Milk Fistula Research Articles

Ultrasound guided aspiration versus incision and drainage in the management of breast abscess

Background: The aim of this study is to compare the results of ultrasound guided aspiration and incision and drainage in the management of breast abscess. Methods: This is a comparative study of between ultrasound guided aspiration and incision and drainage, consist of 50 patients with breast abscess who underwent both the treatment alternatively in our institution Sri. Siddhartha Institute of Medical Sciences and Research Begur during 2021 to 2023. 7th and 14th day following aspiration, patients should be assessed both clinically and by USG breast. Results were tabulated and analyzed. Results: 4 patients developed complications following Incision and drainage. 3 milk fistula and wound gaping, 1 recurrence and 3 patients developed complications following USG guided aspiration All 3 cases were recurrence. Conclusions: USG guided aspiration is simple, painless, day care procedure and effective alternative method of treatment to incision and drainage in properly selected patient and with timely support by sonologist with early postoperative recovery and good patient satisfaction.

Is Lactation Really a Contraindication or an Unjustified Worry for Milk Fistula in Patients Undergoing Endoscopic Thyroidectomy via Breast Approach

Is Lactation Really a Contraindication or an Unjustified Worry for Milk Fistula in Patients Undergoing Endoscopic Thyroidectomy via Breast Approach

Maintaining Breastfeeding During the Treatment of Breast Abscesses Is Not Contraindicated.

Background: World Health Organization guidelines recommend maintaining breastfeeding if a woman develops breast abscess, because of benefits to her recovery and the infant's health. However, clinical staff recommend weaning to promote faster recovery from the abscess. The purpose of this study was to determine whether maintaining breastfeeding after development of a breast abscess has any influence on the resolution of the breast abscess. Methods: The records of 212 patients who were breastfeeding and developed breast abscess treated at Guangzhou Women and Children's Medical Center from January 2018 to December 2019 were retrospectively reviewed. Patients were divided into two groups: those who maintained breastfeeding (study group) and those who stopped breastfeeding (control group). Results: There were 139 patients in study group and 73 patients in the control group. Baseline characteristics were similar between the two groups. The time to cure in the study group and in the control group was 7.20 ± 2.21 days and 7.01 ± 2.39 days, respectively (t = 0.579, p = 0.563). Common complications were milk fistula and galactocele, and the frequency of both was similar between the two groups (milk fistula: 7.9% versus 8.2%, respectively; χ2 = 0.006, p = 0.938; galactocele: 8.6% versus 9.6%, respectively; χ2 = 0.054, p = 0.817). There was no significant difference in the recurrence rates between the two groups (5.0% versus 2.7%; χ2 = 0.184, p = 0.668). Conclusion: Maintaining breastfeeding during treatment of breast abscess does not affect the outcome of treatment provided, on condition that the abscess is treated appropriately.

Low incidence of milk fistula with continued breastfeeding following radiologic and surgical interventions on the lactating breast

Milk fistula is a potential complication of radiologic and surgical procedures on the lactating breast, though its incidence is unknown. Some postulate that larger defects and/or closer proximity to the nipple increase the risk of fistula. This study aimed to estimate the incidence of milk fistula and characterize risk factors in patients who continued breastfeeding after surgical or radiological procedures. A retrospective cohort analysis of pregnant or lactating women treated at a multidisciplinary breast clinic from July 2016 through August 2019 was performed. Demographic and clinical variables were analyzed using ANOVA and Pearson's Chi-square. Two pregnant and 43 lactating patients underwent 71 interventions. The incidence of milk fistula within one week of intervention was 1.4%. One fistula was diagnosed six days after retroareolar abscess drainage. The fistula closed successfully with continued breastfeeding. When categorized by the caliber of the most invasive intervention (large-caliber: mass excision, n =7; medium-caliber: percutaneous drain insertion, n =18; small-caliber: stab incision, aspiration, core needle biopsy, n =20), patients were similar in age, race/ethnicity, weeks postpartum, and frequency of central versus peripheral interventions. The low incidence of fistula prevented quantitative evaluation of potential risk factors. Milk fistula is a rare occurrence following radiologic or surgical breast interventions performed during pregnancy or lactation. Indicated procedures should not be deferred, but periareolar approaches should be avoided when possible. Cessation of lactation is not mandatory for fistula closure, and continued breastfeeding should be recommended.

