Galactorrhea after augmentation mastoplasty

Dear Editor,

We commend the authors of the article entitled, “Galactorrhea: how to approach this uncommon complication after augmentation mastoplasty,” published in the latest issue of Brazilian Journal of Plastic Surgery. The work stands out for highlighting an endocrine problem that may occur after augmentation mastoplasty.

Galactorrhea may or may not be associated with hyperprolactinemia¹-³. Prolactin has, besides its role in lactogenesis, and osmoregulatory and immunological functions such as modulation of T-lymphocytes and macrophages. Its proper regulation may interfere with the postoperative healing process⁴,⁵.

Hyperprolactinemia has physiological, pathological, and pharmacological causes such as pregnancy, breastfeeding, estrogen therapy, exercise, psychological stress, and medications that interfere with dopaminergic tone such as antihistamines, antihypertensives, and anticonvulsants, as well as primary hypothyroidism and pituitary adenomas.

One of the most important stimuli for secretion of prolactin in patients with galactorrhea after augmentation mammoplasty is nipple stimulus by abrupt distension and compression. Thus, the irritation or chest wall injury due to burn, herpes zoster, and intercostal nerve injury also has a similar mechanism. Furthermore, it rules out pregnancy, breastfeeding, and galactocele, as suggested in the algorithm of the article.

As previously mentioned, the prolactin dosage is essential because it plays a key role in the adequacy of the therapeutic response to the dopamine agonist and in the investigation of diseases associated with hyperprolactinemia. The dosage of the thyroid-stimulating hormone for diagnosis of hypothyroidism and magnetic resonance imaging of sella turcica may be necessary.

The surgeon should be aware of the factors that increase the risk of infection of the implant, such as periareolar incision and collection of galactocele around the implant. The combination of these risk factors in patients with high prolactin levels increases the need for use of dopamine agonists such as cabergoline¹,³.

After endocrine and imaging assessments of normal breasts in patients with normal serum prolactin concentrations who display galactorrhea after mammoplasty augmentation, galactorrhea may be considered physiological and transient because of excessive stimulation of breast tissue, with little possibility of underlying disease. In such cases, the best conduct is medical monitoring by an endocrinologist and a plastic surgeon, with regular prolactin doses.

REFERÊNCIAS

• ¹
  Basile FV, Basile AR. Diagnosis and management of galactorrhea after breast augmentation. Plast Reconstr Surg. 2015;135(5):1349-56. PMID: 25919249 DOI: http://dx.doi.org/10.1097/PRS.0000000000001156
  » https://doi.org/10.1097/PRS.0000000000001156
• ²
  Rosique RG, Rosique MJF, Peretti JP. Postaugmentation galactocele without periareolar incision and 8 years after pregnancy. Plast Reconstr Surg Open. 2016;4(3):e644. DOI: http://dx.doi.org/10.1097/GOX.0000000000000648
  » https://doi.org/10.1097/GOX.0000000000000648
• ³
  Yang EJ. Lee KT, Pyon JK, Bang SI. Treatment algorithm of galactorrhea after augmentation mammoplasty. Ann Plast Surg. 2012;69(3):247-9. PMID: 22214792 DOI: http://dx.doi.org/10.1097/SAP.0b013e31822af880
  » https://doi.org/10.1097/SAP.0b013e31822af880
• ⁴
  Ignacak A, Kasztelnik M, Sliwa T, Korbut RA, Radja K, Guzik TJ. Prolactin--not only lactotrophin. A “new” view of the “old” hormone. J Physiol Pharmacol. 2012;63(5):435-43.
• ⁵
  Chavez-Rueda K, Hérnández J, Zenteno E, Leaños-Miranda A, Legorreta-Haquet MV, Blanco-Favela F. Identification of prolactin as a novel immunomodulator on the expression of costimulatory molecules and cytokine secretions on T and B human lymphocytes. Clin Immunol. 2005;116(2):182-91. DOI: http://dx.doi.org/10.1016/j.clim.2005.03.013
  » https://doi.org/10.1016/j.clim.2005.03.013

Publication Dates

• Publication in this collection
  29 May 2023
• Date of issue
  Jan-Mar 2017

History

• Received
  06 Aug 2016
• Accepted
  30 Oct 2016