronic form.

The IMMA Medical Center employs doctors with many years of experience, all staff undergoes a thorough selection, as well as regular advanced training. Our clinics are equipped with modern equipment, which allows us to accurately and quickly diagnose and treat breast diseases.

As part of the diagnosis and treatment of mastitis, you will receive the full range of necessary services:

conducting necessary analyzes;
accurate diagnosis of the disease;
complex treatment;
control analyses.

You can sign up for a consultation with a specialist on the website or by calling the contact number of the clinic.

Purulent mastitis- the most severe and unpleasant disease for women. The most severe of its forms - non-lactational purulent mastitis - we will devote today Special attention because the health of a woman is the main condition for the health and prosperity of the nation.

Research History

Since ancient times, a rare woman has passed the knowledge of the essence of the disease, which since ancient times was called breastfeeding, and later became known as mastitis. Yes, and no wonder, since this pathology, which is massive in the mammary gland, and even has a tendency to actively spread, often led to a purulent lesion of the glandular body of the mammary gland itself and adjacent tissues, and then to sepsis due to the generalization of the infectious process.

Subtleties of statistics

In modern times, mastitis is usually divided into lactational, when milk production occurs in the mammary gland (most often purulent lactating mastitis), and non-lactational, which we would like to talk about today. According to the statistics of recent decades, in 90-95% of registered cases of mastitis, it developed in the period after childbirth, while non-lactational mastitis, which is not associated with pregnancy and childbirth, affects an average of about 5% of women.

Age categories

Usually, women from 15 to 60 years of age are susceptible to the development of non-lactational mastitis. In the specified age range, this form of mastitis, in contrast to lactation, does not manifest itself violently, and septic complications are practically not found. In contrast to this, women who fell ill in the aforementioned age period, have to learn to coexist with mastitis long years, because it often goes into a chronically relapsing form. However, non-lactating mastitis can affect not only women, but also men and infants of both sexes.

Etiology

Non-lactational purulent mastitis is not associated with lactation, occurs relatively rarely and is often due to hormonal imbalance and a decrease in the immune response to infectious agents. As a rule, it is expressed by progressive unilateral or bilateral inflammation of the mammary glands.

Detailing the reasons

It just so happened that most often non-lactational purulent mastitis develops when the hormonal background is disturbed in the female body or the immune response to infectious agents decreases. Typically, these periods include the following:

1. A massive decrease in estrogen levels, and at the same time a significant suppression immune protection, manifests itself in the postmenopausal period.

2. Puberty of a teenager with his unstable hormonal background also becomes a powerful stress for the developing organism, which creates fertile ground for the development of such an undesirable disease. In addition, it is worth noting that non-lactational mastitis affects not only girls, but also boys during puberty.

3. It is impossible not to note cases of infection of wounds after operations performed on the mammary gland, for example, after placing an implant or removing fibrocystic growths, with injuries of the mammary gland, which were accompanied by compression of its tissues.

4. Even the most invisible injury to the skin of the mammary glands or nipples can contribute to the penetration of infection and the development of non-lactational mastitis.

Forms of the disease

The disease we are considering usually occurs in two forms - acute and chronic. Acute non-lactational mastitis without timely admission to the hospital and adequate therapy from the catarrhal (infiltrative) form quite rapidly and relatively imperceptibly for a woman can transform into purulent non-lactational mastitis with an extremely severe course, when it is no longer possible to do without hospitalization, and even before the generalization of the process there are only a few days, or even hours.

Pathogenesis

In the case of non-lactational mastitis, infectious agents usually enter the breast through lesions on the skin, which are caused either by accidental injury or thermal damage, for example, when using a heating pad or an accidental burn, and sometimes due to small pustules on the skin of the breast. . Then the bacteria first damage the subcutaneous fat layer and the fatty capsule of the mammary gland, and then attack again.

Much less often, women have to deal with chronic non-lactational mastitis, which usually develops when acute mastitis left untreated, considering the first signs of improvement as an argument for stopping taking prescribed by the doctor medicines and procedures. In such cases, the recurrence of mastitis becomes a constant companion of a woman, manifesting itself at the slightest hormonal disruption, after hypothermia, stress, or with a general weakening of the body's defenses.

Non-lactational purulent mastitis. Symptoms

At the very beginning of the development of acute non-lactational mastitis - in the serous stage, when the tissue of the affected area mammary gland it is sequentially saturated with serous fluid and leukocytes actively enter it - a woman notes the occurrence of pain in her mammary gland, in which it is possible to palpate a compacted area with clear boundaries in one or more lobes. The body temperature is increased to 37-38 degrees, and in some cases up to 39. In addition, during this period, a woman may be disturbed by severe general weakness. In extremely rare cases, the reverse development of the serous stage and the onset of spontaneous recovery occur, but much more often, the stage of infiltration develops after the serous stage.

