Plastic & Reconstructive Surgery:
Harper, J. Garrett M.D.; Daniel, Jarrod R. M.D.; McLean, J. Nicolas M.D.; Nahai, Foad M.D.
Emory University, Atlanta, Ga.
Correspondence to Dr. Harper, Emory University, 3200 Downwood Circle, Suite 640, Atlanta, Ga. 30327
Galactoceles are extremely rare but potentially devastating complications of augmentation mammaplasty. Although the incidence and precise cause are unknown, certain factors have been thought to contribute to their formation: history of galactorrhea, oral contraceptive use, lactation or recent childbirth, hyperprolactinemia, stimulation of intercostal nerves, and disruption or obstruction of breast ducts. We present the eighth case of galactocele formation following device-based augmentation mammaplasty.
Our patient was a 24-year-old, gravida 1, para 0, abortus 1 woman who underwent bilateral subpectoral augmentation mammaplasty with 380-cc ultra-high-profile silicone gel devices through periareolar incisions in her native country, Colombia. She had no significant medical or surgical history and her only medication was an oral contraceptive.
She presented to our office with unilateral painful enlargement of her left breast on postoperative day 8 (Fig. 1). Aspiration in the clinic removed 800 cc of creamy fluid that we sent for culture and determination of triglyceride level (Fig. 2). Culture results were negative for bacterial growth, but the fluid’s triglyceride level was 4307mg/dl (normal, <150mg/dl). Despite use of a compression garment, it was evident at follow-up that a large volume of new fluid had accumulated. She underwent aspiration in our clinic a total of four times over a 2-week period, with more than 3000 cc drained. She decided for financial reasons to return to Colombia for care.
Ultimately, the devices were removed, the breast pockets were irrigated, new devices were reinserted, and drains were placed. She was placed on a combination of cabergoline and bromocriptine (both dopamine receptor agonists) for 10 days. Drains were removed in 5 days and the patient has had no subsequent complications.
There have been seven previous reports of galactocele formation after implant-based augmentation mammaplasty and several cases following injections of polyacrylamide gel for breast augmentation in other countries. Although data collection is incomplete in these reports, 75 percent of devices were placed subglandularly, 100 percent were placed through periareolar incisions, and 63 percent were silicone devices. Seventy-five percent of patients either were on oral contraceptives at the time of their surgery or were lactating following pregnancy, with a remote history of augmentation mammaplasty (50 and 25 percent, respectively). Treatments have included oral antibiotics, hormone therapy, placement of drainage catheters, formal operation with or without device removal, or combinations of the above.
Although a rare complication in the field of plastic and reconstructive surgery, it is still one that the surgeon should be aware of when presented with postoperative breast enlargement. Prompt drainage of the fluid and concomitant hormonal therapy with dopamine agonists should be started immediately. Consultation with an endocrinologist is also recommended to eliminate more serious causes of milk production. Although the statistics are difficult to interpret because of its low reported incidence, use of oral contraceptives, periareolar incisions, and subglandular device position appear to be contributing factors. The fact that 100 percent had periareolar incisions may be coincidental, but disruption of these mammary ducts with incisions or thermal damage from electrocautery is likely to contribute.1–5
The authors have no financial interest to declare in relation to the content of this article. No external funding was received.
J. Garrett Harper, M.D.
Jarrod R. Daniel, M.D.
J. Nicolas McLean, M.D.
Foad Nahai, M.D.
1. Hartley JH Jr, Schatten WE. Postoperative complication of lactation after augmentation mammaplasty. Plast Reconstr Surg. 1971;47:150–153
2. Tung A, Carr N. Postaugmentation galactocele. Ann Plast Surg. 2011;67:668–670
3. Chun YS, Taghinia A. Hyperprolactinemia and galactocele formation after augmentation mammaplasty. Ann Plast Surg. 2009;62:122–123
4. Deloach ED, Lord SA, Ruf LE. Unilateral galactocele following augmentation mammaplasty. Ann Plast Surg. 1994;33:68–71
5. Acarturk SA, Gencel E, Tuncer I. An uncommon complication of secondary augmentation mammaplasty: Bilaterally massive engorgement of breasts after pregnancy attributable to postinfection and blockage of mammary ducts. Aesthetic Plast Surg. 2005;29:274–279
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