Breast conditions Flashcards
Define/causes of mastitis? What is it called if it occurs in postpartum women lactation?
Inflammation of the breast tissue +/- infection.
If associated with lactation in postpartum women, then this condition is called puerperal mastitis.
Caused by milk stasis that may occur due to:
- inadequate milk removal (poor breastfeeding technique or infrequent feeding)
- entry of bacteria through cracked or sore nipples (Staph aureus)
Presentation of mastitis?
Localised pain, tender, red, and hot breast, nipple discharge purulent. “wedge shaped”
Systemic: fever, rigors, myalgia, fatigue, nausea, headache.
Unilateral breast
May present within first week postpartum.
Can lead to breast abscess
- fluctuant tender mass with redness.
Diagnosis/IVx of mastitis?
Clinical diagnosis
Consider nipple discharge culture and sensitivity if severe/recurrent.
Consider US (to identify potential abscess)
Management of mastitis?
Consider 2ww referral if associated mass.
Lactational:
- more frequent feedings, breast pumping
- analgesia
- flucloxacillin (offered if infected nipple fissure, symptoms not improving after 12-24hrs and/or breast milk culture positive)
Non-lactational:
- analgesia
- warm compresses
- treat predisposing factors (e.g. eczema, candida)
- co-amoxiclav prescribed
Consider IV abx or incision and drainage, especially if a breast abscess develops.
Define breast abscess. Cause, presentation, diagnosis, management?
Localised collection of pus within breast tissue secondary to infection.
Recent mastitis -failed tx, Staph aureus.
Presents same as mastitis.
Diagnosis:
- breast US
- MC&S of nipple discharge
Management:
- surgical incision and drainage or US guided needle aspiration
- abx
Define/causes of fibroadenoma?
Benign solid tumours that consist of a mixture of fibrous and epithelial/glandular tissue, typically arising from lobules (milk-producing glands in the breast).
Unclear cause.
Influence by reproductive hormones (e.g. oestrogen therapy), as they often enlarge during pregnancy and shrink after menopause.
Presentation of fibroadenoma?
A firm, non-tender mass, highly mobile, rounded with smooth edges.
Rubbery consistency.
<3cm in diameter.
Not painful
May become painful immediately before menstruation.
Diagnosis/IVx of fibroadenoma?
Triple assessment:
- clinical examination
- US and/or mammogram
- needle biopsy
Management of fibroadenoma?
No tx, will regress naturally after menopause.
Surgical excision -if large >3cm) and symptomatic
Define/causes of fibrocystic disease?
Benign condition characterised by the presence of fibrous tissues and cysts in the breasts.
In other words, lumpy breasts associated with pain and tenderness that fluctuate with menstrual cycle.
Affects ages 20-50.
Caused by cumulative effect of cyclical hormones (oestrogen and progesterone).
Presentation of fibrocystic disease?
“lumpy” breasts, dull breast pain and cyclical symptoms that typically peak in the week before menstruation.
Found upper outer quadrant of breast.
Bilateral breasts.
+/- nipple discharge.
Diagnosis/IVx of fibrocystic disease?
Clinical examination
Mammogram (to identify any abnormalities)
US (distinguish between solid mass and fluid-filled cysts)
Biopsy (exclude malignancy)
Management of fibrocystic disease?
Breast pain:
- supportive bra
- limit caffeine, sodium
- analgesia
- evening primrose oil
Symptomatic cysts -aspiration
Nipple discharge -refer to breast surgeon
Define/RFs of breast cancer?
A malignant tumor originating from the cells of the breast tissue.
IN Situ = stays in ducts
Invasive = spreads to other breast tissue
RFs:
- early menarche
- late menopause
- nulliparity or late first pregnancy
- oral contraceptive or HRT
- BRCA mutation
- older age
- Caucasian ethnicity
- obesity
- lack of exercise
- alcohol
- smoking
- hx of breast cancer
- previous radiotherapy tx
Presentation of breast cancer?
Unexplained breast mass +/- pain
Firm, immobile, clear border, irregular shape mass
Breast asymmetry
Nipple changes -discharge, retraction, rash
Breast skin changes
- Peau d’Orange
- erythema
- ulceration
- dimpling
- nipple scaling
Axillary lymphadenopathy
