Breast Diseases with Discharge Flashcards
What is Mammary duct ectasia?
Benign condition of inflammation and dilation of the large ducts in the breasts
Leads to intermittent discharge from the nipple which may be white, grey or green
List 2 key risk factors for mammary duct ectasia
- Smoking
- Perimenopausal women
How does mammary duct ectasia present?
- Nipple discharge
- Tenderness or pain
- Nipple retraction or inversion
- Breast lump (pressure on lump may produce discharge)
How is a diagnosis of mammary duct ectasia made?
- Tripple assessment to exclude breast cancer (they present similarly)
- Ductography
- Nipple discharge cytology
- Ductoscopy
Key finding of mammogram of mammary duct ectasia
Microcalcifications
Management of Mammary duct ectasia?
- Reassurance after excluding cancer
- Symptomatic management of mastalgia
- Antibiotics if infection
- Surgical excision of affected duct (microdochectomy) in problematic cases
What is a intraductal papilloma?
Benign warty lesion that grows within one of the ducts in the breast due to proliferation of epithelial cells
How does an intraductal papilloma present?
Clear or blood-stained nipple discharge
How do intraductal papillomas present?
- Nipple discharge (clear or blood-stained)
- Tenderness or pain
- A palpable lump
How is a diagnosis of Intraductal papillomas made?
- Tripple assessment
- Ductography - papilloma will be seen in area with a “filling defect”
Management of Intraductal papillomas?
Complete surgical excision
After removal, tissues examined for things which may not have been picked up on the biopsy
Mastitis?
Inflammation of breast tissue
List the 2 key causes of Mastitis
Breastfeeding ‘lactational mastitis’ - obstruction and accumulation of milk in the ducts. Regularly expressing breast milk can help prevent this
Infection - Staphylococcus aureus is most common
What is a key risk factor for infective mastitis?
Smoking!!!
Typical presentation of mastitis or a breast abscess?
- Unilateral breast pain and tenderness
- Erythema, swelling, warmth and inflammation
- Purulent nipple discharge
- Hardening of the skin or breast tissue
- Fever
Management of lactational mastitis
Managed conservatively → conti breastfeeding, expressing milk and breast massage. Heat packs, warm showers and simple analgesia can help symptoms
Antibiotics if infection is suspected or symptoms do not improve
Management of non lactational mastitis?
- Analgesia
- Antibiotics
- Treatment of underlying cause
Antibiotics of choice in non-lactational mastitis?
Flucloxacillin for 10-14 day
(Erythromycin if penicillan allergic)
What advise regarding breast feeding should you give regarding mastitis or a breast abscesses
Continue breastfeeding
It will not harm the baby and will help resolve the mastitis or abscess by encouraging flow
Rare complication of mastitis is not adequately treated?
Breast abscess - may need surgical incision and drainage
What infection may cause recurrent mastitis?
Candidal infection of the nipple, often after a course of antibiotics
Can lead to recurrent mastitis, as it causes cracked skin on the nipple that creates an entrance for infection
What effect may candida of the nipple have in the infant?
Oral thrush and candidal nappy rash
How may candida of the nipple present?
- Sore nipples bilaterally, particularly after feeding
- Nipple tenderness and itching
- Cracked, flaky or shiny areola
- Symptoms in the baby
Treatment of candida of the nipple?
Treatment for BOTH mother are baby with:
- Topical miconazole 2% to the nipple, after each breastfeed
- Treatment for the baby eg. oral miconazole gel or nystatin
What is a breast abscess and what are the two types?
Collection of pus within an area of the breast, usually due to a bacterial infection. May be a:
- Lactational abscess (associated with breastfeeding)
- Non-lactational abscess (unrelated to breastfeeding)
List the most common bacterial causes of a breast abscess?
- Staphylococcus aureus
- Streptococcal species
- Enterococcal species
- Anaerobic bacteria
Key presenting features of a breast abscess?
Swollen, fluctuant, tender lump within the breast
+/- muscle aches, fatigue, fever, sepsis
Management of a breast abscess
- Referral to the on-call surgical team
- Antibiotics
- USS
- Drainage
- MC&S of drained fluid
