The document discusses various benign breast diseases including congenital abnormalities, mastalgia, gynecomastia, fat necrosis, duct ectasia, galactocele, intraductal papilloma, and fibroadenoma. It provides details on the anatomy, etiology, clinical presentation, pathological features, and treatment approaches for each condition. The majority of benign breast diseases can be treated conservatively without long-term consequences.

1. PROF. Amer Eltwati IRHUMA FRCS

2. Quote
'failure' is not falling down but in staying down ..!
anonymous

3. Definition
The word “breast” refers to the mammary
glands, plus the additional connective
tissue elements and fat that surround and
support the gland.

4. INTRODUCTION
The breast has always been the symbol of womanhood
and Ultimate fertility. As result both, disease and surgery
of the breast evoke a fear of mutilation & loss of femininity .
Benign breast diseases account for about 80 % of the
breast pathology
Very few benign breast disease have an ability to become
malignant , but the majority are treated easily with out
adverse consequences
However management of some benign breast diseases
proven to be troublesome and associated with high
psychological morbidity

5. ANATOMY
The breast is an appendage of skin & is modified
sweat gland, the shape of the female breast is due to
the fat contained within fibrous septa.
In the adolescent & young adults the breast is firm &
prominent , with the age the glandular & fibrous
element atrophies, the skin stretch & breast sags.
The breast lies between the skin & pectoral fascia to
which it is loosely attached. It extends from the 2nd
to the 6th ribs & from the lateral border of the
sternum to the mid-axially line.
A prolongation of paranchymatus tissue, the axillary
tail, runs up-ward between the pectorals major and
latissmus dorsi muscles to blend with the fat of the
axilla .

6. Anatomy of the Breast

7. ANATOMY
 The breast glandular tissue consists of 15 to 20 lobules
(clusters of milk forming glands, or acini) that enter into
branching and interconnected ducts. The ducts widen
beneath the nipple as lactiferous sinuses and then empty
via nipple openings..
The primary secretory unit is group of saccular alveoli
draining into ductless (the terminal duct- lobular Unit ). In
the resting state this secret watery fluid which is believed
to be reabsorbed through the walls of large ducts.
The alveoli ducts are lined by single layer of epithelial
cells. Myoepithelial surround the ducts, but not the
lobules, they are contractile & move secretion along the
duct system

8. Anatomy of the Breast

9. BLOOD SUPPLY
ARTERIAL: -
laterally:- this comes from
branches of lateral
thoracic artery and
perforating branches of
the intercostal arteries.
Medially from perforating
branches of internal
mammary artery.
B- VEINS:-it follows the
same course of arterial
supply.

10. Lymphatic drainage of the breast
The understanding of the lymph
drainage of the breast are of
great importance for the
surgeon. The lymphatic is
profuse &run within the
substance of the breast
Medially:- to the intrenal mammary
nodes
Laterally:- to the nodes along the
lateral thoracic vesseles ( pectoral
group) & subscapular vesseles
(subscapular group), from these
nodes lymph passes-up through the
central & apical axillary nodes to the
subclavin trunk.
Few lymphatic pierce the pectoral
fascia & enter the chest

11. Levels of axillary nodes
Pectoralis Supraclavicular
minor muscle nodes
Pectoralis
major
muscle
Pectoralis major
muscle
Axillary
vein Interpectoral
nodes
Internal
mammary
nodes
Latissimus
dorsi
muscle
Abdominal
nodes

12. Hormones Affecting the Breast

13. Benign breast diseases

14. INTRODUCTION
Host to a spectrum of benign and malignant
diseases.
Benign breast conditions are practically a
universal phenomena among women.
It accounts for 80% of clinical presentation
related to the breast.

15. CONGENITAL & DEVELOPMENTAL
ABNORMALITIES
Although the normal location of the breast is the
anterior thorax, breast tissue with or without a
nipple or just nipple and areola alone can occur
any where along the milk line
The milk line is an ectodermal thickening
appearing at 6 weeks of gestation running from
axilla to the midportion of inguinal ligament

16. Development of the breast
The milk line
(ectoderm) extends
from the axilla to groin.
Along this line
accessory breast or
nipples may be found

17. CONGENITAL & DEVELOPMENTAL
ABNORMALITIES
total lack of breast tissue
( amastia) or of nipple
(athlelia) is un unusual
supernumerary nipples
polythelia & breast
polymasita are quite
common.
when polymastia is
present in women, the
additional breast tissue
can secret milk when
nipple is present.

