Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA.
Surgical Oncology, Ridley-Tree Cancer Center, Sansum Clinic, Santa Barbara, CA, USA.
Breast Dis. 2021;40(3):183-189. doi: 10.3233/BD-201000.
Milk fistula is a potential complication of radiologic and surgical procedures on the lactating breast, though its incidence is unknown. Some postulate that larger defects and/or closer proximity to the nipple increase the risk of fistula.
This study aimed to estimate the incidence of milk fistula and characterize risk factors in patients who continued breastfeeding after surgical or radiological procedures.
A retrospective cohort analysis of pregnant or lactating women treated at a multidisciplinary breast clinic from July 2016 through August 2019 was performed. Demographic and clinical variables were analyzed using ANOVA and Pearson's Chi-square.
Two pregnant and 43 lactating patients underwent 71 interventions. The incidence of milk fistula within one week of intervention was 1.4%. One fistula was diagnosed six days after retroareolar abscess drainage. The fistula closed successfully with continued breastfeeding. When categorized by the caliber of the most invasive intervention (large-caliber: mass excision, n = 7; medium-caliber: percutaneous drain insertion, n = 18; small-caliber: stab incision, aspiration, core needle biopsy, n = 20), patients were similar in age, race/ethnicity, weeks postpartum, and frequency of central versus peripheral interventions. The low incidence of fistula prevented quantitative evaluation of potential risk factors.
Milk fistula is a rare occurrence following radiologic or surgical breast interventions performed during pregnancy or lactation. Indicated procedures should not be deferred, but periareolar approaches should be avoided when possible. Cessation of lactation is not mandatory for fistula closure, and continued breastfeeding should be recommended.
尽管牛奶瘘的发病率未知，但它是哺乳期乳房放射和手术治疗的潜在并发症。一些人推测，较大的缺损和/或更接近乳头会增加瘘的风险。
本研究旨在估计手术后继续母乳喂养的患者发生牛奶瘘的发生率，并分析其危险因素。
对 2016 年 7 月至 2019 年 8 月在多学科乳腺科治疗的孕妇或哺乳期妇女进行回顾性队列分析。采用方差分析和 Pearson's Chi-square 分析人口统计学和临床变量。
2 名孕妇和 43 名哺乳期妇女共接受 71 次干预。干预后一周内发生牛奶瘘的发生率为 1.4%。1 例瘘管在乳晕后脓肿引流后 6 天诊断。继续母乳喂养后瘘管成功闭合。按最具侵袭性干预的口径分类（大口径：肿块切除术，n = 7；中口径：经皮引流管插入术，n = 18；小口径：刺切开术、抽吸术、核心针活检，n = 20），患者的年龄、种族/民族、产后周数、中央与外周干预的频率相似。瘘管的低发生率阻止了对潜在危险因素的定量评估。
在妊娠或哺乳期进行放射或外科乳房干预后，牛奶瘘的发生率较低。应进行有指征的操作，当可能时，应避免乳晕周围入路。瘘管闭合不需要停止哺乳，应建议继续母乳喂养。
