Formations (lumps) of the mammary gland of pregnant and lactating – causes, diagnosis
The benign changes in pregnancy include fibroadenomas, lipomas, papillomas, fibrocystic changes, lactocele and inflammatory pseudotumor.
Byrd et al. in a series of 105 biopsies that revealed benign changes, 71% of patients found conditions characteristic of non-pregnant women, and 29% showed changes specific to pregnancy (ie, hyperplasia of lobules, lactocele, lactational mastitis). As the duration of pregnancy increases, the mammary glands become denser, more nodular and enlarged.
Such changes are also characteristic of the breastfeeding period. Small formations may become imperceptible with increasing gestational age and engorgement of the mammary glands. While the mass in the breast, found during menstruation, can be re-examined after its completion, the hormonal background in a pregnant woman only increases with time, which complicates subsequent examinations.
If fluid is sucked out during puncture and the formation disappears, then it helps to easily differentiate a cyst filled with fluid or a galactocele from a solid tumor. However, in pregnant women, the results of cytological examination of punctate are not as accurate as in non-pregnant ones. Hyperproliferation of mammary gland cells in pregnant women increases the risk of a false positive result. During pregnancy, due to plethora and edema, it is difficult to perform an excisional biopsy under local anesthesia, but it remains the best diagnostic method.
Many experts associate the late stage and poor prognosis of breast cancer (BC) in pregnancy with late diagnosis. More recent studies of breast cancer (breast cancer) in pregnancy have demonstrated an undoubted improvement in survival as a result of more frequent breast biopsies in pregnant women.
Conducting a biopsy of the mammary gland in pregnant or lactating women due to plethora and the risk of postoperative hematoma requires careful hemostasis. Lactating mammary gland is predisposed to the development of postoperative infection in it, since milk is a good nutrient medium for microorganisms. Local anesthesia of an enlarged mammary gland by injection may be difficult to implement, but it is considered the method of choice.
If an excision biopsy is difficult, you can perform an excisional biopsy. Due to the high risk of infection and the formation of fistula of the ductus, a patient who is planning a biopsy should stop feeding in advance of the procedure.