Opening of superficial abscesses
Superficial forms include subcutaneous and intramammary accumulations of pus. Linear incisions are used for their treatment.
Access Features:
- Direction: Incisions are made strictly radially relative to the nipple. This is critically important to prevent accidental transection and damage to the radial lactiferous ducts.
- Restriction: The incision line must under no circumstances affect the area of the nipple-areolar complex.
- Completion of Surgery: After complete evacuation of the purulent cavity, it is drained. Soft rubber strips or tubes are used for this purpose. The wound is only partially sutured to ensure free outflow of exudate.
Surgery of deep abscesses and phlegmons
When the purulent focus is located deeply, standard radial incisions on the anterior surface of the breast are ineffective. In such cases, multiple and very deep tissue dissections would be required, which inevitably leads to pronounced breast deformation and an unsatisfactory cosmetic result.
Preferred Technique: An arcuate incision made along the natural skin fold beneath the breast (submammary access) is considered optimal.
Stages of Intervention:
- Dissection of the skin and subcutaneous fat layer directly beneath the breast.
- Retraction of the breast tissue upward for adequate exposure of its posterior surface.
- Opening of the purulent cavity: performed by a radial incision of the breast tissue, but from its posterior surface.
- Evacuation of accumulated pus and mandatory digital revision of the cavity, during which connective tissue septa are disrupted and necrotic masses are removed.
- Placement of tubular drains with additional lateral openings into the cavity.
- Return of the breast to its natural anatomical position and approximation of the edges of the initial skin incision with sutures.
Retromammary phlegmons and abscesses
Retromammary purulent processes are characterized by a specific localization: they form in the cellular space between the mammary gland itself and the deeper pectoral fascia.
Surgical Tactics: The same access used for deep intramammary abscesses is employed to open retromammary collections. An arcuate incision is made in the submammary fold beneath the breast, which safely approaches the abscess without traumatizing the glandular tissue itself and ensures good gravitational outflow of pus.
Related chest wall interventions (reference)
In addition to breast surgery, thoracic surgery often requires access to the chest organs and pleural cavity in case of trauma or purulent processes (empyema of the pleura, exudative pleurisy).
Basic Principles:
- Pleural Drainage: Performed in the 7th–8th intercostal space along the posterior axillary line (posterior drainage) or the 4th–5th intercostal space (anterior drainage in case of uncertain aerostasis).
- Rib Resection: Requires careful detachment of the periosteum (periosteum). Farabeuf's raspatory is used externally, and Doyen's raspatory (raspatorium Doyeni) is used internally, allowing the periosteum to be separated along with the parietal pleura while protecting the intercostal neurovascular bundle. Bone transection (osteotomy) is performed with rib shears.
- Chest Wall Closure: Requires strictly layered suturing (up to 4 rows) to create absolute airtightness.
Briefly: answers to topical questions
What forms of purulent mastitis exist according to anatomical localization?
Several forms of purulent mastitis are distinguished according to the anatomical localization of the inflammatory focus.
- Subcutaneous — located superficially.
- Subareolar — frequent localization beneath the areola.
- Intramammary — located within the thickness of the gland (most frequent localization).
- Retromammary — located behind the gland.
- Galactophoritis — inflammation of the lactiferous ducts.
- Total — all parts of the breast are affected.
Which arteries supply the mammary gland with blood?
Blood supply to the mammary gland comes from several arterial sources.
- Internal thoracic artery (a. thoracica interna) — gives off anterior intercostal branches for the medial regions.
- Lateral thoracic artery (a. thoracica lateralis) — a branch of the axillary artery, supplying the lateral and inferior regions.
- Posterior intercostal arteries (aa. intercostales posteriores) — give off lateral cutaneous branches from the III–VII arteries.
- Axillary artery (a. axillaris) — participates in blood supply via the thoracoacromial artery and its branches.
Where does lymph drainage from the mammary gland occur?
Lymph drainage from the mammary gland occurs via several main pathways.
- Axillary pathway — the main one (about 75% of lymph), drainage goes to the axillary lymph nodes (nodi lymphatici axillares) and then to the subclavian nodes.
- Parasternal pathway — from the medial quadrants to the parasternal lymph nodes (nodi lymphatici parasternales).
- Supraclavicular pathway — from the upper regions to the supraclavicular lymph nodes.
- Intercostal pathway — from the posterior regions to the intercostal lymph nodes.
- Cross pathway — occurs via anastomoses between lymphatic vessels.
Which nerves provide innervation to the mammary gland?
Innervation of the mammary gland is provided by several groups of nerves and fibers.
- Cutaneous branches of thoracic nerves (rr. cutanei nn. thoracici) — anterior and posterior branches of II–VI spinal nerves provide sensory innervation to the skin and glandular tissue.
- Supraclavicular nerves (nn. supraclaviculares) — branches of the cervical plexus that innervate the skin of the upper parts of the gland.
- Sympathetic fibers — pass as part of cutaneous nerves, providing secretory innervation to glandular cells and innervating vascular smooth muscle.
To memorize incisions: "Superficially — sun rays (radially from the nipple), deeply — a smile under the breast (arcuate in the submammary fold)."
Class and exam questions
What is the disadvantage of radial incisions in deep abscesses?
When deeply localized, they require deep tissue dissection, which is ineffective for drainage and leads to severe breast deformity.
Where is retromammary phlegmon localized?
The purulent process in retromammary phlegmon is located in the space between the posterior surface of the mammary gland and the pectoral fascia.
What else to study on this topic
- Indications and access points for pleural cavity drainage
- Technique of placing pulley sutures for rib approximation
- Osteotomy and periosteal management instruments (Farabeuf and Doyen elevators)
- Steps of surgical debridement of penetrating chest wounds
- Chest wall defect reconstruction using muscle flaps
Master the complete topic in the "Topographic Anatomy" course
This is a summary. The course covers everything tested in classes and exams.
- Complete study guide on «Surgery for Purulent Mastitis» and 2,777 more pages on the subject
- Assignments and quizzes after every topic — just like in a colloquium
- AI tutor answers questions on the topic anytime
- 91 video lessons on the subject
Other topics in the section "Operations on the Chest Wall and Thoracic Organs"
Free video lessons: topographic anatomyShort lessons with study notes — no registration required.
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.