BREAST LUMPS IN PREGNANCY Prof. M.C.Bansal MBBS.,MS. FICOG. MICOG. Ex Principal & controller Jhalawar Medical College and Hospital. Jhalawar MGMC7Hospital Sitapura Jaipur
Physiological changes in Breastin Pregnancy Breast lobules becoming more prominent. Enlarged Montgomery’s tubercles. Thickening and enlargement of an area of the breast. Accessory breast tissue in axilla is a common anatomical anomaly. It may cause little discomfort and may be perceived as a serious problem by some patients. Both breast may be of unequal size.
Differential Diagnosis Of BreastLump In Pregnancy Due to increased “breast awareness” now days women are much worried about any breast lump noticed By themselves on routine self breast examination . It has lead to cancer phobia on one side but early detection of breast cancer on the other hand. Pregnant women may become more conscious of their breast and may present with some changes in pre existing lesions like Lipomas,Sebaceous cyst , Neurofibromas ,fibroadenoma or haemangiomas.
Differential Diagnosis of BreastLump In Pregnancy Physiological. Prominent breast lobule Montgomery’s tubercle. Accessory breast tail. Lipoma. Sebaceous cysts. Neuro fibroma. Haemangioma. Intra mammary lymphnode. Fibroadenoma. Cyst Lactating nodule Galactocoele Mastitis / abscess. Cancer.
Fibrocystic disease of breast It does not occur in pregnancy. It has been labeled as ‘Benign breast change syndrome’ , symptoms of which include cyclic pain and thickening of breast tissue particularly in upper outer quadrant . Biopsy reveals it as fibrocystic disease due to cyclic proliferative features and sclerotic features that are perceived to be the basis of mild inflammation. It requires only assurance to patient.
Fibro adenoma Common benign lump in breast . More common in 2nd and 4th decade of life. They are rubbery in consistency ,irregular or boss elated surface and move freely mobile ‘wandering mouse in breast’ Initially they enlarge over a period of months and then remain unchanged even for years. In late age they shrink and calcification at certain area. In pregnancy They may enlarge to cause concern , or infarct .Infarct may require a surgical excision.
Lactating NoduleCommonly known as ad enosis of pregnancy different from fibrocystic disease of non pregnant women .All breast tissues under go marked proliferation during pregnancy and many women may note one particular area to be more thickened than the rest. Presence of an asymmetrical swelling or well defined lump need imaging /biopsy. Imaging may define it as a solid lump but of similar ecumenicity while the pathologist may describe as norme4al tissue of pregnancy .As other type of benign lesions seen in pregnancy ,it also resolve to excision biopsy which should be avoided.
Cyst And Galactocoele A simple breast cyst may be large compared to the multiple tint cysts of fibrocystic disease. It may present as a lump of sudden on set. They are often found multiple when scanned. Most common in thirties., the child bearing decade in present era. They are more common in non pregnant women as compared to pregnant ones ., as it is due to degenerative changes, while breast under goes proliferative changes in pregnancy. Galactocoeles are more common in pregnancy and present as spherical shape with smooth surface . Diagnosis , for both , is confirmed by FNAC.
Breast Abscess More common in lactating woman than the pregnant one. Localized pain, tenderness and hot and redness of the overlying skin. The main difficulty is in differentiating an abscess from mastitis , the former is associated with throbbing pain and fluctuation may be elicited. Broad spectrum antibiotic , Nsaids, local hot fomentation, Sumac dressing will give relief in cases of mastitis while abscess requires incision and drainage.
Carcinoma BreastIrregular hard lump with presence of induration, which may be freely mobile or fixed and painless. Painful lump is to be differentiated from acute mastitis.Examination of both the breasts and axilla is mandatory followed by FNAC.One should refer such case to the oncologist , if following criterias are full filled— 1.Asymmetry of breasts. 2. A subtle dimpling of skin. 3. Apparent inflammation but without the commensurate tenderness. 4. Nipple retraction. 5. An ill-defined lump. 6. pureed-orange skin. 7. felicity.Useful website– www.breascancercare.org
Carcinoma breast This is a disastrous diagnosis for any young women but in pregnancy it is doubly difficult. If diagnosed in early stage of disease and confirmed by immediate scanning and biopsy, management of cancer breast in pregnancy is similar to that in case of non pregnant state. Pregnancy to be managed , depending on gestational age ,obstetric history, no of living children and willingness to have this baby or not. It has been reported that prognosis is same as that of non pregnant women having same stage of cancer breast.