BREAST PROBLEMS GROUP III.pptx

COLLEGE OF HEALTH SCIENCES
SCHOOL OF NURSING & MIDWIFERY
POST GRADUATE PROGRAM
DEPARTMENT OF MATERNITY AND RH NURSING
ADVANCED MATERNITY AND REPRODUCTIVE HEALTH NURSING II
TITLE : Breast problems
PREPARED BY: ASHEBIR TUFA
ESTELA ABERA
TINSAE MULIYE
5/17/2023 Prepared by Ashebir ,Estela and Tinsae 1

Presentation outline
 Objectives
 Over view of anatomy and physiology of breast
 Benign conditions of the breast
 Pre-cancerous breast lumps
 Malignant conditions of the breast
 Breast infection

Objectives
At the end of this session , students will be able to:
Describe risk factors ,symptoms and management of Benign conditions of
the breast
 Identify different types of Pre-cancerous breast lumps
Describe risk factors ,symptoms and management of Malignant conditions
of the breast
Differentiate between benign and malignant breast conditions
Explain breast infection and its management

Over view of anatomy and physiology of breast

1.BENIGN CONDITIONS OF THE BREAST
1.1.Definition;
 Benign breast condition are unusual growth or other changes in the breast
tissues that are not cancer.
 Is Lumps, swelling, and nipple discharge from female or male breast which
is not cancerous.
 Is common in women of child-bearing age, but all women could develop
them.
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Prepared by Ashebir ,Estela and Tinsae 5

Benign Breast Conditions… Cont’d
 Globaly prevalence of benign breast disease is approximately 68%among all
breast disease ,of this approximately 60%occur in left breast and 40% in right
breast. (Vijayalakshimi R et al 2021)
 In Ethiopia prevalence of benign breast lesion (51%) and the most common
benign breast lesion is fibro adenoma (54.2%),followed by inflammatory breast
lesion is 20%, (Fekade Yerakly,et al.,2022)

1.2 risk factors of benign breast conditions ;
 Hormone therapy
 Birth control pills
 Menopause
 Being overweight
 Infection and Age
 Makeup of breasts (fatty tissue vs. dense or thick tissue)
 Caffeinated beverages

1.3. Types of benign) breast conditions:
1.3.1 Breast Cysts
1.3.2 Breast Fibroadenomas
1.3.3 Adenosis
1.3.4 Mastitis
1.3.5 Duct Ectasia
1.3.6 Fat Necrosis and oil cysts
1.3.7 Other Benign Lumps

1.3.1.Breast Cysts ;
 Is a benign, fluid-filled sac in the breast tissue. also called fibrocystic disease.
 About 50% of women age 30 and over develop breast cysts,
 In some cases, these cysts can be painful and require aspiration ,if the mass is
large and is causing problems.
 Are caused by hormonal imbalances such as increased estrogen levels and
decreased progesterone.
(Stachs A, Stubert J et al ; 2019)

1.3.2.Breast Fibroadenomas ;
 Are benign tumors that consist of glandular and connective tissue.
 They typically affect women in their 20s and 30s, but they can occur at
any age.
 It feels as round and firm and moves beneath the skin during a breast
self examination.

Benign Breast Conditions … Cont’d
 Are often located near the surface of the breast. However, some
may be too small to feel and are detected incidentally on a
mammogram.
 Although cancer risk is extremely rare, if the mass is large enough
,a biopsy may be warranted

