Galactocele: aetiology, clinical presentation, diagnosis and treatment

Galactoceles are cystic formations filled with milk, appearing due to blockage of the lactiferous ducts during lactation, in the early period after the end of breastfeeding, as well as in the third trimester of pregnancy.

Aetiology and pathogenesis of galactocele

The main pathophysiologic mechanism of galactocele development is obstruction of the lactiferous ducts in the lactating breast.

Factors leading to obstruction may include:

• Improper breastfeeding technique;
• Reduced frequency of breastfeeding;
• Trauma or inflammatory diseases of the breast;
• Abnormalities of nipple development;
• The presence of a tumour compressing the lactiferous duct.

Obstruction of the duct leads to incomplete emptying of its proximal parts and gradual enlargement of the latter with the formation of a cystic cavity filled with milk.

Clinical Manifestations

Clinically, a galactocele is manifested by the presence of a painless round or oval elastic mass in the breast (the most common localisation is in the retroareolar region).

The size of the mass is variable, ranging from 1 to 10 cm, and may vary throughout the day, up or down, depending on the frequency and volume of feeding. Galactoceles can be single or multiple, localised in one or both breasts.

In rare cases, infection of a galactocele with the development of inflammatory complications is possible, which is clinically manifested as redness and infiltration of the skin over the formation, the appearance of local soreness and increased body temperature.

Diagnosis of galactocele

1. Medical history, examination and palpation of breasts;
2. Breast ultrasound: allows visualisation of non-echoic fluid-filled, avascular cystic mass;
3. Breast MRI: can be used as a clarifying diagnosis, is not the method of choice;
4. Mammography: is used very rarely due to radiation exposure and is only indicated when a malignant breast tumour is suspected;
5. Fine-needle aspiration biopsy of the contents of the mass under ultrasound control.

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Treatment of galactocele

In most cases, treatment of galactocele is not required, and the masses resolve on their own.

Uncomplicated form

Patients with uncomplicated galactocele are recommended to exclude the risks of traumatisation and to comply with breastfeeding technique (correctly latching the baby to the breast and avoiding both too frequent pumping out and long breaks between feedings).

Larger sizes

In case of a large size of galactocele and ineffectiveness of non-surgical management, aspiration of the contents of the cystic cavity by fine-needle aspiration biopsy or drainage of the cavity with a catheter is indicated. Surgical treatments are generally not used.

Infection

In case of infection of the galactocele, drainage of the cystic cavity and antibacterial treatment are indicated.

Staphylococci and Streptococci are the most common infectious agents.

Medical Therapy

First-line therapy includes antibiotics from the penicillin group (cloxacillin 500 mg 4 times a day for 10–14 days) and first-generation cephalosporins (cephalexin 500 mg 4 times a day for 10–14 days).

In case of ineffectiveness of first-line antibiotics or in the presence of relevant contraindications, clindamycin 300 mg 4 times a day for 10–14 days is recommended.