Inflammatory Breast Disease

Question 1

What is mastitis?

Answer 1

Inflammation of the breast tissue both acute or chronic

Most common cause infection typically S.Aureus but can occasionally be granulomatous

Question 2

What are the two classification of mastitis?

Answer 2

Lactational mastitis (more common)

Non-lactational mastitis

Question 3

What is lactational mastitis?

Answer 3

1/3 or breastfeeding women usually during first 3 months or during weaning
Associated with cracked nipples and milk stasis - often from poor feeding techniques and more common in first child

Question 4

What is non-lactational mastitis?

Answer 4

Can occur in women with other condition such as: duct ectasia, peri-ductal mastitis

Smoking is a important risk factor

Question 5

What are the clinical feature of mastitis?

Answer 5

Tenderness, swelling and erthyema over area of infection - important to determine that no abscess has formed.

Question 6

What is the management of mastitis?

Answer 6

Antibiotic therapy and simple analgesics

Continue milk drainage or breast feeding

If persistent or multiple areas of infection the dopamine agonists can be considered

Question 7

How may breast abscess present?

Answer 7

Tender fluctuant and erythematous masses with a puncutum potentially present.
Associated symptoms - fever, lethargy

Question 8

What is the management of breast abscess?

Answer 8

Ultrasound if doubt about diagnosis
Empirical antibiotics and US-guided needle therapeutic aspiration.

More advanced may require incision and drainage under local anaesthetic.

Question 9

What is a complication of drainage of a non-lactational abscess?

Answer 9

Formation of a mammary duct fistula - managed surgically with fistulectomy and antibiotics

Can often recur

Question 10

What are breast cysts?

Answer 10

Epithelial lined fluid-filled cavities which form when lobules become distended due to blockage usually in the perimenopausal age group.

Peak age 35-55 yrs

Question 11

What are the clinical features of breast cysts?

Answer 11

Singularity or multiple lumps
Affects one or both breasts

Distinct smooth masses which may be tender

Question 12

What investigations can be done for breast cysts and what is seen?

Answer 12

Ultrasound - may be aspirated - if no blood present or lump disappears then not cancer - but if not then cytology must be done

Mammography - halo shape

Question 13

What is the management of breast cysts?

Answer 13

No further management and self-resolve - high risk of recurrence
Analgesia - cyclical pain treated with high dose gamolenic acid(GLA) or danazol

Larger cysts may be aspirated for aesthetic or pt reassurance

Question 14

What are the complications of breast cysts?

Answer 14

2% of patients with have carcinoma at presentation alongside cyst

Higher risk of developing breast cancer

Fibroadenosis - multiple small cysts and fibrotic areas - often benign associated with tenderness and asymmetry - can mask malignancy

Question 15

What is mammary duct ectasia?

Answer 15

Dilation and shortening sometimes calcification of the major lactiferous ducts - common in peri-menopausal women

Question 16

What are the clinical features of mammary duct ectasia?

Answer 16

Green/yellow discharge
Palpable mass
Nipple retraction
Mastalgia

Question 17

What investigations could be done for mammary duct ectasia?

Answer 17

Mammography

Biopsy - typically multiple plasma cells on histology

Question 18

What is the management of mammary duct ectasia?

Answer 18

Conservative management unless cannot exclude malignancy.

Unremitting nipple discharge can be treated with duct excision

Question 19

What is fat necrosis and what are its causes?

Answer 19

Acute inflammatory response in the breast leading to ischaemic necrosis of the fat nodules.

Causes are:

• Trauma
• previous surgical or radiological intervention

Question 20

What are the clinical feature of fat necrosis?

Answer 20

Usually asymptomatic with a lump

Less commonly can preset with fluid discharge, skin dimpling, pain and nipple inversion

Inflammatory response can persist causing chronic fibrotic changes - solid irregular lump

Question 21

What investigations should be done in fat necrosis?

Answer 21

Ultrasound - hyperechoic mass

Mammography- may mimic malignancy so cor biopsy should be taken to rule it out

Question 22

What is the management of fat necrosis?

Answer 22

Self-limiting

Analgesia and reassurance

Question 23

What is periductal mastitis?

Answer 23

Inflammation of due to infection of the subareolar ducts
May be present like duct ectasia
Pus discharge from nipple and mastalgia