1.3.3. Adenosis ;
 Is a benign condition characterized by enlargement in the breast's lobules. A breast
lobule is a gland that makes milk.
 Adenosis can produce a lump that feels like a cyst or a tumor.
 In addition, it can have the appearance of calcification on a mammogram.
Calcifications can signify breast cancer, so a biopsy is required to diagnose
adenosis.
(American C S 2015)
5/17/2023
Prepared by Ashebir ,Estela and Tinsae
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1.3.4. Mastitis ;
 Is an infection of the breast experienced by many women who breastfeed.
 It is often accompanied by Fever, pain, unilateral breast swelling , unilateral
erythema, warmth, swelling and tenderness
Less common presentation Nipple excoriations/ cracking, shock (MOH 2021)
Sometimes it may be difficult to distinguish between mastitis and
inflammatory breast cancer since symptoms of both include breast redness,
tenderness, and rash (Hester RH et al ;2021)
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1.3.5. Mammary duct Ectasia;
 Is a benign condition in which the milk ducts become clogged and swollen,
often causing a grayish discharge from the nipple.
 It may cause a small lump just under your nipple or cause the nipple to be
retracted inward.
 It most commonly occurs around the age of menopause.
 Is usually resolves independently or can be treated with antibiotics
(American C S; 2015)

1.3.6.Fat Necrosis and oil cysts ;
Fat necrosis;
 Is occur when the breasts are damaged by surgery, radiotherapy, or trauma.
 It causes superficial (below the skin), hard, round lumps with skin retraction.
 It mimics breast cancer on imaging tests and requires a biopsy for diagnosis.
 The common causes are , Seatbelt injuries, breast surgeries( such as breast
reduction ), and taking blood thinner drugs.
(Vasei N , Shishegar A et al ; 2019)
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Breast Oil Cysts;
 Is develop as a result of fat necrosis.
 As fat cells die, their contents are released, forming a cyst filled with oil.
 They are usually resolve with time or they can be removed if they become
uncomfortable.
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(Vasei N and Shishegar A et al ; 2019

1.2.7. Other Benign Lumps;
 Other benign lumps include breast
hematomas hemangiomas, adenomyoeptheliomas, and neurofibromas.
 Although these lumps are considered noncancerous,
 It's important to continue monthly BSEs and report new breast changes
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 According to a 2019 study in the International Journal of Cancer, women
with benign breast disease (BBD) have an increased risk of developing breast
cancer in the future. In addition, women with BBD, a family history of breast
cancer, and genetic mutations have an even greater risk of developing breast
cancer.
( International J C ,2019)
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1.4.Signs and symptoms Benign Breast Conditions
 Breast Pain (mastalgia) and swelling in the breast
 Breast tenderness
 A lump that can be felt through the skin or nipple
 Change in breast size, shape or appearance
 Skin irritation of breast
 Abnormal discharge from the breast (that is not milk)
 Retraction of the nipple

1.5.Diagnosis of benign breast condition;
 Physical breasts exam
 Imaging tests
 Laboratory analysis
 Breast biopsy
 Mammogram

1.6.Treatments of Benign breast condition:
 Birth control pills to reduce fluid buildup
 Fine needle aspiration to draw out some fluid
 Antibiotics
 Breast feeding can be continued
 Surgical removal of lump

1.7.Prevention Benign Breast Conditions
 Get regular mammographic screening
 Perform breast self exam
 Maintain ahealthy weight
 Eat nutrious diet
 Quite smoking
 Reduce alcohol intake
 Change birth control to non hormonal method

Mammogram;
 Are low-dose x-rays of the breast.
 Regular mammograms can help find breast cancer at an early stage, when
treatment is most successful.
 A mammogram can often find breast changes that could be cancer years
before physical symptoms develop

A breast self-examination:
 is usually 1 week after menstrual period starts, when breasts are least likely to be swollen or
tender.
 Use the pads of your three middle fingers and Use the middle fingers of your left hand to
check your right breast and vise versa.
Light pressure is needed to feel the tissue close to the skin surface. Medium pressure is used to
feel a little deeper, and firm pressure is used to feel your tissue close to your breastbone and
ribs.

Steps to follows
Step 1: Examine Your Breasts in a Mirror With
Hands on Hips Begin by looking at your breasts in
the mirror with your shoulders straight and your
arms on your hips and to cheek size, shape, color
Redness, soreness, rash, or swelling of Breasts
Step 2: Raise Arms and Examine Your Breasts
Now, raise your arms and look for the same
changes.

