Compaction in the chest occurs with inflammatory and non-inflammatory diseases, benign and malignant tumors of the mammary gland. May be the result of trauma, surgery and aesthetic operations. It is a smooth or bumpy area of tissue of increased density. It can be combined with pain, deformity, discharge from the nipple, and other symptoms. The cause of compaction in the chest is established according to the survey, external examination, ultrasound, mammography, MRI, biopsy, laboratory tests. Self-medication is not indicated, it is urgent to consult a specialist.
Why there is a seal in the chest
The most common inflammatory pathology of the breast is mastitis, which is caused by nonspecific microflora, most often by staphylococci. In clinical practice, the following types of mastitis are encountered:
- lactation. It develops during breastfeeding, becomes a consequence of lactostasis, sometimes occurs without previous signs of milk stagnation.
- Non-lactation. It can be acute or chronic, is the result of aseptic inflammation with bruises, crush, burns, hypothermia. Secondary infection is often observed.
- Nonpurulent. Perhaps the impregnation of tissues with serous fluid or the formation of an infiltrate. Compaction is more pronounced in patients with an infiltrative form of the disease.
- Purulent. It proceeds in the form of phlegmon or abscess of the mammary gland. In the center of the infiltrate, after a few days, a fluctuation site is formed.
- Galactophorite. A type of pathology caused by the development of inflammation of the ducts of the breast.
Common signs of mastitis are pain, induration, tissue swelling, weakness, fever, intoxication syndrome. Symptoms are more pronounced with a purulent variant of inflammation, especially during lactation. Non-lactational and non-purulent mastitis proceed more favorably.
Breast compaction due to specific infectious diseases is quite rare. With tuberculosis, the affected mammary gland enlarges, the skin over it turns red. The size of the pathological focus can vary significantly - from a small mobile compaction to a massive immobile conglomerate, soldered to the surrounding tissues. Patients have common symptoms of tuberculosis: weakness, sweating, weight loss, loss of appetite, prolonged subfebrile condition.
Syphilis of the breast can be primary, secondary or tertiary. With a primary lesion, a practically painless seal (hard chancre) with an ulcerative surface in the center is formed on the skin. In patients with the secondary form, general manifestations, skin rashes predominate. At the third stage, gumma is formed - a dense infiltrate with a diameter of about 2 cm, which transforms into a painless ulcer. Perhaps diffuse compaction of the breast, resembling chronic mastitis.
The main manifestation of mastopathy are small, granular, often painful foci in the breast tissue. There are the following forms of the disease:
- Fibrous mastopathy. A type of diffuse adenomatosis, in which foci of dense connective tissue form in the chest.
- Fibrocystic mastopathy. Another variant of diffuse pathology. Along with areas of fibrosis, multiple cysts are detected.
- Nodular mastopathy. Focal form of the disease. It is accompanied by the appearance of limited mobile seals that are not soldered to nearby tissues.
- Adenosis. Subspecies of the fibrocystic form. May be diffuse or focal. It is characterized by pain, breast engorgement, pathological discharge.
Considered as different types of nodular mastopathy. Slowly increase, surrounding structures do not germinate, do not give metastases:
- Fibroma. It comes from connective tissue. It is a dense, smooth, painless tumor-like formation. Before menstruation, a feeling of fullness is possible.
- Adenoma. Formed from glandular epithelium. Due to the small size, the absence of pain is more often detected during a routine examination. In the chest, a spherical or spherical seal with a smooth, rarely bumpy surface is palpated.
- Fibroadenoma. Consists of connective tissue and epithelial cells. Mobile, painless, smooth or bumpy.
- Lipoma. Formed from adipose tissue. Smooth, elastic, usually small. Individual lipomas reach a significant size, causing external deformation of the breast.
- Fibrolipoma. It comes from adipose and connective tissue. Dense, mobile, elastic, painless. It can be both small, outwardly imperceptible, and large, becoming the cause of an obvious cosmetic defect.
- Cyst. It is a cavity filled with liquid. When palpated in a standing position, a smooth seal of a rounded, less often irregular shape is determined. Unlike solid tumors, it is practically not palpable in a horizontal position.
- Galactocele. A type of cyst that is formed due to obstruction of the milk ducts. The cavity contains unchanged milk or cheese-like mass. The cyst is soft, elastic, asymptomatic for a long time, more often diagnosed when it reaches a large size.
- Intraductal papilloma. It occurs in the lactiferous duct, differs from the benign neoplasms listed above in that the appearance of a seal is preceded by discharge from the nipple.
