Definitive Treatment for Galactocele
When a galactocele is definitively diagnosed on imaging (ultrasound), no further intervention is typically needed, as observation alone is the definitive management. 1
Diagnostic Confirmation
The American College of Radiology recommends ultrasound as the first-line imaging modality for evaluating breast masses in pregnant and lactating women, with 100% sensitivity for diagnosing breast masses in this population. 1 Once imaging confirms the diagnosis of galactocele, the lesion can be managed conservatively without additional treatment. 1
Treatment Options
Asymptomatic Galactoceles
- Observation is the definitive treatment when galactocele is confirmed on imaging, as these are benign cystic lesions that do not require intervention. 1
- No surgical excision or aspiration is necessary for asymptomatic, definitively diagnosed galactoceles. 1
Symptomatic Galactoceles
- Therapeutic aspiration can be performed if the galactocele causes persistent clinical symptoms (pain, discomfort, or significant mass effect). 2
- Fine needle aspiration (FNA) yields milky fluid that is often both diagnostic and therapeutic, providing immediate symptom relief. 3, 4
- If the mass resolves after aspiration of blood-free fluid, the patient should be monitored for any recurrence. 2
Recurrent Galactoceles After Aspiration
- If the mass recurs after aspiration, repeat aspiration can be considered for symptomatic relief. 2
- Surgical excision is rarely necessary and should be reserved only for cases where malignancy cannot be excluded or when recurrent symptomatic galactoceles fail conservative management. 2
Critical Diagnostic Caveat
Galactoceles must be differentiated from other breast masses, including malignancy, as breast cancer can occur during pregnancy and lactation. 1 While over 80% of palpable masses biopsied in pregnant or lactating women are benign, definitive imaging confirmation is essential before adopting a conservative approach. 1
Follow-Up Strategy
- For conservatively managed galactoceles, clinical follow-up with physical examination is appropriate to ensure stability. 2
- If the lesion increases in size or changes character on follow-up imaging, tissue sampling should be performed to exclude other pathology. 2
- Routine screening can resume once the galactocele is confirmed stable or has resolved. 2