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European Journal of Applied Sciences – Vol. 11, No. 3
Publication Date: June 25, 2023
DOI:10.14738/aivp.113.14781.
Arellano, A., Arellano-Montalvo, F.-A., & Arellano-Montalvo, D. (2023). Galactorrhea in Breast Augmentation. European Journal
of Applied Sciences, Vol - 11(3). 218-225.
Services for Science and Education – United Kingdom
Galactorrhea in Breast Augmentation
Aristides Arellano
Dermatological Clinic and Aesthetic Surgery of Puebla. Puebla, Mexico
Fics-Anja Arellano-Montalvo
Dermatological Clinic and Aesthetic Surgery of Puebla. Puebla, Mexico
Dafne Arellano-Montalvo
Dermatological Clinic and Aesthetic Surgery of Puebla. Puebla, Mexico
INTRODUCTION
Augmentation mammoplasty is one of the most used procedures in breast surgery and its
complications have been very well studied. However, periprosthetic galactocele after
prosthetic breast augmentation surgery is a very little-known complication.
Galactorrhea is a rare complication after breast plastic surgery. Its cause is still unknown,
although it is most likely that its appearance has a multifactorial origin. Our casuistry consists
of 40 cases whose ages range from 18 to 40 years, occurring in nulliparous and multiparous
women.
Postsurgical galactorrhea often follows a benign and self-limited course, culminating in
spontaneous resolution. Depending on the severity of the symptoms, its treatment can be
medical and / or surgical, with drainage or even removal of breast implants.
It is a disorder characterized by the emission of milk outside the period of pregnancy and the
puerperium. It is a late and rare complication when associated with breast surgery. It is
believed that the blockage of the milk ducts may be one of the causes of the formation of
galactoceles during pregnancy in previously operated patients (1).
3 Weeks After Surgery
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Arellano, A., Arellano-Montalvo, F.-A., & Arellano-Montalvo, D. (2023). Galactorrhea in Breast Augmentation. European Journal of Applied Sciences,
Vol - 11(3). 218-225.
URL: http://dx.doi.org/10.14738/aivp.113.14781.
However, it can present acutely in the immediate postoperative period of cosmetic breast
surgery, being more frequently associated with breast reduction (3-12), where the drainage of
milk through the wound can interfere with the healing process.
Regarding breast augmentation, its association with galactorrhea is not well documented in the
literature and few articles are devoted to this topic. However, many surgeons report how some
of their patients have experienced episodes of self-limited galactorrhea during surgery and
after breast augmentation surgery with implants, which resolved spontaneously after several
weeks without the need for treatment (2).
Transoperative Pictures, Before Implant Placement the Patient Present Milk
Among the common factors associated with patients suffering from this disorder, the most
frequent is having had children, and no association was found for any other factor.
Different etiologies have been described to explain galactorrhea (13,14):
By default, in hypothalamic inhibition of PRL secretion or by increasing it in serum by
decreasing its elimination from the circulation influenced by dopamine or dopamine agonists:
Drugs:
Neuroleptics (butyrophenones, phenothiazines, risperidone, olanzapine, sulpiride),
antidepressants, antihypertensives (methyldopa, reserpine), opiates (codeine, morphine,
methadone), antiemetics (metoclopramide, domperidolidone, lansopamulator),
cimeovulatory, domperidone, lansopamulator.
Due to Hypothalamic Involvement:
Tumors (craniopharyngioma, pinealoma, meningioma, metastasis). Histiocytosis X, sarcoidosis,
lupus. Irradiation, meningitis, encephalitis, hydrocephalus, vascular lesions.
Due to Involvement of the Pituitary Stalk:
Section of the stalk (traumatic, surgical). Tumor compression.
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Increased PRL-Releasing Factors:
Primary hypothyroidism. Some herbs such as anise, fennel, nettle, holy thistle, or fenugreek
seeds. Addison's disease, adrenal involvement, or Cushing's disease.
PRL-Producing Tumors:
Prolactinomas (PRL-producing pituitary tumors and sometimes also GH). The most frequent
cause (25% of cases). Chromophobic adenomas. Ectopic production of PRL or HPL.
Bronchogenic carcinoma. Hypernephroma. Hydatidiform mole, choriocarcinoma, ovarian
teratoma.