In the infiltrative stage, a painful seal without clear boundaries is formed in the affected mammary gland, called an infiltrate. At the same time, the skin above the infiltrate does not look inflamed at all, there is no edema in this area, and the local temperature remains within normal limits. The body temperature remains elevated, due to the active entry of bacterial products into the blood from the foci of lactostasis through the damaged ducts of the mammary gland. It is extremely important that a woman seek medical help from a mammologist, gynecologist or surgeon when the first symptoms appear, without waiting for their progression and transition to a purulent form. In the catarrhal stage, mastitis is treated extremely successfully and does not entail severe complications, as in the case of non-lactational purulent mastitis.

In the absence of adequate treatment, after 5 days, the stage of infiltration passes into the stage of destruction, that is, destruction. The inflammatory process becomes purulent, and turns into a complete likeness of a sponge, soaked through with pus.

In the destructive stage, which is also known as acute purulent mastitis, general state women deteriorate sharply, as toxins from the focus continuously enter the bloodstream. The body temperature continues to rise and usually in this period is 38-40 degrees, and with it general symptoms intoxication. The affected mammary gland increases in size, becomes tense. The skin over the destruction zone becomes red, the saphenous veins expand. As the pain increases, it spreads to the armpit, since the regional lymph nodes are also quickly involved in the infectious process. The patient becomes unable to sleep and eat.

Kinds

Non-lactational purulent mastitis, a photo of which can be seen in medical reference books, requires a competent approach in making a diagnosis.

There are the following varieties:

1. Abscessing mastitis, which is characterized by the fact that in the affected mammary gland is formed a large number of abscesses - cavities that are filled with pus. Usually, in the area of the infiltrate, you can palpate softening or you can feel under your fingers the liquid that overflows when you feel it - positive symptom fluctuations (in 99% of cases).

2. Mastitis infiltrative-abscessing. He tends to be more severe course than the previous one. A dense infiltrate consists of many small abscesses of various sizes and shapes, so the symptom of fluctuation is positive only in 5% of patients. Such an infiltrate usually occupies no more than two quadrants of the mammary gland.

3. Phlegmonous mastitis. In this case, the mammary gland is totally enlarged and markedly edematous. The skin of the affected breast is pronouncedly red (and in some places bluish-red), tense, with Probing the gland is extremely painful, the symptom of fluctuation is positive. In more than half of the patients, the purulent lesion extends to at least three quadrants.

4. Gangrenous mastitis, as a rule, is accompanied by damage to blood vessels and active thrombosis. Since the normal blood supply to the mammary gland becomes impossible, its necrosis develops. At the same time, the gland is significantly enlarged, on its surface there are areas of tissue necrosis, blisters that are filled with ichor, the skin becomes bluish-purple. Inflammation covers the entire mammary gland. During this period, the condition of patients is extremely severe, consciousness becomes confused, tachycardia increases against the background of a decrease in blood pressure. A clear picture of sepsis is formed in the blood. Of course, at this stage, the risk to the patient's life becomes extremely high.

Surgical treatment

If a diagnosis of "non-lactational purulent mastitis" is made, its treatment can be both operative and conservative.

Direct indications for surgical intervention are all destructive forms of infectious diseases. inflammatory process, purulent-catarrhal which were described by us above.

In the case when drug therapy does not give a significant improvement within two days, the presence of a purulent process in the mammary gland is usually judged, which is the most direct indication for surgical intervention, which is performed exclusively in a hospital, usually under general intravenous anesthesia.

Subtleties of the operation

During the operation, the abscess is carefully opened, cleaned, all non-viable tissues are excised and removed. Thus, purulent mastitis is completely eliminated. The operation, as a rule, is easily tolerated by women. After intervention in the mammary gland, drains must be installed to rinse the wound drip and not give bacteria even a tiny chance to activate. Drip washing of the wound is carried out for 5 to 12 days, which corresponds to the achievement by the patient of a good general condition and the disappearance of fibrin, pus and particles of necrosis from the washings.

Therapy after surgery

Also, after the operation, drug therapy is carried out, which is aimed at removing toxins from the body as soon as possible and more thoroughly and correcting those disorders that have developed against the background of a purulent process. Antibiotics are required (intramuscularly or intravenously). Usually these are drugs of the cephalosporin series I, II, or, in the case of a secondary infection, III-IV generation.

Non-lactational purulent mastitis: treatment without surgery.

Conservative treatment is possible only when the general condition of the patient remains relatively satisfactory, the disease lasts no more than three days, body temperature does not exceed 37.5 degrees, local symptoms purulent inflammation no, the pain in the projection of the infiltrate is moderate, the infiltrate is palpable in no more than one quadrant of the mammary gland, and the picture of progressive inflammation does not increase in the general blood test.