S3027 Breast Milk Fistula: An Unusual Complication of Therapy for Gastroparesis

INTRODUCTION: We report an unusual medication related complication that developed in a patient being treated for chronic idiopathic gastroparesis. CASE DESCRIPTION/METHODS: The patient, a 40-year-old female, has a long history of idiopathic gastroparesis. Symptoms have been present for many years and in the past resulted in weight loss and numerous hospital visits. Gastric emptying scans have been markedly abnormal and on endoscopic examination residual old food was always present in the stomach. She had been evaluated for a possible gastric pacemaker and she has had pyloric Botox injections, pyloric dilation and has been treated with metoclopramide and more recently with domperidone for the last few years. She had also had a Nissen fundoplication for chronic reflux associated with gastric stasis. Her condition has remained stable for many months and she has gained weight and not required hospital visits. She presented to a breast surgeon with a recurrent chronic right breast abscess with overlying necrotic skin. Breast exam revealed no nipple discharge at that time, and she went to surgery for exploration, drainage and debridement. One week post procedure she complained of malodorous drainage from the incision and serous drainage was noted on the dressing. Wound culture was obtained and grew rare Streptococcus anginosis. The patient was started on Bactrim and a wick and plain packing was placed. Eleven days later she presented to the emergency room with complaints of malodorous drainage and right breast pain. Ultrasound revealed 3.1 × 0.7 × 3.5 cm complex fluid collection. Culture grew rare gram-positive cocci in pairs. She was treated with clindamycin and discharged home. She was reevaluated by the surgeon and new left nipple drainage was noted. Wound healing remained impaired. This raised the question of a milk fistula. The patient was instructed to stop taking domperidone. Over the next weeks the wound closed and there was no further drainage. She subsequently resumed her domperidone. DISCUSSION: Galactorrhea can be an uncommon side effect of domperidone. In this case it led to an unusual complication of breast wound milk fistula delaying healing of an abscess.

A Systematic Review of Milk Fistula in Nursing Mothers: Modifying the Perspective Toward Maintenance of Breastfeeding

IntroductionMilk fistula is rare, and cessation of nursing has been recommended for treatment. We performed a comprehensive review of all existing literature to explore the causes of milk fistulae and the necessity of discontinuing breastfeeding, and mention our recommendations given our present practice.MethodGoogle Scholar, Pubmed, Ovid Medline, and Scopus were thoroughly investigated by using relevant keywords. After screening by reading titles, abstracts, and full texts of returned studies, pertinent articles were included and data extracted.ResultsSeventeen studies including 27 cases were included. Lactation ceased in 16 patients, but this was generally done without awaiting results of conservative management.ConclusionWe recommend measures for preventing milk fistulae, conservative measures for treatment, and continuation of breastfeeding throughout the process until healing occurs.

Local Complications of Breast Surgery during Pregnancy and Lactation.

During pregnancy and lactation, breast vascularity increases and edema occurs in the breast . As a consequence, rate of complications of breast biopsy and surgery like bleeding, infection, delayed healing and wound dehiscence is expected to be higher. Milk fistula is a rare event that may complicate surgery or needle biopsy of the breast in a breastfeeding woman, or in late stages of pregnancy . Suppression of lactation has been proposed in the literature as both a preventive and a therapeutic step. However, the advantages of nursing for both mother and child are numerous, and the author do not propose it as a preventive measure nor as a must in treatment of milk fistula. Prevention and management of milk fistula are discussed in this chapter.

