Breast Sinus Tracts: Causes and Treatment Options

Breast duct

Hello, my mother is 52 years old.
Twenty years ago, she had a lobular hyperplasia surgery on her left breast.
Last year, the surgical site unexpectedly opened up and closed several times.
My mother didn't think much of it, but in July, a new hole suddenly appeared above the previously operated area, and it began to drain pus.
She has been seeing doctors, but the wound has not healed.
The doctors mentioned that these two wounds have formed a fistula.
At the end of last year (December 2001), a doctor performed surgery to clean out the pus from the new wound.
However, just a few days after the stitches were removed, the new wound opened again and started to drain pus, which continues to occur every two days.
The wound still hasn't healed and continues to drain pus.
When I asked the surgeon why this is happening, he couldn't provide an explanation.
I would like to ask what could be causing the wound to not heal and to keep draining pus.
Are there similar cases in medicine? How can this be effectively treated? Please provide some feasible solutions.
Thank you, a son concerned about his mother's condition, Wencun.

Anonymous, 50~59 year old female. Ask Date: 2002/01/07

Dr. Huang Zhihui reply Surgery

The wound on your mother's breast, which has suddenly become infected after twenty years and has continued to produce pus for six months, is indeed an uncommon situation.
Based on your description, there are several possibilities, such as the presence of a foreign body in the wound, diabetes, or your mother's own poor resistance to infections.
However, since breast surgery is not my area of expertise, I recommend consulting another physician who specializes in breast surgery for potentially more detailed answers.
Thank you.

Reply Date: 2002/01/07

More Info

Breast sinus tracts, also known as fistulas, can be a complex issue, especially in the context of previous breast surgeries or conditions like sclerosing adenosis (which is often associated with lobular hyperplasia). In your mother's case, the history of a lobular hyperplasia surgery and the subsequent development of a sinus tract that has not healed properly raises several important considerations.

Causes of Breast Sinus Tracts
1. Previous Surgery: Surgical interventions can lead to scar tissue formation, which may disrupt normal healing processes. In your mother's case, the initial surgery for lobular hyperplasia may have created a weak area in the tissue that is prone to infection or further complications.

2. Infection: The presence of pus and the inability of the wound to heal suggest a chronic infection. This could be due to bacteria entering the wound, possibly exacerbated by the previous surgical site. Chronic infections can lead to the formation of sinus tracts as the body attempts to drain the infection.

3. Foreign Body Reaction: Sometimes, materials used during surgery (like sutures or other implants) can provoke a chronic inflammatory response, leading to the formation of a sinus tract.

4. Underlying Conditions: Conditions such as diabetes or immunosuppression can impair healing and increase the risk of infections, making it harder for wounds to close properly.

Diagnosis
To properly diagnose the cause of the sinus tract and the ongoing discharge, a thorough evaluation is necessary. This may include:
- Imaging Studies: Ultrasound or MRI can help visualize the extent of the sinus tract and any associated abnormalities in the breast tissue.

- Culture Tests: Taking samples from the discharge can help identify any infectious organisms, guiding appropriate antibiotic therapy.

- Histological Examination: If there is suspicion of abnormal tissue growth or malignancy, a biopsy may be warranted.

Treatment Options
1. Antibiotics: If an infection is confirmed, a course of appropriate antibiotics is essential. This may need to be adjusted based on culture results.

2. Surgical Intervention: If the sinus tract is persistent and not responding to conservative measures, surgical excision of the tract may be necessary. This involves removing the entire tract and any infected tissue to promote healing.

3. Wound Care: Proper wound management is crucial. Keeping the area clean and dry, and possibly using dressings that promote healing, can help.

4. Follow-Up Care: Regular follow-ups with a healthcare provider are essential to monitor healing and address any complications promptly.

5. Consideration of Underlying Conditions: If there are underlying health issues (like diabetes), managing these conditions can significantly improve healing outcomes.

Conclusion
In summary, breast sinus tracts can arise from various causes, particularly following surgical procedures. In your mother's case, the combination of her surgical history and the current symptoms suggests a need for comprehensive evaluation and management. It is crucial to work closely with a healthcare provider, preferably a breast specialist or surgeon, to determine the best course of action. Early intervention can prevent further complications and promote healing, ensuring your mother receives the care she needs.

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