Benign Breast Disease

Question 1

List Ddx for a benign breast lump.

Answer 1

breast cyst
fibrocystic disease
fibroadenoma
infections - lactational or recurrent mastitis/ duct ectasia
fat necrosis
gynaecomastia

Question 2

Describe the presentation of a breast cyst on examination.

Answer 2

Painful, round, symmetrical lumps

Question 3

A patient comes to the GP with a painful, round, symmetrical lump pin her right breast. Given your most likely diagnosis:
How would you dx?
How would you tx?

Answer 3

Painful, round, symmetrical lumps - Breast cyst
DX - FNA ± triple assessment
Tx - aspiration (if symptomatic)

Question 4

How would you identify fibrocystic disease on a breast exam/history?
How would you dx?
How would you tx?

Answer 4

Multiple breast cysts a/w menstrual cycle.
DX - FNA ± triple assessment
Tx - reassure, proper fitting bra, evening primrose oil

Question 5

What is a fibroadenoma?
How would you dx?
How would you tx?

Answer 5

Painless overgrowth of 1 lobule of breast.
dx - US –> Core biopsy
tx - excision if >3cm or symptomatic

Question 6

What organisms typically cause lactational infections of the breast?
How would you tx?

Answer 6

staphylococcal infection
oral fluclox and aspiration of abscess

Question 7

Explain the pathophysiology of duct ectasia and recurrent mastitis.
How would you identify duct ectasia: recurrent mastitis on a breast exam/history?
What are the 2 main RFs?

How would you tx?

Answer 7

Duct ectasia is the dilation and inflammation of the milk ducts beneath the nipple and hence blockage of lactation. This stasis leads infection (recurrent)
Duct ectasia => inflammation of the nipple/areola
Recurrent mastitis => fever, yellow/green discharge
RF: smoking, breastfeeding, nipple piercing
Tx: oral fluclox +/- abscess

Question 8

What is the most common cause of fat necrosis of the breast?

Answer 8

fat necrosis secondary to trauma

Question 9

What are some causes of gynaecomastia?
How is it tx?

Answer 9