Spectrum of Diseases among Patients Attending a Breast Clinic at a Tertiary Level Hospital of Bangladesh

Background: Breast problems are a burning health issue for today’s women. Breast clinics provide a competent and complete diagnosis for women with any breast symptoms or problems and give appropriate management of the problem. The aim of this study is to determine the disease spectrum among the patients visiting a breast clinic for assistance.
 Methods: This was a cross section study of all female patients visiting a breast clinic with breast problems. The study was conducted at BIRDEM General Hospital-2 over a period of 3 years from March 2015 till March 2018. Patients suffering from superficial skin lesions of the breast were excluded. The findings were tabulated and analyzed for frequency of each problem.
 Results: A total of 1279 patients visited the breast clinic during the period of March 2015 till March 2018. Among them 1204 patients were selected after considering eligibility criteria. The age of the patients ranged from 15 to 80 years. Ten percent of these patients were asymptomatic and attended the clinic for breast screening. Among the symptomatic patients mastalgia was the most common presentation (36.65%) followed by fibrocystic disease (22.26%). Benign Breast lump was seen in 14.96% patients. Ten percent patients presented with breast abscess. Nipple discharge and ductal ectasia was seen in 2.66% patients. Breast cancer was found in 2.33% patients. Other rare entities like milk fistula, giant fibroadenoma were also noted.
 Conclusion: Breast clinincs provide comprehensive assistance to both benign and malignant breast diseases. Breast cancer is the leading cause of cancer deaths in females. Breast screening ensures early detection of breast cancer. Besides malignant disease benign breast diseases also cause much morbidity to female health. This study shows the spectrum of patients coming with breast complaints to such a breast clinic.
 Birdem Med J 2019; 9(1): 11-13

Milk fistula following puerperal breast abscess.

Key Clinical MessageWe present the first reported video of milk fistula. Milk fistula is a rare complication secondary to abscess or breast intervention in lactating women. It is a clinical diagnosis and the treatment is usually conservative, which included cessation of breastfeeding, with a good prognosis.

Chronic Lactiferous Fistula: A Case Report

Lactiferous or milk fistula is a tract between the skin and lactiferous duct. Chronic lactiferous duct is uncommon and generally formed during lactating period. It commonly result from complication of the surgical intervention, such as excision biopsy of breast mass or incision and drainage (I&D) for breast abscess. We reported a case of chronic lactiferous fistula secondary to previous I&D for breast abscess in 31 year old lactating woman.

Giant Lactating Adenoma of the Breast: Safety and Benefits of Surgical Removal

Background and aim: Lactating adenoma is one of the benign tumors of breast that is frequently associated with pregnancy and lactation. Its size ranged from 1cm to 4 cm; however, rare cases with rapid postpartum enlargement up to 25 cm have been reported. Surgical removal of small lactating adenoma usually postponed till weaning, waiting for spontaneous regression and to avoid wound complications. The aim of this study was to assess the safety of surgical removal of giant (more than 5 cm) lactating adenomas during lactation, regarding wound complication specially milk fistula, with maintenance of breast feeding and its benefit. Patients and methods: The present study was conducted on 12 patients with giant lactating breast adenoma in Surgical Oncology unit at General Surgery Department, Tanta University Hospital from March 2013 to July 2016. The patients included in the study were lactating, had solitary breast mass more than 5 cm in size, had subjected to surgical removal through a cosmetic circumareolar or curvilinear incision. The patients resumed breast feeding within 24 hours, then followed-up for wound haematoma, wound seroma, wound infection, milk fistula, psychic and pain relief. Results: The patients' age ranged from 18 to 38 years with a mean age of 27 ± 3.6 years. In all patients; the chief complaint was cosmetically discomforting mass, asymmetry between the two breasts and fear of malignancy, pain was a presenting symptom in 6 patients. The size of the adenoma by ultrasound ranged from 8-18 cm with a mean of 12.6 cm. No wound complications were recorded. Conclusion: Giant lactating adenoma could be safely removed during lactation to alleviate pain, heaviness, and anxiety, to rule out malignancy or coexisting carcinoma with no wound complication, no milk fistula and good aesthetic outcome with maintenance of the breast feeding and its benefits.