18. Amastia
Amastia: A rare condition wherein the normal growth of
the breast or nipple does not occur.
Unilateral amastia (just on one side) is often associated
with absence of the pectoral muscles.
Bilateral amastia (with absence of both breasts) is
associated in 40% of cases with multiple congenital
anomalies involving other parts of the body as well.
Amastia is distinguished from amazia wherein the breast
tissue is absent, but the nipple is present. Amazia
typically is a result of radiation or surgery.

19. amastia

20. Mastalgia
Mastalgia is breast pain and is generally classified
as either cyclical (associated with menstrual
periods) or noncyclic
Breast pain of any type is a rare symptom of breast
cancer , only 7% of breast cancer have mastalgia
as the only symptom.
Most mastalgia is of minor to moderate severity and
accepted as part of the normal changes that occur
in relation to menstrual cycle.

21. Mastalgia
Cyclic mastalgia: begin since average 34 y/o,
relieved by menopause, physical activity can
increase the pain, e.g. lifting and prolonged
use of arm.
Non-cyclic mastalgia: affects older women
(mean age 43), arises from chest wall. Breast
itself or outside the breast.

22. Mastalgia - treatment
Danazol: (200-300 mg daily, slowly reduced
to 100 mg daily or on alternative day, given
on days 14-28 of menstrual cycle, after pain
relief.
Responses are usually seen within 3 months
Weight gain, acne and hirsutism.

23. Gynecomastia

24. Gynecomastia
Gynecomastia is the growth of glandular tissue in
male breasts.
The name comes from the Greek term (gyne + mastos)
meaning "female-like breasts." It is a benign condition
that accounts for more than 65% of male breast
abnormalities.
Gynecomastia is clearly differentiated from
pseudogynecomastia, which is an accumulation of
excess fat in a male breast.
it is usually unilateral & occur in young man. there is
no hormonal dysfunction in unilateral Gynecomastia.
Bilateral Gynecomastia is due to systemic causes.
Causes of Gynecomastia may be regarded as:

25. Primary Gynecomastia
physiological causes
Neonatal gynaecomastia
is due to the trans-placental passage of maternal
oestrogen and may be associated with a nipple discharge
known as 'witch's milk'. It usually resolves during the
first few weeks of life.
Pubertal gynaecomastia
is the commonest male breast lesion. It can be either
unilateral or bilateral. Reassurance is often the only
treatment that is required. The lesion will generally settle
spontaneously but may persist for months or years.
Senile gynaecomastia
can be difficult to differentiate from the pseudo-
gynaecomastia due to general adiposity increasingly seen
in old age.

26. Secondary Gynecomastia –
pathological causes
Primary testicular failure
Anorchia
Klinefelter's syndrome
or bilateral cryptorchidism.
Acquired testicular failure
Mumps
irradiation.
Secondary testicular failure
hypopituitarism.
Isolated gonadotrophin deficiency.
Endocrine tumours
Testicular
adrenal
pituitary.

27. Gynecomastia – pathological causes
Non-endocrine tumours
bronchial carcinoma
Lymphoma
hypernephroma.
Hepatic disease
alcoholic cirrhosis
haemochromotosis.
Drugs
oestrogen agonists (spironolactone),
hyperprolactinaemia (phenothiazines),
Testosterone target cell inhibitors (cimetidine, cyproterone
acetate)

28. Pathophysiology of breast gynecomastia
Pathophysiology of breast gynecomastia.
 Estradiol is the growth hormone of the
breast, and an excess of estradiol leads
to the proliferation of breast tissue.
 Under normal circumstances, most
estradiol in men is derived from the
peripheral conversion of testosterone
and adrenal estrone.
 The basic mechanisms of gynecomastia
are
 a decrease in androgen production,
 an absolute increase in estrogen
production,
 and an increased availability of
estrogen precursors for peripheral
conversion to estradiol.

30. Gynecomastia – clinical features

31. Gynecomastia – clinical features
The cause is often self evident from a full
history and examination.
The testes should always be examined.
Useful investigations may include
a chest x-ray,
full blood count
and liver function test.
If there is suspicion of a testicular tumour
then ultrasound should be requested.
Hormonal assays may confirm
endocrinopathies

32. Gynecomastia
Treatment of gynecomastia
• for physiological causes reassurance is all what
is needed
• stop drugs causing gynecomastia
• subcutaneous mastectomy in troublesome
cases
• Liposuction - assisted mastectomy

33. FAT NECROSIS
 This is traumatic in nature & is met with women with
large fatty breast
 Results from injury to breast fat by Trauma,
surgery, biopsy….
 Causes to focal fibrosis and cicatrix formation.
 Early: edema of the fat lobules,increased
echogenicity.
 Post surgical scar, hematoma, seroma

34. FAT NECROSIS
Clinically:
The patient develop sever bruising after moderately sever
trauma, When the bruise settles the woman notice swelling
which is clinically Impossible to distinguish from carcinoma
of the breast because the Irregular mass is often attached
to the skin.
Microscopically a central area of necrotic fat cells are
surrounded by a granulomatous reaction consisting of
macrophage cells.

