Inflammatory Breast Disease

Question 1

what is mastitis?

Answer 1

inflammation of the breast tissue - acute or chronic

Question 2

what is the most common cause of breast inflammation?

Answer 2

infection - staph

Question 3

how can mastitis be classified

Answer 3

by lactational status

• lactational mastitis
• non-lactational mastitis

Question 4

what is lactational mastitis?

more common

Answer 4

seen in up to 1/3 of breastfeeding women, usually presents in 1st 3 months of breastfeeding
associated with cracked nipples and milk stasis
more common with first child

Question 5

what is non-lactational mastitis?

less common

Answer 5

occurs in women with other conditions ie duct ectasia

Question 6

why is smoking an important risk factor?

Answer 6

causes damage to sub-areolar duct walls and predisposing to infection

Question 7

what are the clinical features of mastitis?

Answer 7

tenderness
swelling or induration
erythema

Question 8

how is mastitis managed?

Answer 8

systemic antibiotics and simple analgesics

Question 9

what advice is given in lactational mastitis?

Answer 9

continue milk drainage or feeding

Question 10

what should breast feeding be stopped in mastitis and how is this done?

Answer 10

women with persistent or multiple areas of infection

dopamine agonists ie Cabergoline

Question 11

what is a breast abscess?

Answer 11

collection of pus within the breast lined with granulation tissue most commonly developing from acute mastitis

Question 12

how to breast abscesses present?

Answer 12

tender fluctuant and erythematous masses

fever and lethargy

Question 13

how can a diagnosis of a breast abscess be confirmed?

Answer 13

USS

Question 14

how are breast abscesses managed?

Answer 14

initially empirical abx and US-guided needle therapeutic aspiration
may require I&D under local anaesthetic

Question 15

what is an important complication of drainage of a non-lactational abscess?

Answer 15

formation of a mammary duct fistula - communication between skin and subareolar breast duct

Question 16

what are breast cysts?

Answer 16

epithelial lined fluid-filled cavities which form when lobules become distended due to a blockage usually in perimenopausal age

Question 17

how do cysts present?

Answer 17

singularly or with multiple lumps
can affect 1 or both breasts
smooth masses
may be tender

Question 18

how are cysts investigated?

Answer 18

mammography - halo shape

definitive diagnosis - USS

Question 19

how are cysts managed?

Answer 19

persisting, symptomatic or undeterminable cystic masses may be aspirated
usually self-resolve

Question 20

what excludes cancer from a cyst?

Answer 20

if the fluid is free from blood when its aspirated and the lump disappears
cystic fluid should be sent for cytology

Question 21

complications of cysts?

Answer 21

2% of patients have carcinoma at presentation

2-3 times greater risk of developing breast cancer in future

Question 22

what is mammary duct ectasia?

Answer 22

dilation and shortening of the major lactiferous ducts

Question 23

what are the clinical features of mammary duct ectasia?

Answer 23

green/yellow nipple discharge
palpable mass
nipple retraction

Question 24

what symptom requires a triple assessment?

Answer 24

blood-stained discharge

Question 25

how is mammary duct ectasia investigated and diagnosed ?

Answer 25

mammography - dilated calcified ducts without any features of malignancy
biopsied -