Mammo Physio

Question 1

Should you biopsy a breast bud?

Answer 1

No, developing breasts during puberty can be permanently damages. No boobies :(

Question 2

Which breast imaging modality for which time?

Follicular, Luteal, perimenopausal (age 50’s), lactating

Answer 2

Day 1 of menstrual cycle is bleeding

Follicular phase (day 7-14) Estrogen dominates (when I’m nicest). BEST to get both mammo and MRI.

Luteal phase (day 15-30): Progesterone dominates (when I’m mean with emotional and physcial syx). Can have breast tenderness as a syx ( Max day 27-30)

1. PROgesterone PROliferates the breast= INCREASED BREAST DENSITY.
2. PROgesterone maintains PREGnancy = inc density = get an US, especially third trimester/ lactating patients.
3. PROgesterone in PERImenopausal women (50’s) = women are “C”hanging and their breasts are more fibroCystic
4. Pituitary PROlactinoma and antiPSYchotics (preg women are crazy) INC BILATERAL DENSITY

Hormone replacement therapy with PROgesterone and estrogen. In density and pain

Basically PRO gives more dense breasts and more breast pain.

Question 3

Fibroadenomas

Dependent on which hormone

What happens to them after menopause.

Answer 3

Estrogen

After menopause they degenerate due to lack of estrogen into “popcorn calcification” (bite me- eat a fibroadneoma after menopause)

” Rod like” Secretory calcifications develop 10-20 years post menopause.

Question 4

1. What complication should you expect if you biopsy a lactating breast or about to lactate?
2. What lesion can you during lactation? What follow up? Expected natural course?
3. What lesion can you see if you stop lactating?

Answer 4

1. milk fistula- cause you’re biopsy-ing milky boobs. They will have to stop breast feeding for it to heal. It can get infected.

remember don’t biopsy pre-pubescent breast - no boobies will form

2. Lactating adenoma:
   - they look like fibroadenomas (also thrive on estrogen). Often multiple.
   - RECOMMEND 4-6 mo fup postpartum/ post delivery or post cessation of lactation WITH ULTRASOUND.
   - Will regress after lactation.
3. Galactocele (GAL CEAses LACTating):
   - benign fat containing (preggo’s are fat)
   - BR-2. Sub-areolar.
   - Variable appearance but can be an aunt minnie fat- fluid level. May form abscess.