Inflammatory Breast Disease Flashcards
what is mastitis?
inflammation of the breast tissue - acute or chronic
what is the most common cause of breast inflammation?
infection - staph
how can mastitis be classified
by lactational status
- lactational mastitis
- non-lactational mastitis
what is lactational mastitis?
more common
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
what is non-lactational mastitis?
less common
occurs in women with other conditions ie duct ectasia
why is smoking an important risk factor?
causes damage to sub-areolar duct walls and predisposing to infection
what are the clinical features of mastitis?
tenderness
swelling or induration
erythema
how is mastitis managed?
systemic antibiotics and simple analgesics
what advice is given in lactational mastitis?
continue milk drainage or feeding
what should breast feeding be stopped in mastitis and how is this done?
women with persistent or multiple areas of infection
dopamine agonists ie Cabergoline
what is a breast abscess?
collection of pus within the breast lined with granulation tissue most commonly developing from acute mastitis
how to breast abscesses present?
tender fluctuant and erythematous masses
fever and lethargy
how can a diagnosis of a breast abscess be confirmed?
USS
how are breast abscesses managed?
initially empirical abx and US-guided needle therapeutic aspiration
may require I&D under local anaesthetic
what is an important complication of drainage of a non-lactational abscess?
formation of a mammary duct fistula - communication between skin and subareolar breast duct
what are breast cysts?
epithelial lined fluid-filled cavities which form when lobules become distended due to a blockage usually in perimenopausal age
how do cysts present?
singularly or with multiple lumps
can affect 1 or both breasts
smooth masses
may be tender
how are cysts investigated?
mammography - halo shape
definitive diagnosis - USS
how are cysts managed?
persisting, symptomatic or undeterminable cystic masses may be aspirated
usually self-resolve
what excludes cancer from a cyst?
if the fluid is free from blood when its aspirated and the lump disappears
cystic fluid should be sent for cytology
complications of cysts?
2% of patients have carcinoma at presentation
2-3 times greater risk of developing breast cancer in future
what is mammary duct ectasia?
dilation and shortening of the major lactiferous ducts
what are the clinical features of mammary duct ectasia?
green/yellow nipple discharge
palpable mass
nipple retraction
what symptom requires a triple assessment?
blood-stained discharge
how is mammary duct ectasia investigated and diagnosed ?
mammography - dilated calcified ducts without any features of malignancy
biopsied -