• Step 3: Look for Signs of Breast Fluid While you’re at
the mirror, look for any signs of fluid coming out of one
or both nipples (this could be a watery, milky, or yellow
fluid or blood).
• Step 4: Feel for Breast Lumps While Lying Down Next,
check for breast lumps or abnormalities by feeling your
breasts while lying down
• Step 5: Feel Your Breasts for Lumps While Standing or
Sitting Finally, feel your breasts while you are standing
or sitting

Article review on breast self examination:
Systematic review and meta-analysis done in Ethiopia ,among female
university students ,by including article published from Jan 1st,2010 to
june16th, 2020 indicates that :
 The estimated pooled prevalence of regular BSE practice among university
students in Ethiopia is 11.23% .
 In addition, the estimated pooled prevalence of irregular self-breast-examination
practice was 33.28%.
(Kassie AM et al ;2021)

A systematic review and meta-analysis done, among female healthcare workers in
Ethiopia from April 2, 2020 to April 24, 2020 , from 12 studies which involve 4129
female healthcare workers shows that:
The pooled prevalence of breast self-examination practice among healthcare
workers in Ethiopia was 56.31% (95% CI: 44.37, 68.25).
(Mekonnen BD et al;2020)

2.Pre-Cancerous Breast Lumps
2.1 Definition
 They are benign breast lumps that strongly associated with increased
cancer risk.
 Are pre-cancerous growths that can transform into cancer cells later.
 pre-cancerous lumps must be excised (surgically removed) entirely.

Pre-cancerous Breast lumps…Cont’d
2.2.Types of Pre-cancerous Breast lumps
2.2.1 Intraductal Papillomas
2.2.2 Radial Scars
2.2.3 Ductal or Lobular Hyperplasia
2.2.4 In Situ Tumors (DCIS and LCIS)
2.2.5 Phyllodes Tumors

2.2.1.Intraductal Papillomas:
 Are tumors that begin in the milk ducts of the nipple and often cause nipple
discharge.
 They are typically benign, they may be associated with an increased risk of
cancer, particularly if there are regions of atypical hyperplasia (abnormal cells).
 Surgical removal of the papilloma and the affected duct are often
recommended. ( American Cancer Society)
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2.2.2.Radial Scars ;
They are not actual scars, but the term describes how they look under a
microscope.
It affects both breasts and is diagnosed with a biopsy.
Are an uncommon breast lesion that puts women at a slightly higher risk
for developing breast cancer.
They do not usually cause a palpable lump, but may appear as a spiky
mass on a mammogram and some radial scars need to be removed.
(American Cancer Society. Hyperplasia of the breast )
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2.2.3. Atypical Ductal or Lobular Hyperplasia ;
 Atypical describes cells that look abnormal under a microscope,
while hyperplasia describes an overgrowth of cells.
 Breast tumors that have these characteristics are more likely to
turn into cancer; therefore, close monitoring or surgical excision is
required to treat these conditions.
(American Cancer Society. Hyperplasia of the breast )
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2.2.4.In Situ Tumors (DCIS and LCIS) ;
A . Ductal carcinoma in situ (DCIS) ;
 Is considered pre-invasive breast cancer or stage 0.
 Formed when cancerous cells line the ducts of a breast lobule
but do not invade the breast tissue.
 However, if the cancer cells spread out to the surrounding
tissue, it is considered invasive breast cancer.
 Several breast surgery options are available to treat DCIS.
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B . Lobular carcinoma in situ (LCIS) ;
 They occurs when cancer cells are found in the lining of the
breast lobule.
 Although LCIS is not considered a cancer diagnosis, people
with LCIS have nine to 10 times the risk of developing invasive
carcinoma compared to the general population.
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2.2.5.Phyllodes Tumors ;
 Most breast cancers start in epithelial cells. In contrast, phyllodes
tumors begin in mesenchymal cells (connective tissue cells).
It account for less than 1% of breast tumors. Approximately
60% to 75% of those cases are categorized as benign.
 The standard treatment is to surgically remove them.
5/17/2023 Prepared by Ashebir ,Estela and Tinsae
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3.Breast Cancer (Malignant conditions of the breast)
3.1 Definition of Breast cancer :
 Is a type of cancer that starts in the breast and spreads. It can start in
one or both breasts.
 It starts when cells begin to grow out of control.
 It occurs almost entirely in women, but men can get breast cancer, too.
(Memirie ST et al ;2018)
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Malignant conditions of the breast…Cont’d
 It can starts from different parts of the breast this includes;
 Lobules (lobular cancers)
 Ducts (ductal cancers)
 The nipple (Paget disease of the breast)
 The fat and connective tissue (stroma) ( phyllodes tumor)
 Blood vessels (angiosarcoma )
 lymph ( Lymphoma)
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 Globally, BC is the leading cause of death with about 2.3 million new cases and
685,000 estimated deaths in 2020 .( Sung Het al;2020)
 In Ethiopia, around 60,000 new cases of BC are diagnosed annually
 According to the Addis Ababa cancer registry report data, BC accounts for 33% of all
female cancer cases and 23% of all cancers (Memirie ST et al ;2018)

