Galactorrhea after aesthetic breast augmentation with silicone implants: report of two cases and management of postoperative galactorrhea

Screening with Metoclopramide Test to Reduce Unnecessary Pituitary Magnetic Resonance Studies in Moderate Hyperprolactinemia

BACKGROUND

In prolactinoma diagnosis, current guidelines recommend prolactin (PRL) assessment, considering values exceeding 200 ng/mL highly suggestive of prolactinoma. However, subtler hyperprolactinemia is more common, and to rule out potential prolactinomas, pituitary resonance magnetic imaging (MRI) studies are necessary. These present limitations in terms of availability, costs, and delays in diagnosis. We aimed to evaluate the screening utility of the metoclopramide (MCP) test in identifying patients with moderate hyperprolactinemia for whom MRI studies might be unnecessary.

METHODS

We retrospectively selected patients with moderate hyperprolactinemia, with an MCP test and a pituitary MRI within the same assistance, and with no interfering pharmacological treatment. Increases in PRL (ΔPRLMax) and thyrotropin (ΔTSHMax) after MCP infusion were compared according to MRI findings: patients with microadenoma (<10 mm; n = 23), with macroadenoma (≥10 mm; n = 5), or without adenoma (n = 39).

RESULTS

ΔPRLMax exceeds baseline PRL capability to identify patients with an adenoma (area under the curve = 0.872 vs 0.776). ΔPRLMax below 220% identifies 100% of these patients with 71% of specificity. This screening would have avoided 42% of MRI, resulting in a cost savings of 34%. Analysis of ΔTSHMax only slightly increased specificity when considered as a secondary criterion. Test duration can be shortened to 30 min without compromising its screening capability.

CONCLUSIONS

A short MCP test is a useful and cost-effective screening tool to avoid unnecessary MRI. Its simplicity allows its performance in almost any clinical facility to easily rule out prolactinoma in an important percentage of patients, something of upmost importance especially in regions where MRI facilities or their access are limited.

Infected Galactorrhea after Augmentation Mastopexy: A Clinical Case

We report the case of a 35-year-old female patient who presented with stabbing pain on inspiration and expiration, fever, and dyspnea. The patient had undergone breast augmentation with mastopexy and upper quadrant liposuction 5 days earlier. Seven days after hospitalization, a fistula ruptured in the left breast at the suture, and copious outflow of thick whitish fluid was observed. The breast implants were then removed. During surgery, a small amount of fluid was found, and bacterial culture revealed a Cutibacterium acnes infection, for which antibiotics were prescribed. Fifteen days after implant removal, the patient complained of uncomfortable tingling sensations, similar to breastfeeding. A dressing was applied, which resulted in the copious discharge of whitish, viscous fluid through the wound and nipple. The prolactin level was four times higher than the normal range. The patient was diagnosed with hyperprolactinemia and prescribed bromocriptine treatment, which restored her prolactin levels to normal within 4 days. After 4 weeks of hospitalization, the patient was discharged in good condition. This is the first case in the world to show that, in addition to infection, galactorrhea can be an extremely rare complication, which in our case was detected at a late stage at a similar clinic.

Galactorrhea/Galactocele After Breast Augmentation: A Systematic Review

AIMS

To review cases of galactorrhea and galactocele postbreast augmentation, determine possible risk factors and consider management strategies of this rare complication.

METHODS

A systematic literature review was conducted in July 2019 searching Pubmed, Embase, and Google Scholar.

RESULTS

The searches revealed 19 articles (17 case reports/series and 2 retrospective chart reviews) collectively comprising 38 women. The average age was 28 years, 42% were on oral contraceptives, whereas a quarter were nulliparous. The most common incision was periareolar (48%) followed by transaxillary (24%). The most common implant location was subglandular (57%) followed by subpectoral (37%). The average time to symptom onset was 61 days (range, 3-912 days) but only 3 cases presented more than a month after implant insertion. Twenty-one patients had galactorrhea, 7 had galactocele, whereas 10 women had both. Bilateral symptoms were present in 72% of cases, whereas hyperprolactinemia was present in only 62%. Management strategies included simple surveillance, antibiotics, dopamine agonists, leukotriene receptor antagonists, estrogenic agents, surgical washout, and implant removal (8 patients). The mean time to symptom resolution was 22.6 days.

