Breast Flashcards
From what does a breast abscess arise?
Severe mastitis
What organism is most common in breast infection?
Staph aureus
What usually causes mastitis?
Milk stasis during lactation
What would be the treatment of mastitis?
-Oral antibiotics if symptoms not improved with milk removal FLUCOXACILLIN (erythromycin/clarithromycin if allergic)
CONTINUE TO BREASTFEED
Management breast abscess?
Breast abscess
- Confirmation of the diagnosis (by ultrasound)
- Drainage of the abscess (by ultrasound-guided needle aspiration or surgical drainage)
- CULTURE of ABSESS FLUID (guide AB choice)
CONTINUE TO BREASTFEED (if this is too painful-recommend breast pump until able to breastfeed again)
What would make you suspect breast abscess?
Breast abscess
-A history of recent mastitis
-Fever and/or general malaise
-A painful, swollen lump in the breast
-Signs of inflammation: red/hot/swelling
On examination, the lump may be fluctuant with skin discolouration.
When would you send a culture of breast milk?
Breast milk culture is not usually done, however:
- if recurrent and severe mastitis
- hospital acquired infection is likely
- deep ‘burning’ sensation (likely to be ductal infection)
How common is fibrocystic disease amongst women of childbearing age?
50%
How does fibrocystic disease of the breast present?
- Lumpiness and tenderness
- itchy nipples
What kind of trend do the symptoms of fibrocystic disease follow?
- Change with menstrual cycle
- Usually worse before period
What does the breast look and feel like on examination of fibrocystic disease?
- lumpy, cobblestone appearance
- smooth lumps with defined edges that are moveable
- most commonly in upper, outer sections of breast
What investigations would you do on someone presenting with fibrocystic disease (depending on their age)?
- Mammography for older patients
- Ultrasound for younger patients (radiation risk and better for denser breasts)
What is thought to cause fibrocystic disease?
- Hormone levels - oestrogen, progesterone, prolactin
- These hormones cause breast cells to grow and multiply
- Fluctuations of hormones over years cause small cysts and dense tissue
What is a fibroadenoma?
Benign tumour (the most common type of benign tumour in women of reproductive age)
What would make you suspect a fibroadenoma?
- HIGHLY MOBILE (breast mouse)
- well defined, rubbery on palpation
- can be multiple and bilateral
What is the management of fibroadenomas?
- Fibroadenomas have very low malignant potential
- Watch and wait with routine follow up appointments
- 30% will get smaller in 2 years
Surgical excision
-if >3cm or patient preference
What is fat necrosis of the breast?
What is the management?
- BENIGN INFLAMMATORY PROCESS where area of breast tissue is damaged
- Instead of forming a scar tissue, the fat cells die and release their contents>this forms a sac-like collection of greasy fluid called an oil cyst
- Usually self limiting and will disappear
What are risk factors for fat necrosis of the breast?
Trauma to the breast causes fat necrosis:
- trauma from a seat belt
- breast biopsy
- implant removal/breast surgery
- radiation treatment
How would fat necrosis of breast present?
Fat necrosis
- firm, round lump (or lumps)
- usually painless but may be tender/painful
- surrounding skin may be red/bruised
- may have dimpling/inverted nipple (present similarly to cancer)
What are the investigations for fat necrosis of breast?
- Breast exam
- Mammogram/USS
- If unclear from imaging do a fine needle aspiration (FNA) or core biopsy