3.2 Risk factors ;
 Age
 Diet high in saturated fat
 Obesity after menopause
 Lack of exercise
 Alcohol intake greater than two units per day
 Family history of breast cancer ,medical treatment such as Oestrogen replacement
therapy
 Early menstruation (at or before age 12) and/or late menopause (after age 50)

• Article review
• In an institution based unmatched case control study conducted in in Addis
Ababa indicated that
Early onset of menarche(AOR= 4.10; 95% CI 1.84, 9.57)
Rural women (AOR= 3.64 ,95% CI 1.38, 9.57)
Utilization of packed foods or drinks (AOR= 2.80, 95% CI 1.52, 5.15
Family history of cancer( AOR= 2.11, 95% CI 1.04, 4.26)
Overweight and obesity were factors that increased breast cancer risk.
AOR= 2.38 , 95% CI 1.31, 4.31) (Lidia t et al ;2021)

Malignant conditions of the breast.
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3.3.Types of Breast Cancer
 The type is determined by the specific kind of cells in the breast that are
affected. These are;
3.3.1 Invasive ductal carcinoma of the breast
3.3.2 Invasive lobular carcinoma of the breast
3.3.3 Less common types of invasive breast cancer

3.3.1. Invasive ductal carcinoma of the breast(IDC);
 This is the most common type of breast cancer.
 About 8 in 10 invasive breast cancers are invasive (or infiltrating) ductal carcinomas.
 It Starts in the cells that line a milk duct in the breast.
 From there, the cancer breaks through the wall of the duct, and grows into the nearby
breast tissues.
 Then it may be able to spread (metastasize) to other parts of the body through the
lymph system and bloodstream. (ACS)
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3.3.2. Invasive lobular carcinoma (ILC)
About 1 in 10 invasive breast cancers is an invasive lobular carcinoma (ILC).
 ILC starts in the breast glands that make milk (lobules). Like IDC, it can spread
(metastasize) to other parts of the body.
 It may be harder to detect on physical exam and imaging, than invasive ductal
carcinoma.
 when compared to other kinds of invasive carcinoma, it is more likely to affect
both breasts.
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3.3.3 . Less common types of invasive breast cancer:
 Typically make up fewer than 5% of all breast cancers:
 This includes
A. Paget's disease of the nipple ;
Is a rare type of breast cancer involving the skin of the nipple
and the areola (the dark circle around the nipple).
Is usually affects only one breast

Signs and symptoms Paget's disease :
 The skin of the nipple and areola often looks crusted, scaly, and
red.
 There may be blood or yellow fluid coming out of the nipple.
 Sometimes the nipple looks flat or inverted.
 It also might burn or itch.
P
47

B. Inflammatory breast cancer ;
 Is rare and accounts for only 1% to 5% of all breast cancers.
Although it is a type of invasive ductal carcinoma, its symptoms,
outlook, and treatment are different.
 IBC causes symptoms of breast inflammation like swelling and redness,
which
is caused by cancer cells blocking lymph vessels in the skin causing the
breast to look "inflamed."
48

