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Breastfeeding can be difficult for many new moms, but one could argue that a 29-year-old Austrian has had a lot worse.
It was not just her breasts that swelled, ached, and produced milk – it was her vulva as well.
Doctors at the obstetrics and gynecological endocrinology section of Kepler University Hospital in Austria saw the woman only five days after the birth of her second baby.
She had been entrusted to their care following complaints of swelling and pain in the vulva. There were some tears during the recent birth and she had received two sets of stitches in two different parts of the sensitive area.
"At the time of transfer, this patient reported that on the fourth day after delivery, she had developed a bilateral flow of milky white fluid on the vulva," the team said.
She noticed increasing swelling on both sides, right and left, ranging from labia majora to labia minora and extending to the perineal area near the anus within 4 days following l & # 39; childbirth. "
The first thought was that something was wrong with the stitches; but the woman told the doctors that she had had similar symptoms after her first pregnancy.
Taking this into account, the medical team realized that the patient had ectopic breast tissue (not in the usual place), right there, in her external genitalia. An ultrasound confirmed the diagnosis.
And, although there was no nipple, there was a duct – and it was milk that excreted.
This may seem like a totally bizarre situation, but it can be explained quite easily when we look in detail at the development of human breasts; they can be much more complicated than we think.
Humans – like all other mammals – have what is known as an embryonic milk line or a breast crest. When we are still tiny embryos, it is the region on which our bodies will form nipples; in some of us, it is along this line that we will also form mammary glands and breast tissue during puberty.
(Geneva Foundation for Medical Training and Research / CC BY 3.0)But here's the thing: nipples and breast tissue can form anywhere along these milk lines; it's what causes things like third (or more) nipples along the milk lines, or in this case, breast tissue on the vulva.
Such a phenomenon is rare, but it is not uncommon; A quick glance will reveal several other cases in the literature.
However, most of the time, this ectopic breast tissue is not discovered until it begins to present problems, such as swelling during pregnancy or the development of a cancerous tumor. To treat such cases of cancer, the tumor and the breast tissue are removed, which generally solves the problem.
With regard to the Austrian mother, it appeared that some stitches on one side had caused a galactostasis, where the milk was accumulated to a painful degree. To treat this, the doctors removed the stitches from the ectopic breast tissue and gave the patient antibiotics to treat the inflammation.
Fortunately, the pain, swelling and discharge of the vulva milk slowed over the next two weeks and the woman was able to continue breastfeeding without further problem.
The researchers explain that the breast tissue has not been removed, although they have discussed potential tumor-related issues in the future.
"Because of the potential for development of malignant tumors in ectopic breast tissue, it seems prudent to recommend excision of these tissues, even in the absence of guidelines for the management of extramammary breast tissue," explains the team
"The diagnosis is important to differentiate from other vulvar masses, such as vulvar carcinoma, and to guide proper management."
The search was published in Obstetrics and Gynecology.
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