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Breast diseases > Breast pain > Flashcards

Breast pain Flashcards

1
Q

Montgomery’s Tubercles: Definition

A

Sebaceous glands in the areola around the nipple.

They are a normal finding, but may become more pronounced during pregnancy.

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2
Q

Breast pain: Classification (2)

A
  • Cyclical

- Non-cyclical

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3
Q

CYCLICAL breast pain

A

CYCLICAL breast pain: The pain is linked to menstrual periods. It tends to affect women before the menopause.

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4
Q

NON-CYCLICAL breast pain

A

NON-CYCLICAL pain: the pain may come from the breast. Or it may come from somewhere else, such as nearby muscles or joints, and may be felt in the breast.

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5
Q

ANY BREAST PAIN =

A

BILATERAL screening mammogram

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6
Q

Breast DENSITY

A
  • Breast density = strong independent RF for breast cancer.
  • Having a lot of dense (white) breast tissue on the mammogram can make it more difficult to detect any breast cancers that do arise.
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7
Q

Lactational mastitis: Definition

A

Inflammatory condition, affects breast feeding women.

It occurs within the interlobular connective tissue. The main underlying cause is milk stasis cause by overproduction or insufficient removal of milk.

It may be infectious (retrograde spread of commensal organisms via a milk duct or a traumatised nipple) or non-infectious.

The development of a focal lump and systemic symptoms raise the concern of a breast abscess. This complications occurs in about 3% of women with mastitis.

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8
Q

Breast ABSCESS: Definition

A

A breast abscess is a painful collection of pus that forms in the breast. Most abscesses develop just under the skin and are caused by a bacterial infection.

Abscesses can be managed by:

  • Repeated aspiration
  • Incision and drainage
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9
Q

Raynaud’s disease of the nipple: Definition

A

In Raynaud’s disease of the nipple, pain is often intermittent and present during and immediately after feeding. Blanching of the nipple may be followed by cyanosis and/or erythema. Nipple pain resolves when nipples return to normal colour.

Options of treatment for Raynaud’s disease of the nipple include advice on minimising exposure to cold, use of heat packs following a breastfeed, avoiding caffeine and stopping smoking. If symptoms persist consider specialist referral for a trial of oral nifedipine (off-license).

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10
Q

Breast Engorgement: Definition

A

Breast engorgement is when your breasts get too full of milk.

Breast engorgement is one of the causes of breast pain in breastfeeding women. It usually occurs in the first few days after the infant is born and almost always affects both breasts. The pain or discomfort is typically worse just before a feed. Milk tends to not flow well from an engorged breast and the infant may find it difficult to attach and suckle. Fever may be present but usually settles within 24 hours. The breasts may appear red. Complications include blocked milk ducts, mastitis and difficulties with breastfeeding and, subsequently, milk supply.

Although it may initially be painful, hand expression of milk may help relieve the discomfort of engorgement.

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11
Q

PHYISOLOGICAL changes of the BREAST during LACTATION

A
  • During pregnancy: oestrogen levels increase
  • This stimulates growth + branching of ductal system.
  • Progesterone: causes alveolar cells to develop secretory ability.
  • Both hormones act synergistically to contribute to ductal and lobular growth.
  • Prolactin: stimulates milk production following childbirth.
  • Oxytocin: is released with each episode of breastfeeding and sustains lactation
  • Clinically: breasts = larger, firmer + more nodular.
  • Alveolar + nipple pigmentation = increased.
  • Montgomery’s tubercle’s = more prominent.
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12
Q

INFLAMMATORY breast cancer

A

Rare form of breast cancer in which cancer cells grow along the lymph vessels causing the breast to become inflamed and swollen - it can mimic mastitis and breast abscess.

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13
Q

BREAST during LACTATION: Changes on IMAGING

A
  • Mammogram: increased breast size + density
  • Ultrasound: glandular enlargement + enogorgement of breast tissue = increased echogenicity of breast parenchyma.
  • Duct dilation + hypervascularity may also be observed.
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14
Q

MASTALGIA: Definition

A
  • Pain in the breast.
  • Cyclical and non-cyclical.
  • Breast pain is a rare symptom of breast cancer.
  • The pain women describe as breast pain can be:
    • Pain from the breast tissue itself
    • Referred pain that is felt in the breast
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15
Q

Chest wall pain: Features

A

Features suggesting that breast pain is referred rather than originating in the breast:

  • Unilateral + brought on by activity
  • Very lateral
  • Very medial
  • Can be reproduced by pressure on a specific area of the chest wall
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16
Q

Principles of MASTALGIA management (3)

A
  • Exclude cancer (examine, mammogram, USS)
  • Provide reassurance and information
  • Assess site of pain (true/chest wall)
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17
Q

PIP implants: Overview

A

PIP breast implants were withdrawn from the UK in 2010 after it was found they had been fraudulently manufactured with unapproved silicone gel, and were far more prone to splitting (rupturing) than other breast implants.