Most often, women seek medical help in the initial stages of mastitis - serous or infiltrative, in which it is possible and quite effective conservative treatment. First of all, it implies providing rest to the affected mammary gland, for which women are advised to move less actively, wear a loose fabric bra or bandage, with which you can support the diseased breast, but not at all squeeze it, so as not to provoke the progression of the process. In order to influence infectious agents, antibiotics (Cefalexin, Cefixime, Levofloxacin) are necessarily prescribed, they are usually administered intramuscularly, in doses not exceeding the average therapeutic dose. In addition to antibiotics, in order to reduce inflammation and swelling, desensitization of the body is carried out. antihistamines latest generations so as not to cause drowsiness in the patient and to minimize side effects.

In addition to the "heavy artillery", vitamins of group B and vitamin C are prescribed to stimulate the body's defenses. processes in the mammary gland.

Take care of yourself, remember about such an insidious disease as non-lactational purulent mastitis. Treatment can be by no means difficult if you start it at the most early stages. Health to you!

A.P. Chadaev, A.A. Zverev
Department of General Surgery, Faculty of Pediatrics, Russian State Medical University, Moscow

In recent years, the birth rate in Russia tends to decrease, but the ratio of the number of cases of lactational mastitis to the number of births is still high and ranges from 2.4 to 18%. Changes in the qualitative composition of milk and the presence in it pathogenic microflora with a purulent-inflammatory process in the mammary gland, they significantly affect the normal development of the child and can cause him serious illnesses. Negative impact on normal development the child may also be transferred to artificial feeding due to a significant decrease or relief of lactation in the mother. Rough scars left after surgery for purulent mastitis have a significant impact on the psyche of young women. In some cases, after purulent mastitis, to improve the aesthetics of the mammary gland, complex plastic surgery. Therefore, in our opinion, the surgical treatment of acute purulent lactational mastitis must meet the following requirements:
relief of the inflammatory process in the shortest possible time;
maximum preservation of breast function;
maximum preservation of the aesthetic state of the breast.
These requirements cannot be fully met in the traditional treatment of purulent mastitis, when the abscess is opened with radial incisions, necrectomy is not performed, or non-viable tissues are partially excised, when the wounds are opened under tampons until complete healing or, more rarely, until secondary sutures are applied after the inflammatory process has stopped. . According to our data, with these methods of treatment, in 60% of cases, the aesthetic condition of the breast should be considered unsatisfactory, and in 33%, its function is significantly impaired.
We summarized the experience of treating more than 2000 patients, of which 1185 women were operated on according to the technique developed by us, and we believe that the basic principles of surgical treatment of acute purulent lactational mastitis at the current stage should be the following:
1. The choice of a rational approach to the purulent focus, taking into account the need for maximum preservation of the function and aesthetics of the mammary gland.
2. Radical surgical treatment of a purulent focus.
3. Adequate drainage of the wound by applying a drainage-washing system.
4. Closure of the wound with a primary suture, and in case of contraindications - the imposition of secondary sutures or the use of skin plastics.
5. Prolonged drip washing of the wound in the postoperative period through the drainage-washing system with antiseptic solutions.
All operations for purulent lactational mastitis should be performed only in a surgical hospital and only under general anesthesia.
When choosing access to a purulent focus, we take into account the localization and prevalence of the purulent process, anatomical and functional features mammary gland. The incisions should be made so that the scars left after them are hardly noticeable, masked in the natural folds of the mammary gland or easily hidden by clothing. We refused to perform radial incisions according to Angerer (Fig. 1), since when they are performed, scars remain in the upper quadrants that are not sufficiently hidden by clothing, and in the lower quadrants often occurs cicatricial deformity mammary gland. In case of subareolar mastitis, we use a semi-oval paraareolar access 3-4 cm long in parallel and indented from the edge of the areola by 0.1-0.2 cm. In any case, the length of the incision should not exceed the semicircle of the areola due to the risk of developing its necrosis. When localizing the abscess in the lower quadrants, we use the access proposed by S.Ya. Ravinsky, in which the incision is made 2 cm above and parallel to the lower transitional fold of the mammary gland. In case of total or retromammary mastitis, we perform a Bardengeier incision - along the lower transitional fold of the mammary gland.
In addition, to open a purulent focus located on the border of the outer quadrants or occupying both outer quadrants, which occurs in 20% of patients, we proposed an arcuate incision along the outer base of the mammary gland. From it, you can widely open the abscess and carry out its radical surgical treatment. It is technically simple, does not violate the innervation and blood supply of the mammary gland, and is well hidden by clothing. With a deep intermammary fold, to open the abscess in the inner quadrants, we use access along the inner base of the mammary gland.
