Revolutionary Surgical Technique for Effective Treatment of Zuska’s Disease: Complete Resection Insights
Background
Table of Contents
Mammary duct fistula is an infection that occurs in the area around the nipple, primarily in young women who are not breastfeeding. The condition does not strongly relate to childbirth or breastfeeding, although some women may have inverted nipples. Men are also increasingly affected, often due to blockage and infection caused by underdeveloped duct systems. Patients who experience repeated infections after surgeries like drainage and curettage may face unnecessary extensive surgeries due to misdiagnosis with conditions like mammary tuberculosis. The disease has distinct clinical stages: mammary duct ectasia, purulent nipple inflammation, periareolar abscess, and periareolar fistula.
Effective treatment involves removing parts of the ducts beneath the nipple and correcting nipple deformities. This study explores a modified surgical approach for treating Zuska’s disease, aiming to reduce recurrences and shorten recovery time.
Case Description
Patient Data
A 45-year-old woman was admitted on May 5, 2023, for redness, swelling, and ulceration in the left areola lasting over a year. She first noticed symptoms on the medial side of her left areola without an obvious cause. One week later, she experienced skin ulceration and pus drainage. An ultrasound showed an irregular area with fluid flow, indicating inflammation, leading to incision and drainage at a local hospital.
One month before her admission, the initial area became red again, and the scar ulcerated, discharging pus. After seeking treatment at the study hospital, her medical history showed no significant issues.
Physical exams indicated symmetrical breasts, with a slight nipple inversion and a skin lesion in the left areola. The lesion had a palpable lump that discharged yellow fluid upon compression. No abnormal discharge was found from either nipple, and there were no enlarged lymph nodes in either axilla.
Routine blood tests showed normal white blood cell levels. Mammary ultrasonography indicated a hypoechoic area in the left areola with clear boundaries and visible blood flow signals.
Surgical Approach and Procedure
- Preparation: Preoperative photos marked the inflammation extent.
- Anesthesia: Local anesthesia was combined with intravenous sedatives to ease patient discomfort.
- Locating the Lesion: A sinus tract opening was identified, and the affected duct was located using sterile tools. The secretions were cleaned.
- Surgical Incision: A radial incision was made, allowing access to the affected duct. An examination was done for abscesses and necrotic tissue.
- Excising the Lesion: Diseased tissue around the duct and sinus tract opening was excised.
- Hemostasis and Gland Flap Transposition: The area was cleaned, and hemostasis was achieved. Glandular tissue was moved and sutured to fill the space.
- Nipple-Areola Plasty: The nipple was reshaped and closed with interrupted sutures to improve aesthetics.
- Wound Drainage: Routine drainage was set up post-surgery.
- Pressure Dressing: A circumferential dressing was applied around the areola to assist in blood supply restoration.
Postoperative Management
Postoperative care included cleaning and dressing changes to prevent infection. The patient received prophylactic antibiotics. Follow-up included physical exams and imaging every six months.
Treatment Outcomes
Post-surgery, dressings were changed until healing was complete within 14 to 22 days. The patient was monitored for six months without recurrence. Nipple inversion was corrected successfully.
Discussion and Conclusions
Zuska’s disease can cause painful symptoms and complications such as abscesses and breast deformity. Effective treatment requires understanding its pathology. Commonly recognized pathogens include coagulase-negative staphylococci. Current treatments for this disease vary, but successful surgical approaches focus on complete excision of affected tissue to prevent recurrences.
Types of surgical techniques include:
- Type A: Transverse nipple incision may cause blood supply issues.
- Type B: Areolar incision may miss deeper ducts.
- Type C: Radial incisions impact blood supply least but can overlook lesions.
In summary, properly excising the infected ducts is critical to preventing recurrences. This surgical technique has proven effective in managing recurrences of mammary duct fistula. Further studies are needed to validate these findings in broader cases.