Successful Treatment of a Recalcitrant Mondor’s Cord Following Breast Augmentation

April 23, 2014

Neil A. Shah, MD, FAAD; Joe Gryskiewicz, MD, FACS; Charles E. Crutchfield III, MD, FAAD

Neil A. Shah, MD, FAAD, is from Clarus Dermatology, Saint Anthony, Minnesota; Joe Gryskiewicz, MD, FACS, and Charles E. Crutchfield III, MD, FACS, are from University of Minnesota Medical School, Minneapolis, Minnesota.

Disclosure: The authors report no relevant conflicts of interest.

Abstract

Mondor’s disease, a superficial thrombophlebitis, is a common complication of thoracoabdominal wall surgeries. While most patients experience disease resolution with expectant management, occasionally the disease may persist. The authors present a case of a 49-year-old woman who had persistent, symptomatic Mondor’s disease 15 months status post- breast augmentation. The patient responded rapidly to intralesional triamcinolone injections resulting in complete disease resolution. To the authors’ knowledge, this is the first report of intralesional corticosteroids being used to treat this common surgical complication. (J Clin Aesthet Dermatol. 2014;7(4):50–51.)

Discussion

Mondor’s disease was first described in 1869 by Fagge, but better characterized by Henri Mondor in [1–2] 1939. It is characterized as a superficial thrombophlebitis of the thoracoepigastric veins resulting from incision, usually transversely, across the thoracoabdominal wall. The putative pathophysiology of this clinical phenomenon is venous stasis in these transected veins leading to thrombus formation, inflammation, organization, and eventually recanalization.[1–3]

The authors report a case of an otherwise healthy 49- year-old woman who presented to dermatology clinic with a 15-month history of bilateral tender inframammary cords that developed rapidly following breast augmentation. Conservative measures, including nonsteroidal anti- inflammatory drugs and expectant management, had failed to resolve one of the cords. The residual cord was 1.5cm in length (Figure 1). The patient was otherwise healthy without a personal history of breast cancer. The authors diagnosed Mondor’s disease, sometimes known as Mondor’s cord.

The patient was treated with intralesional triamcinolone acetonide over two treatment sessions spaced three weeks apart. Each injection session consisted of two injections at the 0.5cm and 1.0cm marks (total cord length of 1.5cm), of 0.1mL of triamcinolone acetonide (20mg/mL) into the substance of the cord at the depth of the mid-deep dermis. At follow-up five weeks after her initial presentation (2 weeks after the second treatment session), she had complete resolution of the cords, both to palpation and to visual inspection, with complete symptom resolution (Figure 2).

The majority of cases of Mondor’s disease arise in the setting of breast surgery, either elective augmentation or related to cancer.[3] The prevalence after breast augmentation using an inframammary approach has been reported at one percent.[3] Although Mondor’s disease classically affects the inframammary region, a similar condition has been reported in the axilla and penis as well.[4–5] Management is usually expectant with most reports suggesting warm compresses, time, and nonsteroidal anti- inflammatory medications.[6] Some guidelines advocate the use of low molecular weight heparin for both prophylaxis and treatment.[6] To the authors’ knowledge, this case represents the first documented use of intralesional triamcinolone to treat this relatively common condition, which had persisted despite conservative management.

References
1. Herrmann JB. Thrombophlebitis of breast and contiguous thoracicoabdominal wall (Mondors’ disease). NY State J Med. 1966;66:3146–3152.
2. Mondor H. Tronculite sous-cutanee subaigue de la paroi thoracigue antero-laterale. Mem Acad Chir. 1939;65:1271.
3. Khan UD. Incidence of mondor disease in breast augmentation: a retrospective study of 2,052 breasts using inframammary incision. Plast Reconstr Surg. 2008;122(2):88e–89e.
4. Conkbayir I, Yanik B, Keyik B, Hekimoglu B. Superficial dorsal penile vein thrombosis (Mondor disease of the penis) involving the superficial external pudendal vein: color Doppler sonographic findings. J Ultrasound Med. 2010;29(8):1243–1245.
5. Shoham Y, Rosenberg N, Krieger Y, et al. Axillary web syndrome—a variant of Mondor’s disease, following excision of an accessory breast. Harefuah. 2011;150(12):893–894,937,936.
6. Cesarone MR, Belcaro G, Agus G, et al. Management of superficial vein thrombosis and thrombophlebitis: status and expert opinion document. Angiology. 2007;58:7S–14S.