Breast Emergencies: Types, Imaging Features, and Management

The objective of this article is to describe the types of breast emergencies that can be encountered in a breast imaging practice, discuss the characteristic imaging features of these emergencies, and explain the most common methods and interventions used for the treatment of breast emergencies and complications. Breast emergencies are uncommon but require prompt identification and management when they do occur. Patients with mastitis or a breast abscess may be seen for either diagnosis or treatment. Most complications are the result of interventional procedures. Pseudoaneurysms, postbiopsy hematoma, and localization wire migration are the most common situations encountered. A milk fistula resulting from a core biopsy is uncommon. Fortunately, seat-belt injuries to the breast are rare. Knowledge of these entities--of the usual presentation, management, and appropriate follow-up protocols--is essential for breast imagers.

Health and Economic Burden of Post-Partum Staphylococcus aureus Breast Abscess

ObjectivesTo determine the health and economic burdens of post-partum Staphylococcus aureus breast abscess.Study designWe conducted a matched cohort study (N = 216) in a population of pregnant women (N = 32,770) who delivered at our center during the study period from 10/1/03–9/30/10. Data were extracted from hospital databases, or via chart review if unavailable electronically. We compared cases of S. aureus breast abscess to controls matched by delivery date to compare health services utilization and mean attributable medical costs in 2012 United States dollars using Medicare and hospital-based estimates. We also evaluated whether resource utilization and health care costs differed between cases with methicillin-resistant and -susceptible S. aureus isolates.ResultsFifty-four cases of culture-confirmed post-partum S. aureus breast abscess were identified. Breastfeeding cessation (41%), milk fistula (11.1%) and hospital readmission (50%) occurred frequently among case patients. Breast abscess case patients had high rates of health services utilization compared to controls, including high rates of imaging and drainage procedures. The mean attributable cost of post-partum S. aureus breast abscess ranged from $2,340–$4,012, depending on the methods and data sources used. Mean attributable costs were not significantly higher among methicillin-resistant vs. –susceptible S. aureus cases.ConclusionsPost-partum S. aureus breast abscess is associated with worse health and economic outcomes for women and their infants, including high rates of breastfeeding cessation. Future study is needed to determine the optimal treatment and prevention of these infections.

Management of Lactational Mastitis and Breast Abscesses: Review of Current Knowledge and Practice

Most breast abscesses develops as a complication of lactational mastitis. The incidence of breast abscess ranges from 0.4 to 11% of all lactating mothers. The traditional management of breast abscesses involves incision and drainage of pus along with antistaphylococcal antibiotics, but this is associated with prolonged healing time, regular dressings, difficulty in breast feeding, and the possibility of milk fistula with unsatisfactory cosmetic outcome. It has recently been reported that breast abscesses can be treated by repeated needle aspirations and suction drainage. The predominance of Staphylococcus aureus allows a rational choice of antibiotic without having to wait for the results of bacteriological culture. Many antibiotics are secreted in milk, but penicillin, cephalosporins, and erythromycin, however, are considered safe. Where an abscess has formed, aspiration of the pus, preferably under ultrasound control, has now supplanted open surgery as the first line of treatment.

Wound Complications from Surgery in Pregnancy-Associated Breast Cancer (PABC)1

there are concerns that physiologic changes of the peripartum breast may result in complications in breast conservation therapy. We present the complications of breast conservation surgeries and mastectomies performed for pregnancy-associated breast cancer (PABC). from April 1989 through April 2008, sixty-seven breast cancer patients underwent surgical management for PABC, defined as surgery during pregnancy or within one year postpartum. Records of women who had surgery were examined for post-operative wound complications of milk fistula, cellulitis, abscess, or hematoma. Forty-seven patients underwent mastectomy. Twenty were treated with conservative breast surgery. There were six complications, all treated in the outpatient setting. There were no documented milk fistulae. in our series, we had few postoperative complications and no milk fistulae for those patients undergoing surgery for PABC. When compared to those who had mastectomy for PABC, women who underwent breast conserving therapy did not appear to have increased frequency of surgical complications.