The leaf-shaped tumor occupies an intermediate position between benign and malignant neoplasia. It can be single or multiple, affecting one or both mammary glands. A typical two-phase flow: a period of slow increase is replaced by a phase of rapid growth, during which the compaction reaches large, sometimes gigantic sizes. The degree of malignancy does not correlate with size, giant tumors can be benign, small ones can metastasize.
Cancer prevails among malignant tumors of the breast. It comes from epithelial cells. At the initial stage, it is asymptomatic, palpation is determined as a dense node. Rapidly increases, sprouting muscles, skin, subcutaneous fatty tissue. During germination, it loses mobility, deforms the mammary gland, and may ulcerate. The following forms of cancer are distinguished:
- Hormone dependent. It is from 3 to 60% of all cases of the disease. More than 10% of tumor cells are sensitive to female hormones. In the treatment regimen, along with operations, chemotherapy, radiation therapy, hormone therapy is included.
- In pregnant women. It is diagnosed in pregnant, lactating women or within 1 year after childbirth. The seal is formed against the background of physiological changes in the mammary gland, which can make diagnosis difficult. The choice of treatment options is limited, especially when a woman decides to keep the child.
- Triple negative. Cells do not have receptors for hormones, so the course of the disease does not depend on cyclic changes in the body. The neoplasm is characterized by rapid aggressive growth.
- Hereditary. Due to the presence of genetic mutations, is associated with an unfavorable family history. Typical features are early onset, high percentage of bilateral lesions, association with other malignant neoplasias.
- Recurrent. The node appears with local recurrence, develops after radical organ-preserving operations in the remaining part of the breast.
- Paget's cancer. The tumor affects the nipple-alveolar complex. Discharge, nipple changes prevail. Compaction is found in 50% of patients.
- Invasive ductal carcinoma. Formed from the epithelium of the milk ducts, is the most common type of breast cancer. May occur some time after successful treatment of non-invasive cancer.
Breast sarcoma does not come from the epithelium, but from the elements of the stroma: blood vessels, adipose, muscle, cartilage, bone tissue. Occurs rarely. It is a compaction area with a bumpy surface, clear contours. It varies greatly in growth rate, with rapid progression it can resemble an abscess.
The appearance of a seal is preceded by a fall at home, during sports, a blow to the steering wheel of a car in an accident. Bruising of the mammary gland is manifested by pain, swelling of soft tissues. A painful swelling is formed in the chest - a hematoma. Sometimes there is a colorless or bloody discharge from the nipples.
During resorption of the hematoma, an area of necrosis is often formed, which is subsequently replaced by dense connective tissue, so the seal can persist throughout the patient's life. There is an increased risk of malignancy of the altered tissues.
Consequences of diseases, injuries and operations
Breast seals are formed as a result of other diseases, tissue damage during injuries, surgical interventions for volumetric formations, aesthetic operations. Possible reasons are:
- Fat necrosis. Along with injuries, it occurs after medical manipulations. Accompanied by the formation of a dense infiltrate. The seal is rounded, painful, soldered to the skin. Sometimes there are deformations, retraction of the nipple.
- Calcifications. They are formed against the background of milk stagnation, diseases, age-related changes in the mammary glands, hypercalcemia. In most cases, they are asymptomatic and are discovered incidentally. With a superficial location, they are palpated as painless dense nodules.
- capsular contracture. Develops after the installation of breast implants. The connective tissue that forms in the body around any foreign bodies grows excessively, thickens, squeezing the endoprosthesis. The degree of breast deformity ranges from slight to pronounced.
- Knots of polyacrylamide gel. It is formed when trying to increase the breast by administering this drug. Over time, the gel is encapsulated, areas of tuberosity appear, multiple small foci, similar to a bunch of grapes.
Other pathologies of the mammary glands
A list of other conditions that can cause a symptom to develop includes:
- Laktostasis. Painful seals are formed during feeding, complemented by a feeling of fullness, heaviness of the mammary gland. After feeding, the signs of lactostasis become less pronounced. With prolonged stagnation of milk, there is a local increase in temperature, general hyperthermia.
- duct ectasia. As a rule, it develops against the background of hormonal changes, other breast diseases. It is manifested by swelling, pain, itching, burning in the projection of the nipple-areolar complex, whitish or greenish discharge.
- Inflammation of the nipple. It is caused by bacteria, less commonly by fungi or viruses. It is characterized by hardening of the areola, soreness, engorgement of the nipple, edema, hyperemia, secretion of a clear, purulent or bloody secretion.