35. FAT NECROSIS

36. Treatment:
by surgical excision, the excised mass is an
infiltrative yellowish white mass.

37. Duct Ectasia
This condition has
several stages of
involvement & vanity of
names include (plasma-
cell mastitis, comedo
mastitis, & chronic abscess
simulating carcinoma).
It is benign lesion may be
virtually impossible to
differentiate from
carcinoma by it is gross
appearance

38. Duct Ectasia
is a widening of the ducts of the breast, a condition
that occurs most frequently in women in their 40s
and 50s. A thick and sticky discharge, usually gray
to green in color, is the most common symptom.
Tenderness and redness of the nipple and
surrounding breast tissue may also be present.
Sometimes, scar tissue forms around the abnormal
duct, leading to a lump that may be initially
mistaken for cancer.

39. Duct Ectasia
Microscopically
-The periductal elastic
tissue is destroyed & the
surrounding tissue are
infiltrated with
lymphocytes & plamsa
cell

40. Duct Ectasia
Clinically:-
this condition present as solitary or multiple tender swelling
in the sub or Peri-areolar region of the breast.
- Nipple retraction, skin adherence, edema & axillary
adenopathy may accompany a hard, diffuse mass within the
breast
- palpation reveals a number of cord like swelling which
radiate from the areola.
- the ducts are dilated & contain an inspissated yellow
cheesy material that can be expressed like toothpaste from
the cut end of a duct.
- occasionally, the inflammatory response are so acute that
skin changes occur & the condition may be mistaken for
a breast abscess.

41. Duct Ectasia
Treatment :
Small volume
discharge is managed
conservatively
Socially embarrassing
discharge is treated
by Major duct
excision

42. Galactocele
Cystically dilated terminal ductules
that are filled with milk and lined by
double layer of breast epithelium
and myoepithelium.
Classically appears as a painless
lump weeks – months after
cessation of breast feeding.

43. GALACTOCELE
It is probably formed by obstruction to a duct in
the puerperium . the milk retained proximal to
the obstruction eventually becomes cheese-like.
The common complication of this type of
swelling is infection.
The treatment is by surgical excision.

44. INTRA-DUCTAL PAPILLOMA
This benign lesions of the
lactiferous duct wall occur
centrally beneath the areola In
75% of cases.
They most commonly produce a
bloody nipple discharge, some
times associated with Pain
They are solitary proliferation of
ductal epithelium
Intraductal papillomas should
be treated by excision of a duct
as a wedge resection.

45. FIBROADENOMA

46. FIBROADENOMA
Fibroadenomas are benign tumors composed of stromal
and epithelial elements. The tumors are commonly seen
in young women.
Fibroadenoma is a common well - circumscribed lesion
of the breast & develop in the breast prior to
menopause.
Pericanalicular tumors usually being found below the age
of 30 & intracanalicular tumors there after.
Either breast may be affected and multiple & successive
tumors may develop in the same or contra-Lateral
breast.

47. FIBROADENOMA
The preicanalicular tumor forms a firm discrete
mass, which is freely mobile in the breast
tissue, hence the name (BREAST MOUSE )
The intracanalicular tumors tends to be softer &
may grow to such size that there is necrosis of
the overlying skin. To such a condition the
terms serocystic disease of bordie OR cystisarcoma
phylloides OR Giant fibroadenoma have been given.
However despite the implication of malignancy
in the later term, the tumor is benign.

48. FIBROADENOMA
Pathophysiology:
Fibroadenomas are benign tumors that represent a
hyperplastic or proliferative process in a single
terminal ductal unit; their development is considered
to be an aberration of normal development. The
cause is unknown. Approximately 10% of
fibroadenomas disappear each year, and most stop
growing after they are 2-3 cm in size.
Fibroadenomas may involute in postmenopausal
women, and coarse calcifications may develop.
Conversely, the tumors may grow rapidly during
pregnancy, during hormone replacement therapy, or
during immunosuppression, in which case they can
simulate malignancy.
Fibroadenoma variants include juvenile
fibroadenoma, which occurs in female adolescents.