After opening the abscess, evacuating its contents and washing the cavity with antiseptic solutions, all non-viable tissue should be excised. The method of radical surgical treatment of a purulent focus depends on the nature of the purulent inflammatory process and, to a lesser extent, on its localization. With an abscessing form of mastitis, it is enough to excise the pyogenic capsule. The infiltrative-abscessing form of mastitis occurs in 53% of cases and is characterized by the presence of a dense, painful infiltrate, which is a whitish tissue, with a cut of which small multiple abscesses are visible. In these cases, the entire infiltrate within healthy tissues is excised. With the phlegmonous form of mastitis, there are no clear boundaries between the purulent focus and healthy tissues. The tissue impregnated with pus should be considered non-viable. She is always loose, has a dim gray look, bleeding a little. In some cases, with phlegmonous mastitis, determining a reasonable amount of surgical treatment of a purulent focus is a difficult task. Therefore, it is very important for this form of mastitis to ensure adequate drainage of the purulent cavity in the postoperative period with local application solutions of proteolytic enzymes.
Surgical treatment of a purulent focus must be supplemented by evacuating the wound with simultaneous irrigation with antiseptic solutions. We complete this stage of the operation by changing the surgical linen, gloves and instruments, and re-processing the surgical field. Carefully express the mammary gland.
For adequate drainage of the cavity left after the surgical treatment of the purulent focus, we proposed and put into practice a drainage-flushing system (DPS), consisting of separate polyvinyl chloride tubes of various sizes (Fig. 2). A tube with an inner diameter of 0.2 cm is passed through upper pole cavity, and both ends of it are brought out through the punctures healthy skin. It serves to irrigate the cavity with solutions of antiseptics in the postoperative period. The tube intended for the outflow of the washing liquid, having an inner diameter of 0.4-0.6 cm, is placed on the bottom of the cavity and brought out in its lower pole. Both tubes have side holes within the cavity. Variants of the location of the drainage and microirrigator in relation to each other and their number may be different depending on the localization, form and volume of the inflammatory process in the mammary gland (Fig. 3-5). To irrigate the cavity with antiseptic solutions, one thin tube is always enough.
Radical surgical treatment of the purulent focus and its constant washing in the postoperative period makes it possible to close the wound with primary sutures, regardless of its volume. The sutures are removed on the 8-9th day after the operation. Primary wound healing was observed in 91.4% of cases.
Contraindications to the imposition of primary sutures are the anaerobic component of the infection and an extensive skin defect, which makes it impossible to bring the edges of the wound together without tension. In these cases, we close the wound with secondary sutures with the imposition of a drainage-washing system, if possible. early dates or we perform autodermoplasty of a skin defect.
In the absence of contraindications, we apply one row of interrupted sutures to the subcutaneous tissue and separate sutures to the skin. As a result, a closed cavity is formed, which communicates with the external space through the tubes of the drainage-flushing system, in which, according to our studies, optimal conditions are created for the development of granulation tissue. The latter, evenly filling the remaining cavity, retains the volume and shape of the mammary gland, which is very important in terms of aesthetics. The daily decrease in the cavity in the first 5 days of the postoperative period is 10-20% of the initial volume, and the rate of development of granulations is higher in women who had a smaller purulent focus. In the following days, the percentage of the decrease in the volume of the cavity per day increases by one and a half to two times. When examining women at various times after surgery (from two to five years), we did not find any pathological changes.
In the postoperative period, we wash the purulent cavity with antiseptic solutions starting immediately after the operation. For this purpose, we use 0.02% water solution chlorhexidine, which is injected into both ends of the through microirrigator at a rate of 10-15 drops per minute through the system for intravenous administration liquids. The flow of an antiseptic solution to both ends of the irrigator contributes to a more complete filling of its lumen with liquid throughout, due to which the remaining cavity is evenly irrigated through all the holes of the tube. In total, no more than two to three liters of fluid per day is required to implement adequate flushing drainage. Washing is carried out constantly with interruptions for patients to visit the dining room, toilet, etc. In the case of a phlegmonous form of mastitis or the presence of a large number of necrotic tissue particles in the washing liquid, washing the purulent cavity should be combined with fractional administration of solutions of proteolytic enzymes into it. However, the use of enzymes in the first two days after surgery is not advisable because of the risk of bleeding from the walls of the cavity.
