Disorders of the Breast

Question 1

breast abscess

Answer 1

• occurs especially during nursing (MC s. aureus)
• presentation: redness, tenderness, induration
• dx: incision and bx if severe or indurated - r/o inflammatory carcinoma
• tx: bactrim, clinda, doxy

Question 2

breast fibroadenoma

Answer 2

• more common in AA and young (15-35)
• presentation: round, firm (soft, rubbery), painless, freely movable, discrete, mobile
  
  • hormonal relationship: cyclical size
• signs: nontender, unilateral, mobile density, smooth firm mass
• dx: if <30 - US +/- FNA
  
  • if >30 - mammogram
  • Excisional bx (if <25), if BRCA + mom
• tx: decrease caffeine

Question 3

fibrocystic breast dz

Answer 3

• MC benign breast condition (MC 30-50yo)
• Presentation: asx or painful, bilateral, size fluctuation during menstrual cycle
  
  • MULTIPLE LESIONS distinguishes fibrocystic changes from carcinoma
  • breast pain, dipple discharge, lumpy and bumpy prior to menses
• signs: tender, bilateral, mobile density, thick gray-green nipple d/c, worse with caffeine intake
• dx: US +/- bx, FNA (diagnostic and tx)
• tx: support bra, decrease caffeine, danazol
• increased risk breast CA when atypia is present

Question 4

mastitis

Answer 4

• MC in postpartum (2-4th week, S. aureus)
• Presentation: lactating women, FEVER, chills, flu-like, acute, responds to abx
• signs: decreased milk, redness, tenderness, firm mass, breast pain, unlilateral, heat
• dx: culture of purulent material or milk (not routine)
• tx: dicloxacillin (PCN allergy - erythromycin)
  
  • cold compress, NSAIDs and tylenol, continue to breast feed and express milk