Research hasn’t found any evidence to suggest that PIP implants pose a serious health risk, but they can cause inpleasant symptoms if they rupture and you may be anxious about leaving them in.

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18
Q

PIP implants: Definition

A

PIP implants are silicone breast implants containing unapproved silicone gel. They were manufactured in France by a company called Poly Implant Protheses (PIP). The concerns relate to all breast implants manufactured by PIP.

19
Q

PIP implants: Risk of rupture

A

PIP implants are 2-6 times more likely to rupture than standard silicone implants.

20
Q

PIP implants: Signs of rupture

A
  • Lumpiness or swelling in/around the breast
  • Change in the shape of the breast
  • Redness
  • Pain and tenderness
  • Burning sensation
  • Enlarged lymph nodes in the axilla
21
Q

PIP implants: Removal + replacement

A
  • First, contact place where implants were put in.
  • See if they will remove them.
  • Some private clinics will remove them for free.
  • Others might charge a fee.
  • NHS can remove them free of charge.
22
Q

Where can you get PIP implants REPLACED for free (if medically necessary)

A
  • BMI Healthcare
  • HCA international
  • The Holly Private hospital
  • Make yourself amazing/MYA cosmetic surgery
  • Nuffield health
  • Ramsay Health care
  • Spire healthcare
23
Q

NHS vs. PIP implants

A

Normally the NHS will pay for removal of PIP implants fitted by a health provider, but will not pay to replace them (except in Wales).

Some private clinics have agreed to replace PIP implants free of charge, but others have refused.

24
Q

Phyllodes tumour: Definition

A

Phyllodes tumours are rare breast tumours. They don’t usually spread to other parts of the body. There are three types of Phyllodes tumour:

  • 50 to 60% are benign (non-cancerous)
  • 20 to 25% are malignant (cancerous)
  • borderline tumours that are more abnormal than benign tumours, but not quite malignant.

We don’t know what causes Phyllodes tumours. They are more common in women who have benign breast lumps called fibroadenomas and in pre-menopausal women between 40 and 50.

25
Q

Fibroadenoma: Definition

A

A fibroadenoma is a type of lump that can develop in the breast and typically appears in females.

Fibroadenomas are very common, but they are benign, which means that they are noncancerous. Other than the lump itself, a person with a fibroadenoma is unlikely to experience any symptoms.

26
Q

Fibroadenoma: Needle biopsy

A
  • For suspected fibroadenomas in patients under 25, a biopsy need not be performed if the clinical and ultrasound features are benign.
  • Core biopsy = preferred method of choice for most solid lesions.
27
Q

Fibroadenoma: Histology

A
  • Benign fibroepithelial lesion of the breast which is composed of both stromal and epithelial components.
  • Round or oval masses with a rubbery cut surface.
  • They are composed of relatively uniform pale brown tissue.
  • Well defined margins.
  • Often lobulated.
  • Duct structures within the lesion.
28
Q

Fibroadenoma: Management

A

If a diagnosis of fibroadenoma has been made through triple assessment then she does not need any treatment.

Reasons for excision of fibroadenoma:

  • Large lesion (> 4cm)
  • If it is growing
  • If patient requests it

Generally fibroadenomas do not change in size (although some do increase/decrease) in size.

29
Q

Fat necrosis: Definition

A

Fat necrosis is a lump of dead or damaged breast tissue that sometimes appears after breast surgery, radiation, or another trauma. Fat necrosis is harmless and doesn’t increase your cancer risk. It usually isn’t painful, but it can cause anxiety.

30
Q

Breast cyst: Definition

A

Breast cysts are fluid-filled sacs inside the breast, which are usually not cancerous (benign). You can have one or many breast cysts and they can happen in one or both breasts. They’re often described as round or oval lumps with distinct edges. A breast cyst usually feels like a grape or a water-filled balloon, but sometimes a breast cyst feels firm.

31
Q

Breast cyst: Does it need treatment?

A

Cysts are benign and therefore don’t really need treatment. However if the cyst is causing the patient symptoms such as a lump or pain, then the fluid is usually aspirated.

32
Q

Breast cyst: Could it turn into cancer?

A

Cysts do not turn into cancer.

However, having cysts may make it more difficult to find new breast lumps or other changes that might need evaluation by your doctor..