In the first five days after surgery, daily dressings are necessary to early detection purulent wound complications. In the future, when inflammation in the mammary gland subsides, dressings can be done in one or two days. During dressings, the cavity is washed with solutions of hydrogen peroxide and chlorhexidine, while paying attention to its volume, DPS function and the nature of the discharge. We treat the skin in the area of the surgical wound and tubes with iodine. The dressing is completed by applying an alcohol bandage.
The drainage-washing system is removed 5-12 days after the operation. Indications for its removal:
relief of the inflammatory process in the mammary gland;
the absence of pus, fibrin and necrotic tissues in the washing liquid;
the volume of the residual cavity is not more than 5 ml.
In the wounds left after the removal of the tubes, we introduce rubber strips for one or two days. In 44.1% of patients, small amounts of milk are released from the wounds at the site of standing drains for 5-10 days, which does not require any treatment and is not considered by us as a wound complication.
Mandatory component drug therapy in the postoperative period are antibiotics, which we prescribe according to generally accepted principles. AT complex treatment purulent mastitis, we also include desensitizing drugs, and in case of a severe course of the inflammatory process, we prescribe immunocorrective therapy.
In the postoperative period, one of the important tasks is the timely relief of lactostasis. Our experience shows that in cases where lactostasis is not stopped within three to four days after surgery, there is a real threat of the emergence of new purulent foci in the mammary gland or the progression of the inflammatory process in the wound. In the postoperative period, women decant the diseased and healthy mammary glands every three hours. We always recommend decanting a healthy gland first, and then a sick one. The question of the possibility of less frequent pumping is decided individually, but not before the inflammatory process subsides. To stop lactostasis, we prescribe intramuscularly no-shpu and oxytocin for three to four days. We do an injection of no-shpa 20 minutes before pumping, and 0.5 ml of oxytocin (2.5 units) - one to two minutes.
We try to maintain lactation and set indications for its interruption only in exceptional cases:
with a severe course of the inflammatory process in the mammary gland (gangrenous or total phlegmonous mastitis, sepsis);
with relapses of the disease;
at the urgent request of the mother to stop lactation;
if there are any other reasons why it is impossible to feed the child with mother's milk after her recovery.
Lactation can be interrupted only after the relief of lactostasis. The most effective drugs for interrupting lactation are Dostinex (USA) and Parlodel (Switzerland), which inhibit prolactin secretion. However, it should be noted that the Pharmacological State Committee of the Ministry of Health of Russia recommended the use of parlodel to suppress lactation only in severe septic mastitis due to the possible development of serious complications: stroke, decreased visual acuity, pulmonary embolism and others, up to death (“Safety of Drugs”, 1998. No. 1; 2000. No. 1).
Parlodel is prescribed half a tablet (1.25 mg) twice a day with meals with a mandatory gradual decrease in the volume and frequency of pumping. On the 5th day of taking this drug, pumping of the mammary glands should be minimized. The course of treatment with Parlodel is, on average, 12-15 days. We would like to note that in 80 cases of Parlodel use, we did not observe serious complications from taking the drug, except for dizziness against the background of a moderate decrease in blood pressure in five patients.
Dostinex, which has a longer prolactin-lowering effect than parlodel (up to two to three weeks), is prescribed half a tablet (0.25 mg) with meals every 12 hours for two days. We carefully express the mammary gland immediately after taking the first dose of the drug and again - after three hours. In the future, we perform milk expression in a small volume only if necessary (excessive milk production). When stopping lactation, it should be borne in mind that, on the one hand, an abrupt cessation of breast expression during mastitis can cause a relapse of lactostasis, and on the other hand, milk expression increases the secretion of prolactin.
The terms of treatment, the percentage of relapses and breast fistulas, the functional and aesthetic state of the mammary gland after surgery are the main criteria that we used to assess the immediate and long-term results of treating patients with acute purulent lactational mastitis using the traditional and the active surgical method proposed by us.
We analyzed the long-term results of treatment in 534 women, of which the control group ( traditional treatment) amounted to 266 people, the main one - 268. Comparative analysis showed that the proposed method of surgical treatment of acute purulent lactational mastitis with the use of drainage-washing systems and the imposition of primary sutures on the wound has significant advantages over the traditional one, since it allows to reduce the total duration of treatment (inpatient and outpatient) by more than 3.5 times ( from 41.9 ± 1.9 to 12.1 ± 0.6 days), reduce the number repeated operations from 25 to 3%, the formation of breast fistulas from 5.3 to 0.7%, to reduce the number of cases of unsatisfactory aesthetic condition of the mammary glands to 2.6%, and the functional condition to 16.3%.