CONCLUSIONS

The numbers are too small for definitive conclusions but there is a weak suggestion that periareolar incisions, subglandular implants, prior hormonal contraceptive use, gravidity, and recent history of breastfeeding (<1 year) may be risk factors for galactorrhea/galactocele. Symptom onset is usually within 3 months. Treatments providing the fastest response (2 days) comprised of a composite approach (antibiotics, dopamine agonist, surgical drainage, and implant removal), whereas the use of estrogenic medications appeared to confer little benefit.

Galactorrhea Following Minimally Invasive Reoperative Mitral Valve Replacement: An Unexpected Complication

Galactorrhea, or nonpuerperal lactation, is a rare complication that can occur after trauma to the chest wall. Although galactorrhea has been reported after thoracic surgery, it has not been previously noted as a potential outcome following cardiac surgery. We present a unique case of hyperprolactinemic galactorrhea experienced by a 39-year-old nongravid female patient after having undergone reoperative mitral valve replacement via a right minithoracotomy. To the best of our knowledge, this is the first reported case of spontaneous lactation occurring after cardiac surgery.

Galactocele After Aesthetic Breast Augmentation with Silicone Implants: An Uncommon Presentation

BACKGROUND

Breast augmentation is one of the most frequently performed esthetic operations. Galactorrhea and galactocele formation are both very rare complications. The real cause still remains unknown, but various risk factors have been well reported in the literature. This report concerns a case of postoperative galactocele following bilateral breast augmentation via the inframammary approach with dual-plane insertion of implants, which is usually considered a protective approach in terms of risk factors for induction of postoperative galactorrhea.

METHODS

The patient had no significant surgical, gynecological or medical history, including galactorrhea or hyperprolactinemia, and did not present any chest wall abnormalities. There has been no use of oral contraceptives or any other drugs. After the surgical procedure, the patient presented with infection-like symptoms, for which galactorrhea or galactocele was initially not considered, mainly for the absence of specific risk factors.

RESULTS

After antibiotic and bromocriptine therapy, her breast returned to normal, with no pain, inflammation, enlargement or esthetic alterations. After 6 months of follow-up, the patient did not present any abnormality and she was satisfied with the result.

CONCLUSION

With our report, we want to underline that galactorrhea and galactocele cannot be ruled out, even in patients with no risk factors and with procedures considered as "protective." With a fast diagnosis and a specific therapy, implants and final result can be rescued. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

[Lactation after breast plastic surgery: literature review]

The occurrence of lactation is a rare complication of breast plastic surgery. During the course of his practice, the plastic surgeon will probably encounter this complication. The goal of this article is to carry out a literature review of all published galactorrhea and/or galactocele cases following a breast-reduction or a breast-augmentation, representing a total of 34 cases reported in 21 articles. The physiopathology of this complication is linked to an inappropriate secretion of prolactin in a surgical context. The factors favoring this complication would be the number of pregnancies, a history of recent and extensive nursing, and the intake of certain medicines such as an oestro-progestative pill. The main symptom of this complication is the occurrence of a uni- or bilateral galactorrhea, on average 12.6 days after the surgery. The main differential diagnosis is a postoperative infection. The explorations presented a hyperprolactinemia in 69% of cases. No biological inflammatory syndrome was reported. A fluid collection evoking a galactocele was visible on the ultrasound in 65% of cases. One case of prolactin-secreting pituitary adenoma was reported. Depending on the case, the treatment varied from a simple surveillance to the association of a dopamine agonist, an antibiotic therapy, and a surgical revision. A diagnostic and therapeutic management strategy is proposed.