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Benign Breast Disease.pptx
- 2. Mastalgia • The commonest breast symptom in women • The commonest presenting symptom to General Practitioner (GP) • Two third or 60-70% of women at the age between 15-40 year olds • 10-20% of the women suffer from severe pain • There are two types of mastalgia: • Cyclical mastalgia • Non-cyclical Mastalgia
- 3. Cyclical Mastalgia • Bilaterally and diffuse with more at the upper outer quadrant of the breast • It could be more severe in one breast than the other • It usually occurs 1-2 weeks before menstruation • It is resolved after the onset of menstruation • It is often described as fullness, heaviness with dragging or aching
- 4. Non-cyclical Mastalgia • It is common among the women at their 40s • It is usually unilateral • The pain is felt more at the inner part of the breast or behind the nipple • It is described as throbbing, burning or stabbing pain • It is more likely associated with some breast pathology like breast cysts, fibroadenoma or ductal ectasia. • It could be caused by stretching of the Cooper’s ligament, diabetic mastopathy, traumatic fat necrosis
- 5. Non-breast pain • The pain can mimics mastalgia • It could be chest wall pain: • Costochondritis • Herpes zoster • Non-chest wall pain: • Ischemic heart disease • GERD • PUD • Biliary colic
- 6. Etiology of Mastalgia • Hormonal Abnormalities • Increased estrogen • Deficiency of progesterone • Hyperprolactinemia • Water retention • Study showed mastalgia is not associated with water retention • It is not related to caffeine intake ( Good news for coffee drinkers)
- 7. Assessment • History taking and clinical examination by clinician • USG breast palpable breast lumps or abnormalities • MMG Women age > 35 “ Triple Assessment for any Breast Abnormalities”
- 8. Management • Daily Breast Pain Chart • “P” at the day of having pain with the score of 0-10 (VAS score) • Score > 3 required therapy
- 9. • Reassurance no abnormalities detected at triple assessment • Supporting and well-fitting bra (70% women has poorly fitted bra) • Relaxation therapy • Evening Primose Oil (EPO) • Some studies did not show any benefits • Simple Medication • Diclonec gel (3x / day for 6 months)
- 10. Hormonal Therapy • Danazol • Only FDA approved medication for mastalgia • Testosterone deratives • The dosage is 50mg daily up to twice a day for at least 3 months • Side effects : hair growth, weight gain, voice changes, hot flush and menstruation irregularities • Contraindicated for pregnancy as it has teratogenic effect • Reserved for patient whom is not responded to tamoxifen
- 11. Hormonal Therapy • Tamoxifen • It is selective estrogen receptor modulator • It is the first line of treatment for mastalgia • The dosage is 10mg daily • Relieve cyclical mastalgia in 70 to 90% of cases and non-cyclical mastalgia in 56% of the cases • Side Effect : Hot flush, menses irregular • Goserelin (LHRH analog) • Effective for recurrent mastalgia or mastalgia not responds to others hormonal therapy
- 12. Other Medications • Bromocriptine • Dopamine agonist, block the release of prolactin • 50-80% of patients have long-lasting relieve from breast pain • It was stopped because severe side effect of nausea, vomiting and dizziness • Lissuride Maleate • Dopamine agonist • Binds to prolactin receptor • Well tolerated and effective • Not being used widely as it has been associated with pathological gambling and hypersexuality
- 13. Surgical Intervention • Trigger point • Pain localised at one tiny point of the breast • If imaging not reveal any underlying pathological abnormalities • Lignocaine injection • Steroid injection • Mastectomy
- 14. Benign Breast Lumps • Fibroadenoma • Breast Cyst
- 15. Fibroadenoma • It is the most common benign breast lump • They have peak incidence in age 21-25 year olds • Fewer than 5% occurs at women age > 50 year olds • It is associated of usage of OCP before age of 20 • It is a hormonal dependent neoplasm
- 16. Presentation • Painless mobile breast lump • It is usually unilateral, but in some case it could be bilateral or multiple lesion in one breast • It is usually solitary lesion measuring 1-3 cm in diameter • Only 20% of cases are multiple or greater than 4cm • It is mostly found at the upper outer quadrant of the breast • 15% regress spontaneously; 5-10% of cases progressing to grow • Malignant potential is extremely low in fibroadenoma
- 17. Investigation • Ultrasound Breast • Ovoid smooth solid mass • AP narrower than transverse diameter • Low internal echoes • Mammogram • Well-circumscribed lesion • Diagnosis • FNA or Core biopsy
- 18. Managment • Conservative management • Small lesion (<3cm) • 6 monthly follow-up with imaging till age of 35 • For surgical intervention if the lesion not regress or slow increasing in size by the age of 35 • Surgical intervention • Size > 5cm • Rapidly increasing in size • Symptomatic lesion • Cosmetic reason by the patient
- 19. Surgical Intervention • Ultrasound-guided Vaccum Assisted Biopsy (VAB) • Cryo-ablation therapy • Better cosmetic outcome • Only for lesion less than 3cm • Surgical excision of the breast lump • It is a daycare procedure • It could be done under general anaesthesia or local anaesthesia • Encourage to wear the sport bra for less post-operative pain
- 20. Breast Cyst • It is part of the fibrocystic disease in women • It is typically developed in 30-50 year-olds women • The etiology of the breast is unknown but related to estrogen • That is why most of the simple cyst disappears after menopause
- 21. Presentation • Asymptomatic, incidental finding • Painless palpable breast lump • It is also associated with cyclical mastalgia
- 22. Investigation & Management • Ultrasound breast • Round, well-circumscribed, anechoic lesion • Complex cyst thick wall, intracystic mass or discrete solid component • Mammogram • Not much helpful in breast cyst • Management • USG-guided aspiration / FNA • Follow-up in 4-6 weeks • If it recurs rapidly after aspiration surgical excision is warranted
- 23. Mastitis • Inflammation of the breast • It could happen spontaneously or during lactation • It more commonly affect women aged 15-45 years, especially during lactation. • Mastitis can be worsening into breast abscess
- 24. Lactational Mastitis • Mastitis occurs approximately 10% of the breast-feeding mother • It is most common in first 6 weeks of breast-feeding • The highest incidence occurs in the second and third weeks postpartum • The is approximate 10% of mastitis develops into breast abscess
- 25. Risk factors for lactational mastitis • Primiparity • Previous mastitis • Cracked nipple • Local milk stasis • Age > 30 • Pregnancy > 41 weeks of gestation
- 26. Clinical Presentation • Breast pain • Fever, flu-like symptoms • Engorgement of the breast • Redness and warm on touch at the affected breast • There is an area of fluctuating (abscess formation) • Mastitis is a clinical diagnosis • USG breast is important if there is suspicious of breast abscess
- 27. Management of mastitis • Simple analgesia • Ibuprofen is a good option with paracetamol as an alternative • Tramadol and other opiods are avoided due to CNS depression to the infant • Breast Support • Emptying the breast • Suckling or by manual expression • Mechanical suction recommended for subaerolar abscess • Hot pack before feeding and cold pack after feeding • ? Cabbage leaves
- 28. Medication for mastitis • Lactation suppression medication • Carbergolamine • Bromocriptine • Side effect : nausea and vomiting • Antibiotic for 10 days
- 30. Management of breast abscess • USG-guided aspiration with antibiotic • Incision and drainage • Prolonged healing time • Regular dressing • Difficult in breast feeding • Risk of milk fistula
- 31. • Thank you