Literature
1. Dolzhnikov A.P. Modern principles treatment of lactational mastitis: method. recommendations. Saratov, 1991. S. 94-95.
2. Danilov M.E. Comprehensive prevention lactational mastitis / Diss. … cand. honey. Sciences. Smolensk, 1998.
3. Levitskaya S.K., Yelinevskaya G.F. Some aspects of intrauterine infection of newborns // Obstetrics and Gynecology. 2004. No. 11. S. 5-7.
4. Vishnevsky A.A., Kuzin M.N., Olenin V.P. Mammoplasty for the consequences of purulent mastitis // Plastic surgery mammary gland. M.: Medicine, 1987. S. 149-165.
5. Yusupov S.I. Classification of cicatricial deformities of the mammary glands // Reconstructive and restorative surgery of the mammary glands. M., 1996. S. 41-43.
6. Chadaev A.P., Zverev A.A. Acute purulent lactational mastitis. M.: Medicine, 2003. 126 p.

Since mastitis is often a purulent inflammatory disease of the breast tissue, its treatment may require surgical intervention by physicians.

Surgical treatment of mastitis, today, is not considered a rarity, if only because modern women the primary forms of the disease can simply be ignored.

Of course, primary lactostasis, as well as the serous form of mastitis, do not require urgent surgical treatment.

But that is why, inexperienced women often fall into such a peculiar trap, who are sure that these conditions are not dangerous at all, and they can be treated without the involvement of doctors.

I would like most women to remember - mastitis is an insidious disease, which in some cases may seem completely harmless (it disappears on its own in a few days), and sometimes it can develop into life-threatening emergency conditions(abscess for example).

Numerous videos of the treatment of such patients can be found on the Internet. At the same time, I would like to reassure those representatives of the fair sex who are still faced with complex (infiltrative or purulent) forms of mastitis. Modern surgery does not stand still, and today, in the arsenal of physicians, there are many sparing options for both conservative and surgical treatment of this disease.

To date, mastitis is treated quite successfully, and most patients who have learned what breast surgery is to remove the infiltrate subsequently return to a full life. And for many, faced with the concept of "mastitis operation", later it turned out even to return full breastfeeding. And there are also unusually many such evidence-based videos on how to restore lactation after purulent mastitis.

What forms of breast inflammation are there, and which ones require surgery?

By pathogenicity this disease, doctors usually distinguish between two forms of mastitis:

Physiological inflammation of the breast. A condition that can occur in newborns (of any gender), due to the effect of mother's hormones on their body, in adolescents (with hormonal changes during puberty), and in people over 50 years old. This state usually does not require treatment and often disappears on its own over time. As confirmation, on the global network you can find a lot of video clips about how newborns with physiological breast mastitis look and feel.
And pathological inflammation of the mammary gland. A pathology that is clearly not included in the state of the norm, when the symptoms of the disease are clearly expressed and require a strictly defined treatment. Moreover, sometimes pathological forms of mastitis are directly related to the concept of surgery, and no other treatment can help the patient. And as proof of this, we see the corresponding video on the network.

According to the severity of symptoms and the form of the inflammation itself, doctors distinguish:

Acute mastitis. A more common form, which is characterized by an acute onset, high body temperature, symptoms of intoxication, etc.
And chronic. A disease that can be latent and of little concern to the patient.

By qualitative nature, it is customary to distinguish three forms of inflammation of the mammary gland. It could be:

The serous form of the disease is characterized by the absence of clearly defined seals in the chest. This variant of inflammation can be characterized, rather, by the general swelling of the mammary gland and its general compaction.
An infiltrative form of the disease, when a clear seal develops under the skin, which has its own clear boundaries. Infiltrates, as a rule, are initially characterized by a non-purulent character.
And the most complex form of the disease is purulent, when a purulent focus of the disease is observed directly in the patient's chest.

But, according to their localization, all mastitis is divided into:

Subcutaneous. When the focus of inflammation is located directly under the top layer of the skin.
The so-called intramammary (inside the mammary gland). This variant of the disease is characterized by the location of foci of inflammation in the glandular tissues of the breast.
And retromammary, quite rare. This type of inflammation turning into abscesses, melting the fascia of one's own mammary gland in a peculiar way, can spread to the tissue located behind it, thereby forming an extensive cavity with purulent tissue destruction.

It is believed that the most common form of inflammation of the mammary gland is the intramammary form. So what forms of this disease require treatment in the department called surgery.

As a rule, surgery is required only in cases where patients are faced with the most severe, pathological, acute, purulent, intramammary conditions of mastitis.

How such variants of the disease look is clearly seen in the video about the forms of this disease. It must be understood that the development of such an acute purulent-inflammatory process is determined by a rather complex interaction of the immune forces of a particular female body with those pathogenic (or opportunistic) microorganisms that penetrate the woman's mammary gland. And to predict the dynamics of such pathological changes, especially on early stages their occurrence is extremely difficult.

This happens, on the one hand, because of the difficulties in assessing the state of the general resistance of the female body, often weakened by childbirth, or vitamin deficiency, as well as comorbidities. And on the other hand, due to the extremely rapid selection of ever stronger (antibiotic-resistant) strains of the same staphylococci or other bacteria.