33
Q

Breast cysts: Do I need to come back if I have another lump?

A

Yes. Even if patients are known to have cysts, they should be advised to see their doctor if they find a new lump, rather than assume it is a cyst.

34
Q

Breast cysts: SYMPTOMS

A

Breast cysts may be found in one or both breasts. Signs and symptoms of a breast cyst include:

  • A smooth, easily movable round or oval lump with distinct edges (which typically, though not always, indicates it’s benign)
  • Nipple discharge that may be clear, yellow, straw colored or dark brown
  • Breast pain or tenderness in the area of the breast lump
  • Increase in breast lump size and breast tenderness just before your period
  • Decrease in breast lump size and resolution of other symptoms after your period
35
Q

Mastitis: SYMPTOMS

A
  • a red, swollen area on your breast that may feel hot and painful to touch
  • a wedge-shaped breast lump or a hard area on your breast
  • a burning pain in your breast that might be constant or only when you breastfeed
  • nipple discharge, which may be white or contain streaks of blood
36
Q

MASTITIS: Definition

A

Mastitis is inflammation of the breast with or without infection.

Mastitis with infection may be lactational (puerperal) or non-lactational (e.g., duct ectasia).

Non-infectious mastitis includes idiopathic granulomatous inflammation and other inflammatory conditions (e.g., foreign body reaction).

A breast abscess is a localised area of infection with a walled-off collection of pus. It may or may not be associated with mastitis.

37
Q

MASTITIS:

  • Epidemiology
  • Aetiology
A

Epidemiology: Breast infection (including infectious mastitis and breast abscess) more commonly affects women aged 15-45 years, especially those who are lactating. Mastitis and breast abscess can occur at any age.

Aetiology: Staphylococcus aureus is the most frequent pathogen isolated.

38
Q

TREATMENT of infectious and non-infectious mastitis (5)

A 
- Antibiotic therapy 
  (oral dicloxacillin, cloxacillin, or flucloxacillin)
- Effective milk removal 
 (breastfeeding, pumping, massage)
- Warm compress
- Symptomatic relief 
- Supportive counselling
39
Q

Breast cysts may be defined by their SIZE (2)

A

MICROCYSTS are too small to feel, but may be seen during imaging tests, such as mammography or ultrasound.

MACROCYSTS are large enough to be felt and can grow to about 1 to 2 inches (2.5 to 5 centimeters) in diameter. Large breast cysts can put pressure on nearby breast tissue, causing breast pain or discomfort.

40
Q

ASPIRATION of a symptomatic LUMP (5)

A
  • Performed under USS guidance.
  • Cysts is aspirated to dryness.
  • Normal cyst fluid can be many different colours.
  • It does not need cytological or microbiological examination (+ can be discarded).
  • One exception: if fluid is bloodstained - then it is sent for cytology.
41
Q

Breast INFECTION: Treatment principles (3)

A
  • Appropriate antibiotics should be given early to reduce the chance of an abscess developing.
  • Hospital referral if infection does not settle following one course of antibiotic treatment.
  • If an abcess is suspected, it should be confirmed by ultrasonography, aspiration or both before surgical drainage is considered.
  • Breast cancer should be excluded in patients with an inflammatory lesion that is solid on USS or on aspiration that does not settle despite adequate antibiotic use.
42
Q

Mammary duct fistula: Definition

A

A mammary duct fistula is a communication between the skin, usually in the periaerolar region, and a major subareolar breast duct.

A fistula can develop after incision and drainage of a non-lactating abcess, it can follow spontaenous discharge of a periaerolar inflammatory mass, or it can result from biopsy of a periductal inflammatory mass.

43
Q

Breast cellulitis:

  • Definition
  • Areas affected
  • Symptoms (3)
  • Risk factors (3)
A

Cellulitis is an infection of the skin and underlying tissue caused by bacteria.

Areas affected:

  • Lower half of breast
  • Where sweat and bacteria tend to build up.

Symptoms:

  • skin = red, warm, and inflamed
  • rash tends to spread throughout the area.
  • fever + chills

Risk factors include:

  • being overweight
  • having large breasts
  • having previous breast surgery or radiation therapy.
44
Q

MASTITIS: Cause

A

Mastitis is common in breastfeeding women as it can be caused by a build-up of milk.

Women who are not breastfeeding can also get mastitis, as can men. This can happen due to:

  • smoking – toxins found in tobacco can damage breast tissue
  • damage to the nipple, such as a piercing or skin condition like eczema
  • you have a breast implant
  • having a weak immune system due to a health condition like diabetes
  • shaving or plucking hairs from around your nipples

Breast diseases (3 decks)

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