Mammary Fistula - From Concept to Reality

Breast fistula belongs to the group of chronic mammary suppuration,one pathology marked by several reappearance,apparently without a cause, which raise many problems both for the patient and surgeon. One characteristic of this pathology is the microbial mammary abcess which untreated develops into fistula. The possibility of uninfectious mastitis less specified it's still the most usual reason for mastitis. This thing rise questions regarding clinics, pathology and treatment. This were relyes on a retrospective and prospective study of a number of 55 cases represented by patients with mammary infections which were diagnosed and surgicaly treated in Surgery Clinic of the Constanta County Hospital between 2014-2018. Mammary fistulas that appear as a consequence of amicrobial breast abscesses are characterized by multiple recurrences, even if they are treated by surgery through excision of the fistulous path. Numerous studies are trying to elucidate the cause of this pathology. There are many hypotheses, but from the studies we have found that smoking is an important etiological factor, having toxic effect through double mechanism : • directly - on the retroareolar lactiferous duct. • indirectly – hormonally, by stimulating lacteous secretion. Both hypotheses explain why this condition is recurrent. Treatment of mammary fistulas requires both smoking cessation and proper surgical treatment. Studies have shown that a simple excision of the fistula tract is not sufficient and leads to recurrences. A wide, sectoral intervention must be practiced, with excision taking the ductal branches that underlie the recurrences.