Local Causes:
Repeated mechanical stimulation. Thoracic trauma such as major surgery, thoracotomy, breast
surgery. Local infections (mastitis, herpes zoster).
Others:
Chronic renal failure (50% have elevated PRL, although galactorrhea is rare), empty Sella
turcica, liver cirrhosis, polycystic ovary, feminizing adrenal carcinoma, hyperthyroidism, spinal
cord injury.
Idiopathic:
It is a diagnosis of exclusion and can account for up to 50% of cases.
The mechanical stimulation of the breast, mastitis, trauma and thoracic surgery, as well as
herpes zoster of the chest, trigger a reflex nervous irritative mechanism that ascends through
the thoracic nerves, affecting the release of the factors that regulate PRL and can produce
galactorrhea.
This may be the most founded etiology in the case of galactorrhea associated with breast
surgery; However, we must indicate that in most of the patients in whom this complication
develops, no change in prolactin values was detected in laboratory studies, they remain in
normal values, so the placement of silicone prostheses does not it is related to an increase in
PRL levels or an increase in lactation (15). A bilateral breast ultrasound, head CT, and thyroid
and adrenal hormone analysis are also recommended.
Some cases have been treated with oral bromocriptine, at an initial dose of 1.25 mg, 3 times a
day. After a week of treatment and when there is no response, the dose can be increased to 2.5
mg. 3 times a day. The treatment would be maintained until 2 weeks after cessation of
discharge. Long-lasting synthetic alkaloids derived from ergotamine can also be used with good
results, the recommended dose is 10 mg orally once a week for 4 weeks.
The presence of abnormal discharge from the nipple or wound after breast surgery should lead
to suspicion of infection; however, it presents with pain, inflammatory symptoms and purulent
discharge, while in galactorrhea the discharge is opalescent and there are no inflammatory
signs in the breast.
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Arellano, A., Arellano-Montalvo, F.-A., & Arellano-Montalvo, D. (2023). Galactorrhea in Breast Augmentation. European Journal of Applied Sciences,
Vol - 11(3). 218-225.
URL: http://dx.doi.org/10.14738/aivp.113.14781.
Skin Erithema
Neeple Dischard 3 Months Later
Germs from the normal flora of the skin may appear in cultures of milk secretion and may
confuse the diagnosis. When in doubt, a microscopic examination of the discharge showing the
presence of fat globules would confirm the diagnosis of galactorrhea.
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In these cases, the evolution is unpredictable, concluding that in cases of galactorrhea without
associated complications, the natural tendency is to spontaneously end the condition in a
variable period of time (17), our attitude should be conservative, but warning the patient that
the chances of developing a capsular contracture in the future may increase. On the contrary,
fistulization causes notable control difficulties and complicates both the treatment and the
evolution of the condition, eventually causing significant aesthetic alterations in the breast (18).
The recommendation in case of galactorrhea with fistulization is the removal of the implants
without proceeding to their repositioning (3 to 6 months) until the inflammatory activity in the
breasts does not subside. Replacing implants in the short or medium term does not ensure that
capsular contracture does not form. If fistulization does not occur, we can adopt an expectant
attitude, reserving surgical treatment for those cases in which a significant degree of capsular
contracture is established.
It is important to note that these complications were associated to a greater extent with the
choice of the peri areolar route as an access for augmentation mammoplasty, a route in which
there is a greater risk of damaging the milk ducts. The incidence is lower but not impossible in
the case of using the sub mammary route, since these ducts remain intact in most cases.
Therefore, another important recommendation would be to use the sub mammary route as the
route of choice for breast augmentation with implants in those patients with a history of
galactorrhea or who have been breastfeeding for long or recent periods.
CONCLUSIONS
Galactorrhea after breast augmentation with implants is a rare complication. In most cases no
cause is found to explain it. In the same way, the resolution of the picture occurs spontaneously
in several weeks, sometimes without the need for any treatment in most patients. However, in
some cases, the appearance of a fistula and the intensity and duration of the galactorrhea
complicate the clinical picture, giving it a different dimension, having to remove the implant (s)
depending on the evolution of the patient.
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Arellano, A., Arellano-Montalvo, F.-A., & Arellano-Montalvo, D. (2023). Galactorrhea in Breast Augmentation. European Journal of Applied Sciences,
Vol - 11(3). 218-225.
URL: http://dx.doi.org/10.14738/aivp.113.14781.