What is the surgical treatment of inflammation of the breast

Modern surgery, as has been noted more than once, is updated and improved in its methods every day. Today, the “mastitis operation” is safer for a woman, less painful, and much more accurate in terms of aesthetics.

Anyway, medical tactics(whether surgery or conservative treatment) followed to help patients with mastitis is based on:

A strictly differentiated approach, which always takes into account the form of development of a particular pathological process. When conservative measures are prescribed exclusively for serous or initial stages of infiltrative inflammation, and surgery is necessary in cases of development of purulent destructive forms illness.
direction medical measures exclusively to fight the pathogen that caused the disease.
Prevention of the grossest deformation, any cosmetic violations of the type and shape of the mammary gland.
Full or partial preservation of the lactation capacity of the mammary gland.

It should be noted that timely conservative treatment, in the overwhelming majority of cases, allows achieving regression of the pathological process, but irrational treatment of the primary forms of the disease contributes to the transition of the process to more complex purulent-destructive variants of the disease.

Surgical treatment of purulent forms of the disease consists in the timely opening and subsequent drainage of purulent accumulations directly in the mammary gland. This treatment is always used general anesthesia, which can be clearly seen in the video about surgical treatment Problems.

Almost always, subcutaneously located abscesses are opened with more accurate linear incisions, which allow not to enter the area, the so-called near the nipple circle.

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But for opening the so-called intramammary abscesses, a strictly radial incision is used, directly above the site of the resulting compaction and the most obvious hyperemia of the skin.

Such incisions, in most cases, prevent the most severe injuries of the radially located mammary ducts of the gland itself. As a rule, after a careful dissection of the skin, the subcutaneous tissue following it and the capsule of the mammary gland itself, surgeons open the formed abscess and remove the pus. Which is just as great in the video.

Further, after removing the pus, the doctors spread the edges of the wound with special sharp-toothed hooks for the most thorough examination of the abscess cavity. This is necessary in order to excise them in a timely manner when necrotic tissues are detected. The abscess cavity itself is tried to be washed with a special antiseptic solution.

This type of operation ends with standard wound closure with mandatory drainage. In addition, intramammary abscesses, which are located in the posterior sections of the gland itself, are sometimes opened from a specific arcuate incision (according to Bardengeyer).

In this case, after cutting skin the gland is somewhat lifted, exfoliating from the fascia of the pectoral muscle.

The abscess itself is opened directly from the back surface of the existing capsule of the gland. Such access provides an excellent opportunity to drain the abscess, and at the same time, such a section is incomparably better, if we talk about the cosmetic point of view.

Do you still think that it is completely impossible to cure your body?

How can they be identified?

nervousness, sleep disturbance and appetite;
allergies (watery eyes, rashes, runny nose);
frequent headaches, constipation or diarrhea;
frequent colds, sore throat, nasal congestion;
pain in the joints and muscles;
chronic fatigue(You get tired quickly, no matter what you do);
dark circles, bags under the eyes.

The disease of purulent mastitis remains topical issue modern surgery, despite the advances in medicine in the treatment of infections. The main difficulties encountered by patients with this pathology are a long period of hospitalization, a large number of relapses of the disease and repeated cases of surgical intervention, blood poisoning as a severe complication of mastitis, pronounced cosmetic problems after treatment.

Causes of the disease

This disease develops in 0.6-3.5% of women after the birth of a child. Approximately 50% of cases of lactational purulent mastitis occur in the first month after childbirth. The predisposing factor is the stagnation of milk in the ducts of the gland (lactostasis), which lasts from 3 to 5 days. The causative agent of the disease is pathogenic bacteria, in 93-95% of cases it is Staphylococcus aureus.

Way of infection:

Nosocomial infection;

Infection in the hospital from visitors, medical staff;

Transmission of infection from a child suffering from inflammatory diseases of the nasopharynx, pustular inflammation of the skin.

Most often, purulent mastitis develops in an organism weakened by difficult childbirth, postpartum complications women with somatic diseases.

Non-lactational purulent mastitis is much less common, its occurrence does not depend on breastfeeding.

Reasons for its development:

consequences of injury;

Purulent inflammatory diseases subcutaneous tissue (, furunculosis);

Fibrocystic mastopathy and its complications (fibroadenoma, intraductal papilloma);

Malignant tumors mammary gland;

Implantation of synthetic materials into the breast tissue;

Tuberculous, syphilitic lesions of the mammary gland.

The causative agents of non-lactational mastitis are a combination of anaerobic infection with enterobacteria or Staphylococcus aureus. In 20% of cases, bacteria belonging to the Enterobacteriaceae family, P. Aeruginosa, are sown.