Signs and symptoms ;
 Swelling (edema) and Redness of the skin of the breast
 Thickening of the skin of the breast so that it may look and feel like an
orange peel
 A retracted or inverted nipple and One breast looking larger than the other
because of swelling
 One breast feeling warmer and heavier than the other
 A breast that may be tender, painful, or itchy
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c . Medullary carcinoma;
 Constitutes about 5% of breast cancers and grows in a capsule inside a
duct.
 This type of tumor can be-come large, but the prognosis is often favorable.
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d. Mucinous (or colloid) carcinoma;
Accounts for about 3% of breast cancers.
A mucin producer, it is also slow-growing and thus has a more favorable
prognosis than many other types.
e . Tubular carcinoma:
Accounts for only 2% of cancers.
 Because axillary metastases are uncommon with this histology, prognosis is
usually excellent
52

Article review
A five years (2015-2020) retrospective study conducted southern and southwest
Ethiopia indicates that invasive ductal carcinoma was the commonest histologic
type of breast cancer (77.1%), followed by invasive lobular carcinoma (11.1%)
and papillary carcinoma( 2.8%)
( Fekade Y et al; 2022)

Article review :
In an institution based retrospective longitudinal study conducted in BLSH Adult
Oncology among total of 627 adult patients with breast cancer included in the study
showed that 169 patients (26.95%) were died giving a crude death rate of 9.8 per
100 person years (95% CI: 8.49- 11.47).
The overall median survival time was 56.5(95% CI (53.46 - 60.83)) months. The
overall estimated survival rate after diagnosis of breast cancer was 26.42% (95% CI,
17.09 to 36.67 %) at 72 months of follow up (Wondimeneh S et al ;2018)

3. 4 . Stages of Breast Cancer;
According to American college of surgeons
There are five stages of breast cancer, including 0 (zero) through 4, written as 0,
I, II, III, and IV.
 The higher the number, the more the cancer has spread.
 The cancer is staged when you are first diagnosed

55

 The stage of breast cancer is also described by the "TNM" system:
T: Tumor size (in T centimeters)
N: Number of near by lymph nodes with cancer
M: Whether the cancer has metastasized or spread to other organs of the body (0 = no
spread, 1 = it has spread)
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Stage 0:
 The disease is only in the ducts and lobules of the breast.
 It has not spread to the surrounding tissue.
 It is also called noninvasive cancer (T0, N0, M0).
57

Stage I:
The disease is invasive.
 Cancer cells are now in normal breast tissue.
 There are 2 types:
Stage IA:
The tumor is up to 2 centimeters (cm).
It has not spread to the lymph nodes (T1, N0, M0).
Stage IB:
The tumor is in the breast and is less than 2 cm. Or
The tumor is in the lymph nodes of the breast and there is no tumor in the breast tissue.

Stage II ;
 Describes invasive breast cancer.
Stage IIA:
 A tumor may not be found in the breast, but cancer cells have spread to at least 1 to 3 lymph
nodes. Or,
 Stage IIA may show a 2 to 5 cm tumor in the breast with or without spread to the axillary
lymph nodes.
Stage IIB:
The tumor is 2 to 5 cm and the disease has spread to 1 to 3 axillary lymph nodes. Or
The tumor is larger than 5 cm but has not spread to the axillary lymph nodes.

Stage III
 Describes invasive breast cancer.
Stage IIIA:
 The tumor is in the breast and any size or no tumor is found in the breast
but is in the lymph nodes.
 The disease has spread to more than 4 lymph nodes in the breast or axilla.
 It has not spread to other parts of the body.
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Stage IIIB:
The tumor may be any size and the disease has spread to the chest wall.
It may cause swelling of the breast and may be in up to 9 lymph nodes.
 Inflammatory breast cancer is considered Stage IIIB.
Stage IIIC:
tumor may be any size and may have spread to the chest wall or breast skin.
The disease has spread to 10 or more axillary lymph nodes, or nodes above or
below the collarbone or breastbone
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Stage IV (metastatic):
 The tumor can be any size .
 The disease has spread to other organs and tissues, such as ;
 The bones, lungs, brain, liver,
 Distant lymph nodes, or chest wall (any T, any N, M1).
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3.5 . Signs and symptoms of breast cancer
Some warning signs of breast cancer are
 lump in the breast or underarm (armpit).
 Thickening or swelling of part of the breast.
 Irritation or dimpling of breast skin.
 Redness or flaky skin in the nipple area or the breast.
 Nipple discharge other than breast milk, including blood.
 Any change in the size or the shape of the breast