- Eczema of the nipple. Pathology occurs in the first weeks of lactation, manifested by itching, erosion, peeling. Superficial seals are formed during secondary bacterial infection of the skin.
- Involution of the mammary glands. It is observed after 5 years, accompanied by the formation of small self-absorbable foci. It is possible to involute the MF according to the fibrocystic type with the formation of elastic mobile rounded seals of different diameters.
Sometimes seals in the chest develop against the background of non-mammological diseases, they can be found in both women and men:
- Non-Hodgkin's lymphoma. When the lymphoma is located in the projection of the mammary gland, a diffuse seal or a node with clear boundaries is palpated.
- Parapleurisy. A rare pathology resulting from the spread of inflammation to the surrounding tissue in patients with tuberculous pleurisy. Dense swelling is palpable along the anterior, anterolateral surface of the chest at the level of 4-6 intercostal spaces.
- Gynecomastia. Breast enlargement in men is accompanied by an increase in tissue density.
Diagnosis of compaction in the chest
Diagnostic measures are carried out by a mammologist. The specialist finds out from the patient the time and circumstances of the onset of the symptom, examines the dynamics of the disease. A mammologist assesses the condition of the nipple-alveolar zone, skin, underlying tissues, detects deformities, determines the location, size, consistency, compaction mobility, examines regional lymph nodes. To clarify the diagnosis are assigned:
- Sonography. A safe basic way to study the mammary glands. Detects tumors, areas of inflammation, structural anomalies. It is more informative in young women, because their breast tissues are denser, they are well visualized during an ultrasound examination.
- Mammography. A type of radiography. Preferred in older women. Confirms fibrotic changes, tumor-like formations. To increase the information content, it can be supplemented with ductography. With ambiguous results of the procedure, digital tomosynthesis is performed. Patients with cysts undergo pneumocystography.
- Biopsy of the breast. To obtain a tissue sample, a puncture, a fine-needle biopsy, a trephine biopsy under ultrasound or X-ray control are performed. Punctates and biopsies are sent for microbiological examination to identify the pathogen, cytological or histological analysis to exclude malignancy.
- Other Imaging Techniques . MRI and scintigraphy are used to clarify the size and localization of malignant neoplasia, the choice of surgical treatment tactics. Patients with endoprostheses, according to indications, undergo MRI control of breast implants.
- Laboratory tests . Assign a determination of the level of sex hormones, an analysis for oncomarkers, blood tests to assess the severity of inflammation, a microbiological analysis of secretions from the mammary gland.
Help at the prehospital stage
Breast compaction is often a sign of a dangerous disease; in the absence of timely assistance, dangerous complications may develop. Self-medication upon detection of this pathology is unacceptable. With severe pain, a single dose of an analgesic is possible. After detecting a seal, you should immediately contact a mammologist.
The tactics of treatment is determined by the nature of the pathology that caused the formation of a seal in the chest. It is possible to use etiotropic, pathogenetic, symptomatic agents, physiotherapeutic methods of treatment. Most often used drugs of the following groups:
- Antibiotics . Necessary for mastitis, other infectious diseases of the breast. At the initial stage, broad-spectrum drugs are prescribed, then the antibiotic therapy regimen is adjusted taking into account the results of microbiological analysis.
- Hormonal preparations . Antiestrogens are recommended for patients suffering from mastopathy. Medicines minimize the effect of female hormones on the state of the mammary gland, and prevent the progression of pathological changes.
- NSAIDs . Shown to patients with mastitis, injuries, consequences of chest injuries. Reduce the severity of inflammation, reduce swelling and pain.
- Cytostatics. They are part of the treatment of malignant tumors of the breast. They can be used alone or in combination with radiation therapy, prescribed at the stage of preparation for surgery.
The method of surgical intervention is chosen taking into account the characteristics of the pathology. When sealing the breast, the following interventions are carried out:
- Mastitis : opening and drainage of mastitis, puncture and drainage of abscess.
- Cysts : excision, sclerosis, laser vaporization, opening of a festering cystic formation.
- Consequences of operations : removal of breast implants.
- Benign tumors : removal of the neoplasm, sectoral or radical resection, quadrantectomy, lumpectomy.
- Malignant neoplasia : various types of mastectomy, in some cases with simultaneous or subsequent mammoplasty.
At the initial stages of cancer, it is possible to carry out organ-preserving operations that are used for benign tumors. To reduce the risk of recurrence, surgical treatment is supplemented with radiation and chemotherapy.