Breast

Question 1

From what does a breast abscess arise?

Answer 1

Severe mastitis

Question 2

What organism is most common in breast infection?

Answer 2

Staph aureus

Question 3

What usually causes mastitis?

Answer 3

Milk stasis during lactation

Question 4

What would be the treatment of mastitis?

Answer 4

-Oral antibiotics if symptoms not improved with milk removal FLUCOXACILLIN (erythromycin/clarithromycin if allergic)

CONTINUE TO BREASTFEED

Question 5

Management breast abscess?

Answer 5

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)

Question 6

What would make you suspect breast abscess?

Answer 6

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.

Question 7

When would you send a culture of breast milk?

Answer 7

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)

Question 8

How common is fibrocystic disease amongst women of childbearing age?

Answer 8

50%

Question 9

How does fibrocystic disease of the breast present?

Answer 9

• Lumpiness and tenderness

- itchy nipples

Question 10

What kind of trend do the symptoms of fibrocystic disease follow?

Answer 10

• Change with menstrual cycle

- Usually worse before period

Question 11

What does the breast look and feel like on examination of fibrocystic disease?

Answer 11

• lumpy, cobblestone appearance
• smooth lumps with defined edges that are moveable
• most commonly in upper, outer sections of breast

Question 12

What investigations would you do on someone presenting with fibrocystic disease (depending on their age)?

Answer 12

• Mammography for older patients

- Ultrasound for younger patients (radiation risk and better for denser breasts)

Question 13

What is thought to cause fibrocystic disease?

Answer 13

• 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

Question 14

What is a fibroadenoma?

Answer 14

Benign tumour (the most common type of benign tumour in women of reproductive age)

Question 15

What would make you suspect a fibroadenoma?

Answer 15

• HIGHLY MOBILE (breast mouse)
• well defined, rubbery on palpation
• can be multiple and bilateral

Question 16

What is the management of fibroadenomas?

Answer 16

• 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

Question 17

What is fat necrosis of the breast?

What is the management?

Answer 17

• 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

Question 18

What are risk factors for fat necrosis of the breast?

Answer 18

Trauma to the breast causes fat necrosis:

• trauma from a seat belt
• breast biopsy
• implant removal/breast surgery
• radiation treatment

Question 19

How would fat necrosis of breast present?

Answer 19

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)

Question 20

What are the investigations for fat necrosis of breast?

Answer 20

• Breast exam
• Mammogram/USS
• If unclear from imaging do a fine needle aspiration (FNA) or core biopsy