Surgery A - Breast conditions

Question 1

27 y/o female
pc: 6 weeks post natal, breast feeding, red tender area on left breast

otherwise well

likely diagnosis?

Answer 1

engorgment

or lactation mastitis

Question 2

advice for managing lactational mastitis?

Answer 2

• re-emptying breast (feed, breast pump)
• warm/cool compress
• massage
• breast support
• if infection sus then abx

Question 3

give an example of antibiotics that might be given in lactational mastitis?

Answer 3

flucloxacillin

Question 4

should breastfeeding still be encouraged in patients with lactational mastitis?

Answer 4

• encouraged

- watch for oral thrush in baby and in nipple area

Question 5

33 y/o female

pc: 3 month hx of lump in left breast, seems to fluctuate in size and tenderness in relation to periods.

lump now persistent.

very concerned as aunt had breast cancer in 50s.

otherwise well.

SH: smokes 10 a day, 3 bottles of wine a week.

examination: tender left upper outer quadrant modularity, but no discrete lump.

has kids, did not breast feed.

Dx: combined pill

history is very typical of:

Answer 5

cyclical mastaglia

Question 6

management of cyclical mastaglia?

Answer 6

• good firm support non wire bra
• NSAID gel/tablet
• keep pain chart
• exercise in water

tamoxifen and danazol are very effective at managing pain but have significant Side effects so only consider these after 3 months pain chart review and for shortest time possible

Question 7

types of benign breast tumours

Answer 7

fibroadenoma

adenoma

papilloma

lipoma

phyllodes tumour
- rare fibroepithelial tumours

Question 8

breast examination you feel:

• highly mobile lesion
• well defined
• rubbery on palpation

Answer 8

fibroadenoma
- common benign growth

• very low malignancy potential
• common in women of reproductive age

Question 9

breast examination you feel:

• nodular lesion
• can easily mimic malignancy

Answer 9

adenoma

• benign glandular tumour
• typically in older female population
• lesions are nodular, can easily mimic malignancy

Question 10

breast examination:

• soft mobile lump

Answer 10

lipoma

• benign adipose tumour
• low malignancy potential

Question 11

mainstay of distinguishing between breast lumps is:

Answer 11

triple assessment clinic

main differentials

• cysts
• abscesses
• malignancy lesions

Question 12

common cause of mastitis?

Answer 12

• infection

- staph aurea

Question 13

breast exam:

• tenderness, swelling and erythema over area of infection

Answer 13

mastitis

Question 14

breast exam:

• distinct smooth masses may be tender
• may be single or multiple lumps affecting one or both breasts

Answer 14

breast cysts

- epithelial lined fluid filled cavities