Breast abscesses, mastitis, breast fat necrosis

Question 1

What is the presentation of a breast abscess

Answer 1

• redness, tenderness, induration
• palpable and fluctuant

may arise from previous mastitis

Question 2

how do you treat a peripheral breast abscess

Answer 2

• I&D
• Dicloxacillin or Keflex
• clinda for PCN allergy

Question 2

what typically causes peripheral breast abscesses

Answer 2

skin infections such as epidermal cyst or folliculitis

Question 3

what typically causes subareolar breast abscesses

Answer 3

keratin plugged milk duct behind nipple.

Question 4

what is the treatment for subareolar breast abscesses

Answer 4

• 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

Question 5

what is the cause of mastitis

Answer 5

• typically seen in breastfeeding mothers
• staph aureus MC

Question 6

what is the presentation of mastitis

Answer 6

• painful, erythematous lobule in outer quadrant of breast
• can have systemic signs (fever, malaise, leukocytosis)

Question 7

how do you diagnose mastitis

Answer 7

clinically, but breast milk coated in antibodies supports the diagnosis

Question 8

what is the treatment for mastitis

Answer 8

• dicloxacillin or keflex
• clinda for PCN allergy (can also use bactrim but not in first month peripartum)
• severe = IV vanc + rocephin or pip/taz

Question 9

what is the presentation of breast fat necrosis

Answer 9

• breast mass with skin/nipple retraction and ecchymosis/tenderness
• hard to distinguish from breast cancer

Question 10

how do you diagnose fat necrosis of the breast

Answer 10

ultrasound or mammogram

Question 11

what is the treatment for fat necrosis

Answer 11

• self resolving
• if not sesolved in several weeks do a biopsy

Question 12

what is fibrocystic breast changes

Answer 12

benign changes in breast epithelium typically in sync with cycle

Question 13

what causes fibrocystic breast changes

Answer 13

estrogen

Question 14

what are the s/s of fibrocystic breast changes

Answer 14

pain/tenderness associated with new breast lump

could be present with each cycle and wax/wane

Question 15

treatment for fibrocytstic breast changes

Answer 15

• well fitted bra
• avoid caffeine, chocolate and eat low fat diet
• NSAIDs/tylenol
• SEVERE= danzol or tamoxifen or surgery

Question 15

what is the diagnostic for fibrocystic breast changes

Answer 15

• mammogram or ultrasound
• can aspirate for confirmation
• biopsy if suspicious

only use mammo in 30+

Question 16

what is the presentation of a fibroadenoma of the breast

Answer 16

• round, firm, discrete, relatively
  mobile, nontender mass
• 1-5cm in diameter

Question 17

how do you diagnose a fibroadenoma

Answer 17

• clinically
• biopsy can confirm
• US shows well-defined solid mass with benign features

Question 18

what is the treatment for fibroadenoma

Answer 18

• repeat US in 3-6 months
• if rapid growth -> excision with wide margins

Question 19

what can fibroadenomas be confused with? how do you differentiate this

Answer 19

• May be confused with a Phyllodes tumor, a fibroepithelial tumor that clinically resembles fibroadenomas and has a small chance of becoming malignant
• biopsy

Question 20

what is the treatment for phyllodes tumor

Answer 20

excision with wide local margins