Classification and symptoms of purulent mastitis

Distinguish the following types purulent inflammation of the mammary gland:

Spicy serous mastitis;

Acute infiltrative mastitis;

Abscessing purulent mastitis (divided into apostematous, mixed mastitis and mammary gland);

Phlegmonous purulent mastitis;

Necrotic gangrenous mastitis.

Depending on the location of the inflammatory process, the following forms of purulent mastitis are distinguished:

Subcutaneous;

Retromammary;

Subareolar;

Intramammary;

Total.

The disease begins with lactostasis - stagnation of breast milk. If the stagnation lasts 3-4 days, it passes into the serous stage.

Her symptoms:

Pain in the mammary gland, heaviness;

Body temperature rises to 38?;

The affected breast increases in size;

The skin over the site of inflammation turns red;

Reduced volume of expressed milk.

Lack of treatment, reduced immunity lead to further development disease - the appearance of a dense infiltrate. A few days later, purulent abscessing mastitis begins.

Deterioration of health, weakness;

Sharp pain in the area of infiltration;

The seal acquires clear boundaries, its center softens.

With an infiltrative-abscessing form, many small abscesses filled with purulent contents are formed.

With the phlegmonous form of mastitis, the phenomena of intoxication intensify, the temperature rises to 39? C. The mammary gland swells strongly, increasing in size, the skin acquires a bluish tint. Due to swelling, the nipple is drawn into the gland.

Diagnostics

If one or more symptoms of purulent mastitis appear, you should contact your surgeon as soon as possible. After a visual examination, the doctor may prescribe an ultrasound scan - the most informative method, allowing to determine the location of the focus of purulent inflammation. Under ultrasound guidance, it is easy to perform a puncture of the affected tissues to bacteriological research biopsy.

Laboratory methods diagnostics:

General analysis urine - ESR increased, leukocyte formula shifted to the right;

Bacteriological examination of the discharge taken by puncture with a thick needle;

Treatment of purulent mastitis

Exist different approaches to the treatment of purulent mastitis - from sparing methods to radical surgical methods. In almost all cases it is required surgical intervention to the site of inflammation. In the initial stage, it is possible to introduce an antibacterial drug (penicillin) into the abscess cavity. Before manipulation, the breast skin is anesthetized with novocaine, then the tissues are opened and pus is removed from the cavity.

Then novocaine and an antibiotic are injected there, repeating the treatment daily.

Every day the amount of pus decreases, the temperature decreases, the intensity of pain decreases, and the state of health improves. As soon as the discharge becomes serous-bloody, we can say that the treatment was successful. In addition, the woman is prescribed a blood transfusion.

Advantages of the method:

The chest is almost not injured;

There are no cosmetic defects of the breast.

A similar method of treating purulent mastitis is not used for phlegmonous and gangrenous forms of the disease. If after 3 days from the start of treatment the woman's health does not improve, the temperature does not decrease, a radical surgical intervention is performed under general anesthesia.

An incision is made towards the nipple to remove pus, then a drainage system is installed for 5-10 days to drain the purulent discharge. During this time, novocaine, antiseptics and antibiotics (Dioxidin, Furacillin, Chlorhexidine, Penicillin) are injected into the incision. The sutures are removed after 8-10 days.

Should I continue breastfeeding after treatment?

Until the results of a bacteriological study of milk from healthy and damaged breasts are known, the child should not be fed. breast milk. If milk has positive characteristics in a healthy breast, it can be expressed, pasteurized and used to feed a baby ().

If mastitis takes a severe course, complicated by relapses, breastfeeding is stopped by medication (Dostinex, Parlodel).

Complications of purulent mastitis

The negative consequences of the disease are divided into complications of mastitis (phlegmon, gangrene, blood poisoning) and postoperative complications:

milk fistula;

Inflammation of the surgical wound;

Recurrence of purulent mastitis;

cosmetic defect;

Scarring and deformity of the breast.

Prevention

To prevent purulent inflammation of the mammary gland, precautionary measures must be taken:

Rationally and fully eat to maintain immunity;

Take a shower in a timely manner, change clothes;

Wear a cotton bra that fits exactly the right size;

Wash your breasts after feeding warm water leaving it open for 10-15 minutes;

Treat nipple cracks (bepanten, solcoseryl ointment);

Express milk without allowing it to stagnate.

At the slightest suspicion of the onset of inflammation in the mammary gland, you should immediately consult a doctor. In this case, it is possible to minimize the consequences of purulent mastitis.

Education: Diploma in Obstetrics and Gynecology obtained from the Russian State medical university Federal Agency for Health and social development(2010). In 2013, she completed her postgraduate studies at the NMU. N. I. Pirogov.