Breast abscesses, mastitis, breast fat necrosis Flashcards
What is the presentation of a breast abscess
- redness, tenderness, induration
- palpable and fluctuant
may arise from previous mastitis
how do you treat a peripheral breast abscess
- I&D
- Dicloxacillin or Keflex
- clinda for PCN allergy
what typically causes peripheral breast abscesses
skin infections such as epidermal cyst or folliculitis
what typically causes subareolar breast abscesses
keratin plugged milk duct behind nipple.
what is the treatment for subareolar breast abscesses
- I&D has 40% recurrence rate SO
- requires subareolar duct excision w complete removal of sinus tracts
- biopsy of abscess wall to r/o cancer
what is the cause of mastitis
- typically seen in breastfeeding mothers
- staph aureus MC
what is the presentation of mastitis
- painful, erythematous lobule in outer quadrant of breast
- can have systemic signs (fever, malaise, leukocytosis)
how do you diagnose mastitis
clinically, but breast milk coated in antibodies supports the diagnosis
what is the treatment for mastitis
- dicloxacillin or keflex
- clinda for PCN allergy (can also use bactrim but not in first month peripartum)
- severe = IV vanc + rocephin or pip/taz
what is the presentation of breast fat necrosis
- breast mass with skin/nipple retraction and ecchymosis/tenderness
- hard to distinguish from breast cancer
how do you diagnose fat necrosis of the breast
ultrasound or mammogram
what is the treatment for fat necrosis
- self resolving
- if not sesolved in several weeks do a biopsy
what is fibrocystic breast changes
benign changes in breast epithelium typically in sync with cycle
what causes fibrocystic breast changes
estrogen
what are the s/s of fibrocystic breast changes
pain/tenderness associated with new breast lump
could be present with each cycle and wax/wane
treatment for fibrocytstic breast changes
- well fitted bra
- avoid caffeine, chocolate and eat low fat diet
- NSAIDs/tylenol
- SEVERE= danzol or tamoxifen or surgery
what is the diagnostic for fibrocystic breast changes
- mammogram or ultrasound
- can aspirate for confirmation
- biopsy if suspicious
only use mammo in 30+
what is the presentation of a fibroadenoma of the breast
- round, firm, discrete, relatively
mobile, nontender mass - 1-5cm in diameter
how do you diagnose a fibroadenoma
- clinically
- biopsy can confirm
- US shows well-defined solid mass with benign features
what is the treatment for fibroadenoma
- repeat US in 3-6 months
- if rapid growth -> excision with wide margins
what can fibroadenomas be confused with? how do you differentiate this
- May be confused with a Phyllodes tumor, a fibroepithelial tumor that clinically resembles fibroadenomas and has a small chance of becoming malignant
- biopsy
what is the treatment for phyllodes tumor
excision with wide local margins