3.6.Diagnosis breast cancer
 History
 Physical examination
 Laboratory investigation
 Pathological diagnosis
 Clinical staging
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3.7.Treatment Breast Cancer
3.7.1 Surgery
3.7.2 Chemotherapy
3.7.3 Hormonal therapy
3.7.4 Radiation therapy

3.7.1. Surgery :
 Breast conserving surgery:-
 Is an option for the treatment of early stage breast cancer,
 where the cancer is not too large in comparison to the breast and has not invaded
the surrounding tissues.
 Oncoplastic breast surgery
 is combination of plastic surgery techniques and breast cancer surgery techniques.
It allows removal of large tumours with wider margins while maintaining, or in
some cases improving the shape of the breast
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Mastectomy:
 Is a surgical procedure used to cut out malignant, or cancerous tissue
 Two types
A . Modified Radical Mastectomy:- is recommended in Ethiopia (STG)
Is a procedure where the lymph nodes in the armpit and other tissue is
removed (the 'axillary contents') along with the breasts.
B . Radical Mastectomy :-
is the removal of the breast/s, lymph nodes and pectoral muscles behind
the breast tissue
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3.7.2.Chemotherapy:
 The uses of drugs to stop the growth of cancer cells, either by killing the cells or by
stopping them from dividing.
 Is usually systemic, meaning it is injected into a vein or given by mouth.
 Drug Regimen in Ethiopia
 First line AC regimen (doxorubucin and cyclophosphamide)
FAC regimen (5 fluorouracil ,doxorubucin and cyclophosphamide )
CMF regimen(5 fluorouracil, methtrixate and cyclophosphamide )
(STG of Ethiopia )
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3.7.3.Hormonal therapy
 It slows or stops the growth of hormone-sensitive tumors by blocking the body’s
ability to produce hormones or by interfering with the effects of hormones on breast
cancer cells.
 Types of hormone recommended in Ethiopian standard treatment guideline is
Tamoxifen 20 mg po for 5 years after chemotherapy
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]
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3.7.4.Radiation therapy
 Treatment that uses high-energy x-rays or other types of radiation to kill cancer
cells or keep them from growing.
Breast conservative surgery is not recommended as it always needs adjuvant
radiotherapy to reduce recurrence of cancer
(STG of Ethiopia 2014 )
5/17/2023

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 Hospital based retrospective cohort study conducted in Ethiopia at HUCSH and
(YIMSC),among 302 female breast cancer patients Diagonized from 2013 to 2018
indicates that the median survival time is 50.8 months and declined to 30.57months
in worst case analysis and the overall survival probability of patients at two and
three years was 73.2% and 63% respectively
(Shita A ; 2023)

Breast Cancer Screening Guidelines for Women:According to ACS
1.Women aged 40 to 49 with average risk:
Women aged 40 to 44 years should have the choice to start annual breast cancer screening with
mammograms if they wish to do so.
The risks of screening as well as the potential benefits should be considered.
Women aged 45 to 49 years should get mammograms every year.

2.Women aged 50 to 74 with average risk:
 Women aged 50 to 54 years should get mammograms every year.
 Women aged 55 years and older should switch to mammograms every 2 years, or have the
choice to continue yearly screening
3.Women aged 75 or older with average risk:
Screening should continue as long as a woman is in good health and is expected to live 10 more
years or longer
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4.Women with dense breasts:
There is not enough evidence to make a recommendation for or against yearly MRI screening
5.Women at higher than average risk:
Women who are at high risk for breast cancer based on certain factors (such as having a
parent, sibling, or child with a BRCA 1 or BRCA2 gene mutation) should get an MRI and a
mammogram every year.

