Inflammatory Breast

Question 1

What is duct ectasia

Answer 1

dilatation and shortening of the large terminal breast ducts
Within 3cm of the nipple
most common around the menopause

Question 2

Symptoms and signs of duct ectasia

Answer 2

most common around the menopause

Tender lump around areola
Nipple retraction
Green nipple discharge
Rupture → local inflammation

Question 3

Management for duct ectasia

Answer 3

Conservative

Young, troublesome → microdochectomy
Old, troublesome → total duct excision

Question 4

Symptoms and signs of fat necrosis

Answer 4

RF: obese women with large breasts

PAINLESS firm, round → hard, irregular lump
may follow trivial or unnoticed trauma

Question 5

Management for fat necrosis

Answer 5

rare and may mimic breast cancer → ix further
Triple assessment (including core biopsy)

Question 6

Features of periductal mastitis

Answer 6

Younger women
RF: smoking

Peri-areolar or subareolar infections, may be recurrent

Question 7

Aetiology and risk factors of acute mastitis

Answer 7

• Staphylococcus aureus
• affects 1 in 10 breastfeeding women
• associated with nipple injury and smoking

Question 8

Symptoms and signs of acute mastitis

Answer 8

Coryzal symptoms (aches, chills, fevers)
Nipple discharge
Red
Tender breast
± abscess: painful lump with overlying inflammation

Question 9

Management for lactational mastitis

Answer 9

– simple analgesia
– supportive care (warm compresses)
– continue breastfeeding

Question 10

Management for non-lactational/severe mastitis

Answer 10

(infected nipple fissure, S/S not better after 12-24h, breast milk culture +ve)

– 1st line: flucloxacillin 500mg QDS, oral, 10-14 days
– 2nd line (after 48 hours): co-amoxiclav
– MRSA – trimethoprim 160-800mg BD PO

Question 11

Management for breast abscess

Answer 11

USS diagnosis:
– incision and drainage and culture of fluid