Question: I have a patient who underwent a needle biopsy of a galactocele. A week later, she continues to leak fluid from the entry site on the upper lateral aspect of her breast. I don’t know much about galactoceles. How does she get the entry site to heal so that it will stop leaking?
Heather Henry, RN, IBCLC
Answer: A galactocele is a sterile cyst formed when a milk duct becomes blocked. How this happens is poorly understood. There isn’t much detail about galactocele formation in the standard lactation texts. Investigation and treatment are similar to management of breast abscesses.
The fluid in a galactocele is trapped milk rather than pus (as would be the case in an abscess.) Over time, the encapsulated milk becomes thick and cheesy. Galactoceles often recur after aspiration, and are generally removed surgically under local anesthesia. Post-procedure infection is a major risk.
It is not necessary to wean owing to a galactocele. Some women opt to wait until after weaning to remove them. In other cases, the recurrence of plugged ducts creates so many problems that the galactocele is removed immediately.
Procedures performed on a lactating breast are often messy during the healing phase. The wounds may leak milk, lymphatic fluid, and perhaps small amounts of blood. While the leaking tends to worry mothers, it is important that these wounds heal properly. Reassure the mother such wounds heal slowly. Several weeks may pass before the wound heals externally. But if the skin closes before the wound has healed internally, there is a risk that trapped fluid may form a fistula. If a fistula bursts, more trauma occurs.
Some surgeons insert a wick or a drain in order to prevent the skin from closing too soon. These are withdrawn as the wound granulates and fills in internally. Figs. 262, 265, and 268 in The Breastfeeding Atlas, 4th edition show various types of drains and wicks. Chapter 11 reviews issues related to management of women with galactoceles and breast abscesses.
Advise this mother to be patient and to keep the wound area clean. Kay Hoover advises using a small disposable diaper worn inside a sports bra to soak up leaks. The plastic backing of the diaper helps protect clothing.
A controlled trial in Thailand looked at 2 treatments for galactocele. The first treatment involved needle aspiration of galactoceles. If the galactocele recurred, excision took place. The second treatment used a 6-0 nylon thread to probe the duct, mimicking a traditional Thai folk remedy that uses twisted strands of human hair to open the plugged duct. Both methods worked to eliminate the symptoms. The needle aspiration was painful; nylon probing was not. The aspiration technique was faster taking 15 minutes less time. In 2 of the 5 aspiration cases the galactocele recurred; none recurred in the nylon probing group.
Auvichayapat P, Auvichayapat N, Tong-un T, Thinkhamrop B, Vachirodom D, Uttravichien T: A controlled trial of a new treatment for galactocele. J Med Assoc Thai 86(3):257-61, 2003
To read about a novel way to manage galactocele, see:
http://www.ncbi.nlm.nih.gov/pubmed/12757066?ordinalpos=8&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