6.Additional issues relevant for all women:
Women should be familiar with the known benefits, limitations, and potential
harms associated with breast cancer screening.
They should also be familiar with how their breasts normally look and feel and
report any changes to a health care provider right away

4.BREAST INFECTION
4.1.Definition :
 A breast infection is occurs when bacteria invade the breast, resulting in
inflammation. This is called mastitis.
 It can cause an infected lesion on the surface of the breast and pain deep
in the breast.
 Although mastitis is often associated with lactation, people who are not
lactating can also get breast infections
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Breast infection…Cont’d
Mastitis
 Is a common type of breast infection.
 It is particularly prevalent during lactation because the nipples can crack,
allowing bacteria to enter the breast.
A milk duct can also become clogged due to incomplete breast emptying or
excess pressure on the breast.
Clogged milk ducts allow bacteria to multiply, which can lead to an infection.

Hyperlactation or over supply of milk
Narrowing of milk ducts
Engorgement
Bacterial mastitis

4.2 Risk factors
Previous bout of mastitis while breast –feeding.
 sore or cracked nipple .
wearing tight bra or putting pressure on breast
Smoking
 with diabetic mellitus

 A Community based cross sectional household surveys conducted on self
reported lactational mastitis ,in 2020 with 3315 women from four countries
(Ethiopia, Kenya, Malawi and Tanzania ) indicates that lowest prevalence
noted in Ethiopia (3.1%) and the highest is Kenya ( 12%)
(Ouedraogo M; et al 2022)

4.2.Types of breast infection and causes:
There are several types of breast infections, including:
4.2.1.Central or subareolar infection:
 This occurs when the milk ducts become infected or inflamed.
 It is most likely to develop in people who smoke.
 It can cause nipple changes, such as nipple retraction or unusual discharge.
4.2.2.Granulomatous lobular mastitis:
 This causes a painful but noncancerous mass to develop in the breast.
5/17/2023
83

4.2.3. Peripheral, nonlactating infection:
 This type of infection often leads to inflammation or a visible abscess on the
breast.
 It commonly occurs in people with diabetes or those who smoke.
4.2.4. Cellulitis:
This is a skin infection more common in people with large breasts or those with
a history of breast surgery or radiotherapy.
 It can cause a rash that can spread quickly if not treated
84

4.3.Sign and symptoms of Breast infection :
 An infected lesion on the surface of the breast.
 Pain deep in the breast.
 The breast feeling hot to the touch
 A fever and nausea
 Flu-like symptoms, including body aches and feeling tired
 Sores on the nipple or breast that do not heal
 Ulcers on their skin, which may leak pus or blood.
85

4.3.Diagnosis of Breast infection;
 Ask History of ;
 Breastfeeding,
 Breast trauma, or has had surgery
 Treatments on the breast.
 Fever, chills, or fatigue
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87

88
 Physical examination:
 Breast and nipple
 Lab investigation and imaging:
 Culture or swab of breast discharge.
 Mammogram.
 Ultrasound
 Breast biopsy:

4.4.Treatment of Breast infection:
Antibiotics Frequency and duration
Cloxacillin 500mg QID for 10 days
Or Erythromycin 250mg TID for 10 days
Paracetamol
500-1000mg QID or TID

Non pharmacological:
 Encourage the woman to:
 Continue breastfeeding; -
 Support the breasts with a binder or bra
 Apply cold compresses to the breasts between feedings to reduce swelling
and pain.
 Follow up in three days to ensure response
(MOH 2021)
90

4.5 .Complication of breast infection ;
Recurrence
 is appears especially in cases of delayed or inadequate treatment
 Breast abscess:
Fever, unilateral breast swelling and pain,
localized and fluctuant mass with erythema of overlying skin
Less common presentation Draining pus, pus discharge per nipple
(MOH 2021)
91

