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Junior Surgery- Breast Care > Inflammatory Breast Disease > Flashcards

Inflammatory Breast Disease Flashcards

1
Q

What is mastitis?

A

Inflammation of the breast tissue

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2
Q

What aetiologies can cause mastitis?

A
  • Infection (by far the most common)

- Granulomatous disease

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3
Q

Which organism typically causes mastitis?

A

Staphylococcus aureus

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4
Q

What are the classes of mastitis?

A
  • Lactational mastitis

- Non-lactational mastitis

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5
Q

What is lactational mastitis?

A
  • Mastitis usually seen within the first three months of breastfeeding or during weaning
  • Associated with cracked nipples and milk stasis (due to poor feeding technique)
  • Most common prima gravida
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6
Q

What is non-lactational mastitis?

A
  • Mastitis in women who are not breastfeeding
  • More common with other conditions such as duct ectasia
  • Tobacco smoking is an important risk factor- causes damage to sub-areolar duct walls, predisposes to infection
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7
Q

How does mastitis present?

A

Breast tenderness, swelling, tissue hardening (induration) and erythema.

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8
Q

What is it important to exclude?

A

Abscess formation

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9
Q

How is mastitis managed?

A

Systemic antibiotics (broad-spectrum) and simple analgesia

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10
Q

What advice should you give in lactational mastitis?

A

Keep breastfeeding

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11
Q

What can you do in lactational mastitis with persistent infection?

A

Cease breastfeeding with dopamine agonist e.g. cabergoline

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12
Q

What are breast cysts?

A
  • Epithelial lined fluid-filled cavities
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13
Q

Why do breast cysts form?

A

Lobules become distended when blocked

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14
Q

When are breast cysts most common?

A

Peri-menopausal (45-55)

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15
Q

How does a breast cyst present?

A
  • Singular or multiple lumps
  • One or both breasts
  • Distinct smooth masses
  • Tenderness
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16
Q

How would you investigate a suspected breast cyst?

A

USS (definitive)
- Fluid-filled sac

Aspiration
- If fluid is free of blood, or the lump disappears, cancer may be excluded

17
Q

What treatment is required for breast cysts?

A
  • Self resolves, normally not treated
  • Analgesia
  • Can be aspirated for symptomatic relief
18
Q

Do breast cysts carry any risk of breast cancer?

A
  • Yes, 2-3x greater risk of developing cancer in the future

- 2% of cases have carcinoma on presentation, although usually incidental/unrelated

19
Q

What is mammary duct ectasia?

A

Dilatation and shortening of lactiferous ducts

20
Q

Who is at most risk of mammary duct ectasia?

A

Peri-menopausal women

21
Q

What percentage of women will have mammary duct ectasia by 70yo?

A

40%

22
Q

What are the symptoms of mammary duct ectasia?

A
  • Green/yellow discharge
  • Palpable mass
  • Retracted nipple
23
Q

What imaging is used for mammary duct ectasia?

A

Mammogram- dilated and calcified ducts

24
Q

What will biopsy of mammary duct ectasia show?

A

Plasma cells- ‘plasma cell mastitis’

25
Q

How is mammary duct ectasia managed?

A
  • Conservatively

- If discharge persists, duct excision may be required

26
Q

What do you do if a Pt has bloody discharge?

A

2ww for triple assessment

27
Q

What is fat necrosis of the breast?

A

Acute inflammation of the breast, causing ischaemic necrosis of fat lobules

28
Q

What are the causes of fat necrosis?

A
  • Trauma 40%

- Surgery and radiotherapy 60%

29
Q

What is the usual presentation of fat necrosis?

A
  • Usually asymptomatic

- Can present as a lump

30
Q

What other symptoms might fat necrosis have?

A
  • Discharge
  • Skin dimpling
  • Pain
  • Nipple inversion
31
Q

What can happen in chronic cases of fat necrosis?

A
  • Acute inflammation becomes chronic
  • Fibrotic changes occur
  • Lump becomes hard and irregular - biopsy is the only differentiator from malignancy
32
Q

What does fat necrosis look like on USS?

A

Hyperechoic mass (bright white)

33
Q

How is fat necrosis treated?

A

Self Limiting

  • Analgesia
  • Reassurance

Junior Surgery- Breast Care (4 decks)

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