Breast - Benign Flashcards
What are the main causes of mastalgia?
Cyclical pain:
- hormone changes e.g. menstruation or HRT
Non-cyclical pain:
- medication e.g. contraception, sertraline, haloperidol
Extramammary pain:
- chest wall, shoulder pain
How can mastalgia be managed?
Reassurance
Pain control:
- oral ibuprofen or paracetamol
What is mastitis and what causes it?
Inflammation of the breast tissue
Most commonly staph aureus
How is mastitis classified?
Lactational mastitis (more common) - usually in first 3 months of breastfeeding or during weaning
Non-lactational mastitis (less common)
What is the main risk factor for non-lactational mastitis?
Smoking
What are the clinical features of mastitis?
Tenderness, swelling or induration, and erythema
Lactational mastitis associated with cracked nipples and milk stasis
Abscess formation can occur
What is the management for mastitis?
Antibiotics and simple analgesia
Continue milk drainage or breastfeeding
How does a breast abscess present?
Tender, fluctuant and erythematous mass
May have a puncutum
Associated fever and lethargy
How is a breast abscess managed?
Antibiotics + US guided needle aspiration
If advanced, incision and drainage under local anaesthetic
How do breast cysts present?
May be single or multiple, affecting one or both breasts
Distinct, smooth masses
May be tender
How is a breast cyst diagnosed?
Mammography –> typical halo shape
USS definitive diagnosis –> fluid filled cavity
How are breast cysts managed?
Usually self resolve
Large cysts can be aspirated for aesthetic reasons or patient reassurance
What is mammary duct ectasia?
Dilation and shortening of the major lactiferous ducts in peri-menopausal women
How does mammary duct ectasia present?
Coloured green/yellow nipple discharge
- if blood stained –> triple assessment
Palpable mass
Nipple retraction
How is mammary duct ectasia diagnosed?
Mammography –> dilated calcified ducts, without features of malignancy
If biopsied –> multiple plasma cells (plasma cell mastitis)
How is mammary duct ectasia managed?
Conservatively unless unable to exclude malignancy
Duct excision if unremitting nipple discharge
What is fat necrosis and what causes it?
Acute inflammatory response in breast –> ischaemic necrosis of fat lobules
Associated with blunt trauma or previous surgical/radiological intervention
What are the clinical features of fat necrosis?
Usually asymptomatic or presents with lump
Less commonly - discharge, skin dimpling, pain and nipple inversion
Can lead to chronic fibrotic change –> solid irregular lump
How is fat necrosis diagnosed?
Positive traumatic history + hyper echoic mass on USS
May mimic carcinoma on examination/mammography so core biopsy to definitively rule out malignancy
What is the management of fat necrosis?
Analgesia + reassurance
What is the most common type of benign breast lump and what are the other types?
Fibroadenoma (most common) Adenoma Papilloma Lipoma Phyllodes Tumour
What are the features of a fibroadenoma?
Women of reproductive age Highly mobile (breast mouse) Well defined and rubbery Usually less than 5cm Very low malignant potential
What are the indications for excision of a fibroadenoma?
> 3cm diameter
Patient preference
What are the features of an adenoma?
Benign glandular tumour
Older females
Nodular and easily mimic malignancy (so usually triple assessment)
What are the features of a papilloma?
Females 40-50s
Subareolar region (usually less than 1cm away from the nipple)
Often present with bloody or clear nipple discharge
Similar to ductal carcinoma on imaging so biopsy
What are the features of a lipoma?
Soft + mobile benign adipose tumour
Low malignant potential
Only removed if enlarging or symptomatic
What is a Phyllodes tumour and what are the features?
Rare fibroepithelial tumours
Large, comprise of both epithelial and stroll tissue
Often grow rapidly
1/3 have malignant potential so wide excision (or mastectomy if large)