Spontaneous Milk Fistula from an Accessory Breast – an Annoying Complication

Ectopic breast tissue presents as solitary or multiple masses in young woman along the milkline. Ectopic axillary breasts are the most common variant of supernumerary breast tissue. Accessory breasts can present in a number of ways like fibrocystic disease, fibroadenoma, mastitis etc., but the incidence of milk fistulas in them is very, very rare. We encountered an interesting case of a 23-year-old lactating female in whom a left axillary accessory breast was associated with a milk fistula of spontaneous origin. When the milk leak did not stop with conservative treatment, suppression of lactation was done followed by excision of the axillary accessory breast to prevent this complication in future pregnancies and lactation.

PUERPERAL BREAST ABSCESSES

. Objectives: The aim of this study was to compare the management of puerperal breast abscess by ultrasound guidedpercutaneous drainage v/s incision and drainage with special attention to resolution time and complications. Setting: Allied Hospital Faisalabad.Period: Jan 2005- June 2007. Patients and Methods: 60 patients with puerperal breast abscess were studied. Patients were divided into twogroups randomly after informed consent. In Group A; patients were treated with percutaneous drainage under local anesthesia while GroupB patients were treated by conventional incision and drainage, and results were compared with reference to resolution time and complicationsrate using student’s t-test. Results: By percutaneous method abscess healed in 5-8 days time. Recurrent abscess was found in one case (3%),milk fistula formation in one case (3%) and no residual abscess was found. There was no scar formation, induration or distortion of the breastparenchyma. Breast-feeding was interrupted in four patients (13%) only due to milk fistula (one case), recurrent abscess (one case) andpatient’s own preference (two cases). On the other hand by conventional method healing took 15-25 days with pain and discomfort of dailydressings, scarring and cessation of breast feeding in most of the cases. Conclusion: Percutaneous ultrasound guided placement of suctiondrainage catheter in puerperal breast abscess for 5-8 days is less invasive, high resolution rate, scarless, low complication rate and preservesthe function of breast-feeding as compared to conventional incision and drainage.

Milk Fistula: A Conservative Approach to Treatment after Core Breast Biopsy

Milk Fistula: A Conservative Approach to Treatment after Core Breast Biopsy

Complications of breast core biopsy

A pictorial review of some of the complications of breast core biopsy is presented. Core biopsy of the breast is a commonly performed procedure that plays a vital role in the investigation of suspected breast cancer. Serious complications related to it are rare. The commonest problem is bleeding, which is usually easy to control at the time of the procedure. Arterial bleeding usually leads to the procedure being abandoned and repeated later. Applying pressure normally brings arterial bleeding under control within 15 min. Lesser degrees of haematoma can result in the lesion being obscured, which prevents a representative biopsy being obtained. In these cases repeat biopsy after an interval of 2 weeks allows the haematoma to resolve. Rarer complications of core biopsy include infection and abscess formation, pneumothorax, milk fistula formation, cosmetic deformity and seeding of tumour along the biopsy track. Complete removal of a mammographic abnormality such as microcalcifications can result in difficulty if localisation for excision is required.

Lactating adenoma: US features and literature review.

To describe the ultrasonographic (US) features of adenoma in a lactating breast. The US scans of 11 lactating adenomas in nine patients aged 25-36 years examined in 1991-1996 were retrospectively reviewed. In all lesions, diagnoses were cytologically or histologically proved after US-guided fine-needle aspiration biopsy (eight lesions) or core biopsy (three lesions). Six patients were lactating, and three patients were in the third trimester of pregnancy. The US features analyzed were shape, orientation to the chest wall, border characteristics, echogenicity, homogeneity, enhancement or shadowing, and depth within the breast. Most lesions had benign US features such as ovoid shape with the long axis parallel to the chest wall (10 of 11), well-defined margins (eight of 11), homogeneous echotexture (eight of 11), and posterior acoustic enhancement (10 of 11). Four lesions had US features that resembled malignant lesions, such as irregular margins, heterogeneous echotexture, and posterior acoustic shadowing. The US features, although generally benign, are not specific. Tissue sampling with fine-needle aspiration biopsy is recommended. Core biopsy is necessary if a diagnosis cannot be made with the aspirate but is not performed initially because of the possibility of milk fistula formation.