 Can be classified as into lactational (LBA) and non lactational breast abscess
(NLBA)
 Descriptive cross sectional study conducted among in Ethiopia ,at SPHMMC from
sept 2015-Aug 2020 indicates that LBA(87.1% ) is more prevalent than NLBA(12.9)
based on retrospective review of clinical records.
( Suga Y et al ;2023)
92

 Treat with antibiotics with Cloxacillin or Erythromycin for 10 days
 Supportive Treatment
 Surgical Treatment; Pus must be drained either by incision and drainage or
ultrasound-guided needle aspiration
(MOH 2021)

4.6.Counseling and advising for prevention;
 Breastfeed regularly. Do not delay or skip feedings
 Air out your nipples after nursing.
 Don’t wear nursing pads or tight-fitting bras that keep nipples moist.
 Nurse your baby on one side, allowing the breast to empty, before switching to the
other breast.
 Switch up breastfeeding positions to fully empty all areas of the breast.
 Eat healthy foods and drink plenty of fluids
94

 To avoid poor position and attachment for reducing nipple fissure
and breast engorgement advice on the following signs;.
Four good sign of position
 with the newborn’s head and body straight .
 facing her breast, with baby’s nose opposite her nipple .
 with the newborn’s body close to her body .
 supporting the baby’s whole body, not just the neck and shoulders

Four good sign of attachment
 Mouth widely opened .
Lower lip turned upward .
Chin touching the breast .
More of the areola (the dark ring around the nipple) is seen above the baby’s mouth
than below it

97
References
1. Stachs A, Stubert J, Reimer T, Hartmann S. Benign breast disease in women Dtsch Arztebl Int.
2019;116(33-34):565-574. doi: 10.3238/arztebl.2019.0565
2. Obstetrics management protocol for hospitals Ethiopia 2021
3. Lee M, Soltanian HT. Breast fibroadenomas in adolescents: current perspectives AHMT. 2015;6:159-
163.doi: 10.2147/AHMT.S55833
4. American Cancer Society. Adenosis of the breast.
5. Hester RH, Hortobagyi GN, Lim B. Inflammatory breast cancer: early recognition and diagnosis is
critical. American Journal of Obstetrics and Gynecology. 2021;225(4):392-396.
doi:10.1016/j.ajog.2021.04.217
6. American Cancer Society. Duct Ectasia
7. Vasei N, Shishegar A, Ghalkhani F, Darvishi M. Fat necrosis in the Breast: A systematic review of
clinical Lipids in Health and Disease. 2019;18(1):139. doi:10.1186/s12944-019-1078-4
8. Kassie AM, Abate BB, Kassaw MW, Shiferaw WS. Breast Self-Examination Practice Among Female
University Students in Ethiopia: A Systematic Review and Meta-Analysis. Cancer Control. 2021 Jan-
Dec;28:10732748211019137. doi: 10.1177/10732748211019137. PMID: 34169755; PMCID:
PMC8236787.
9. Mekonnen BD. Breast self-examination practice and associated factors among female healthcare workers in Ethiopia: A
systematic review and meta-analysis. PLoS One. 2020 Nov 10;15(11):e0241961. doi: 10.1371/journal.pone.0241961.
PMID: 33170880; PMCID: PMC7654829.

References
8.Zeinomar N, Phillips KA, Daly MB, et al. Benign breast disease increases breast cancer
risk independent of underlying familial risk profile: Findings from a prospective family
study cohort. Int J Cancer. 2019;145: 370-379. doi:10.1002/ijc.32112
9.American Cancer Society. Intraductal papillomas of the breast.
10.Cohen MA, Newell MS. Radial scars of the breast encountered at core biopsy: Review
of histologic, imaging, and management consideration Am J Roentgenol.
2017;209(5):1168-1177. doi:10.2214/AJR.17.18156
11.American Cancer Society. Hyperplasia of the breast (ductal or lobular)
12.Wen HY, Brogi E. Lobular carcinoma in situ Surgical Pathology
Clinics. 2018;11(1):123-145.
13.Suga Y, Kuehn T, W/Ammanuel G, Knfe G , Teklewold B, Review of Breast Abscess Cases
https://doi.org/10.2147/IJWH.S39166,2023.

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