It is important to assess the evolution of the symptoms that the patient presents, with the
affectation that it entails both from the physical and psychological point of view, being able to
recommend that in the event of abundant galactorrhea after a breast augmentation, that they
are complicated with the formation of galactocele and on All with fistulization, a correct attitude
could be to remove the implants and wait for the resolution of the picture to reassess the
increase through another access route or even advise against it in the future depending on the
evolution of the patient.
Erythema in Right Breast Patient 3 Months Later Prior to the Release
of Milk.
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Patiens Before and After Pictures Treated with Long-Lasting Synthetic Alkaloids
References
1. Acartürk S, Gencel E, Tuncer I.: An uncommon complication of secondary augmentation mammoplasty:
bilaterally massive engorgement of breasts after pregnancy attributable to postinfection and blockage of
mammary ducts. Aesth. Plast Surg. 2005;29(4):274.
2. Chun YS, Taghinia A.: Hyperprolactinemia and galactocele formation after augmentation mammoplasty. Ann
Plast Surg. 2009;62(2):122.
3. Inguenault C, Capon-Degardin N, Martinot-Duquennoy V, Pellerin P.: Galactorrhea after mammary plastic
surgery. Ann Chir Plast Esthet. 2005;50(2):171.
4. Arnon O, Mendes D, Winkler E, Tamir J, Orenstein A, Haik J.: Galactorrhea complicating wound healing
following reduction mammaplasty. Aesthet Surg J. 2006;26(3):300.
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Arellano, A., Arellano-Montalvo, F.-A., & Arellano-Montalvo, D. (2023). Galactorrhea in Breast Augmentation. European Journal of Applied Sciences,
Vol - 11(3). 218-225.
URL: http://dx.doi.org/10.14738/aivp.113.14781.
5. Majdak-Paredes EJ, Shafighi M, During V, Sterne GD.: An unusual case of galactorrhea in a postmenopausal
woman complicating breast reduction. J Plast Reconstr Aesthet Surg. 2009;62(4):542.
6. Gundeslioglu O, Altundag O, Altundag K, Bilen BT, Borman H.: Lactation, galactorrhea, and timing of
reduction mammaplasty. Plast Reconstr Surg. 2006; 117(2):701.
7. Bentley M, Ghali S, Asplund OA.: Galactorrhoea causing severe skin breakdown and nipple necrosis following
breast reduction. Br J Plast Surg. 2004;57(7):682.
8. Schuurman AH, Assies J, van der Horst CM, Bos KE.: Galactorrhea after reduction mammaplasty. Plast
Reconstr Surg. 1993;92(5):951.
9. Menéndez-Graíño F, Pena Fernández C, Burrieza PI.: Galactorrhea after reduction mammaplasty. Plast
Reconstr Surg. 1990;85(4):645.
10. Song IC, Hunter JG.: Galactorrhea after reduction mammaplasty. Plast Reconstr Surg. 1989;84(5):857.
11. Bronson DL.: Galactorrhea after reduction mammaplasty. Plast Reconstr Surg. 1989;83(3):580. [ Links ]
12. Bruck JC.: Galactorrhea: a rare complication following reduction mammaplasty. Ann Plast Surg. 1987;
19(4):384.
13. Vance ML, Thorner MO.: Prolactin: hyperprolactinemic syndromes and management. En: Degroot LY, ed.
Endocrinology. Philadelphia: W.B. Saunders, 1989, Pp:408-18. [ Links ]
14. Basil HY: Etiology and treatment of hyperprolactinemia. Semin Reprod Endocrinol
1992;10:228. [ Links ]
15. El-Hassan ND, Zaworski RE, Castro A, LeMaire WJ.: Serum prolactin levels following augmentation
mammaplasty. Plast Reconstr Surg. 1981;68(2):215. [ Links ]
16. Bedinghaus JM.: Care of the breast and support of breast-feeding. Prim Care. 1997;24(1):147. [ Links ]
17. Caputy GG, Flowers RS.: Copious lactation following augmentation mammaplasty: an uncommon but not rare
condition. Aesth Plast Surg. 1994;18(4):393. [ Links ]
18. Mason T C.: Hyperprolactinemia and galactorrhea associated with mammary prostheses and unresponsive
to bromocriptine. A case report. J Reprod Med. 1991;36(7):541. [ Links ]