Breast & its diseases

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Breast & its diseases

  1. 1. Breast Problems
  2. 2. Breast Development <ul><li>Contains mainly fat tissue, connective tissue and glands </li></ul><ul><li>15-25 ducts </li></ul><ul><li>Breast tissue extends into axilla (“tail”) </li></ul><ul><li>Smallest, day 4-7 </li></ul>
  3. 3. Quadrants <ul><li>Breast is divided into quadrants </li></ul><ul><li>Upper-Outer quadrant has the greatest mass </li></ul><ul><li>UOQ is the site of about half of all breast cancers </li></ul>
  4. 4. Supernumerary Breasts <ul><li>Relatively common </li></ul><ul><li>Found along “milk line” </li></ul><ul><li>Most identified during pregnancy/lactation </li></ul><ul><li>Most common in axilla </li></ul><ul><li>Not dangerous </li></ul>
  5. 5. Supernumerary Nipples <ul><li>More common than supernumerary breasts </li></ul><ul><li>Found along milk line </li></ul><ul><li>May darken during pregnancy </li></ul><ul><li>Not dangerous </li></ul>
  6. 6. Inverted Nipples <ul><li>Often will evert with stimulation </li></ul><ul><li>Mostly a cosmetic issue </li></ul><ul><li>Successful breastfeeding is usually possible. </li></ul>
  7. 7. Adolescent Breast Problems <ul><li>Assymetric growth is the rule rather than the exception. </li></ul><ul><li>Mammary hypertrophy: Postpone surgical intervention until all growth has occurred </li></ul><ul><li>Breast masses are ~100% benign and surgery or FNA is almost never warranted (disturbs breast architecture and may be disfiguring </li></ul>
  8. 8. Pregnancy Changes <ul><li>1st TM: Tender breasts and nipples </li></ul><ul><li>2nd TM: Non-tender breasts enlarge </li></ul><ul><li>2nd-3rd TM: Steady darkening of nipples and prominent Montgomery’s glands </li></ul>
  9. 9. Puerperal Mastitis <ul><li>Rapid onset of red, hot, swollen, tender breast </li></ul><ul><li>High fever </li></ul><ul><li>Prompt treatment (Amox, Diclox, Erythromycin, Azithromycin </li></ul><ul><li>Abscess needs drainage </li></ul><ul><li>Keep breast-feeding </li></ul>
  10. 10. Nipple Laceration <ul><li>Keep clean and dry. </li></ul><ul><li>Stop breastfeeding that side and allow to heal </li></ul><ul><li>Antibiotics usually not necessary </li></ul>
  11. 11. Cyclic Breast Pain <ul><li>Worst just before menses </li></ul><ul><li>Thick, tender, nodular breasts </li></ul><ul><li>Not dangerous but annoying </li></ul><ul><li>Rx: OCPs (cyclic or continuous) </li></ul><ul><li>Rx: Danazol (extreme cases) </li></ul><ul><li>Reduce caffeine? Vitamin E? </li></ul>
  12. 12. Non-Cyclic Breast Pain <ul><li>Often due to trauma (breast or chest wall) </li></ul><ul><li>May be due to muscle strain </li></ul><ul><li>May be due to increased levels of estrogen </li></ul><ul><li>Usually not due to cancer </li></ul><ul><li>Examine and refer if cause is not obvious. </li></ul>
  13. 13. Nipple Discharge <ul><li>Normal nipple discharge is clear, milky or green-tinged. </li></ul><ul><li>If bloody, needs surgical evaluation </li></ul><ul><li>If it stains the inside of the bra each day, that is galactorrhea and will need thyroid and pituitary evaluation. </li></ul>
  14. 14. Fat Necrosis <ul><li>Tender, thickened, bruised area of breast </li></ul><ul><li>Follows trauma </li></ul><ul><li>Benign </li></ul><ul><li>Resolves spontaneously over weeks to months </li></ul><ul><li>Atypical cases should have FNA </li></ul>
  15. 15. Breast Cyst <ul><li>Smooth, unilateral mass </li></ul><ul><li>Feels like a cyst </li></ul><ul><li>Infrequently associated with malignancy </li></ul><ul><li>Aspirate </li></ul><ul><li>Watch for reforming of cyst </li></ul><ul><li>Recurring cysts are more worrisome </li></ul>
  16. 16. Paget’s Disease <ul><li>Crusty, flaking lesion </li></ul><ul><li>Gradual onset over months or years </li></ul><ul><li>Associated with underlying breast malignancy </li></ul><ul><li>Diagnosis confirmed by needle biopsy </li></ul>
  17. 17. Breast Mass <ul><li>Dominant mass </li></ul><ul><li>Unilateral </li></ul><ul><li>Persists through the menstrual cycle </li></ul><ul><li>Usually biopsied (FNA or excisional) </li></ul><ul><li>Can wait weeks but not months </li></ul>
  18. 18. Fibroadenoma <ul><li>Common </li></ul><ul><li>Benign </li></ul><ul><li>Solid, rubbery, non-tender </li></ul><ul><li>Round or oval </li></ul><ul><li>Rarely grow > 2-3 cm </li></ul><ul><li>FNA or excisional Bx </li></ul><ul><li>Observe in adolescents </li></ul>
  19. 19. Breast Cancer <ul><li>30% of all cancers in women </li></ul><ul><li>Treatment is successful in 3/4 </li></ul><ul><li>Rare before age 25 </li></ul><ul><li>Steadily increasing frequency with increasing age </li></ul><ul><li>Affects 1/9 women reaching age 90. </li></ul>
  20. 20. Breast Cancer Risk Factors <ul><li>Strong family history </li></ul><ul><li>Menopause after age 55 </li></ul><ul><li>No term pregnancy prior to age 35 </li></ul><ul><li>Most (80%) of breast cancer occurs in women not at increased risk. </li></ul>

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