49. FIBROADENOMA - Pathology
This swelling has been
variously regarded as a
simple hyperplasia of
epithelial and / or
connective tissue
elements or as a
composite neoplasm of
the breast in which the
epithelial & mesnchymal
components grow
simultaneously

50. FIBROADENOMA
Clinical Features:
On clinical examination, fibroadenomas may be nonpalpable
or palpable, oval, freely mobile, rubbery masses. Their
size varies from smaller than 1 cm in diameter to as large as
15 cm in diameter in the giant forms.
Most commonly, the tumors are removed surgically when
they are 2-4 cm in diameter. In young women, the tumors are
usually palpable. In older women, the tumors typically appear
as a mass on mammograms, and the tumor may be palpable
or nonpalpable.
The size of fibroadenomas also can vary during the
menstrual cycle and during pregnancy.
In the postmenopausal period, tumors regress and often
develop calcifications

51. Fibroadenoma
Types Natural history
Solitary
Few (< 5 / breast ) Majority remain small & static
Multiple (> 5 / breast ) 50% involute spontaneously
Giant (> 4 / 5 cms) & Juvenile No future risk of malignancy

52. DIAGNOSIS : Triple assessment
Triple Assessment
Hx and clinical pathology
exam Imaging
FNAC
Ultrasound Core biopsy
Mammography Open biopsy

53. FIBROADENOMA - investigation
Breast, fibroadenoma
Sonogram. demonstrates
a hypoechoic mass with
smooth partially
lobulated margins that
are typical of a
fibroadenoma.

54. FIBROADENOMA - investigation
Breast, fibroadenoma.
Craniocaudal mammograms
obtained 1 year apart
demonstrate a newly
developing mass in the outer
part of the breast.

55. FIBROADENOMA
Treatment
Reassurance of the patient
Excisional biopsy

56. Treatment
The natural history of these lesions has recently been
elucidated and has resulted in a change in management
policy.
Over a 2 year period approximately 20% slowly increase in
size, 10% reduce in size, 20% completely resolve and 50%
remain static.
With knowledge of this natural history a conservative
management policy can often be adopted.
In those <35 years and with a triple assessment
supporting the diagnosis then observation with regular
review is acceptable.
In those > 35 years and in younger patients requesting it,
excision biopsy should be considered.

57. Management algorithm for Fibroadenomas
F ib ro a d e n o m a
( c li n i c a l d i a g n o s i s )
T r i p le a s s e s s m e n t
A ll r e s u lt s c o n c u r r R e s u lt s d o n o t c o n c u r r M u lt i p le f i b r o a d e n o m a s G ia n t fib ro a d e n o m a /
A g e < 3 0 y e a rs A g e > 3 0 y e a rs ( S e le c t i v e t r i p le a s s e s s m e n t ) J u v e n i le f i b r o a d e n o m a
C li n i c a l o b s e r v a t i o n f o r 2 y e a r s E x c is io n E x c i s i o n o f la r g e s t E x t r a c a p s u la r E x c i s i o n
w ith r i m o f n o r m a l tis s u e C li n i c a l o b s e r v a t i o n o f r e s t
N o c h a n g e / s h rin k a g e / d is a p p e a re n c e In c r e a s e i n s i z e /
A t p a tie n t r e q u e s t
D is c h a rg e w ith a d v ic e o n B S E E x t r a c a p s u la r E x c i s i o n

58. Cystosarcoma phyllodes (CSP)
Cystosarcoma phyllodes (CSP) is a rare, predominantly
benign tumor that occurs almost exclusively in the
female breast. Its name is derived from the Greek words
sarcoma, meaning fleshy tumor, and phyllo, meaning
leaf.
Grossly, the tumor displays characteristics of a large,
malignant sarcoma, takes on a leaflike appearance when
sectioned, and displays epithelial cystlike spaces when
viewed histologically (hence the name).
Because most tumors are benign, the name may be
misleading. Thus, the favored terminology is now
phyllodes tumor.

59. Cystosarcoma phyllodes (CSP)

60. Pathophysiology of CSP
Pathophysiology:
Phyllodes tumor is the most commonly
occurring nonepithelial neoplasm of the
breast, and it occurs only in the female
breast.
It has a sharply demarcated, smooth texture
and is typically freely movable. It is a
relatively large tumor, and the average size is
5 cm. However, lesions more than 30 cm in
size have been reported.

61. Cystosarcoma phyllodes (CSP)

62. Cystosarcoma phyllodes (CSP)

63. TREATMENT of CSP
Surgical Care:
In most cases, perform wide local excision with a rim
of normal tissue
If the tumor/breast ratio is sufficiently high to
preclude a satisfactory cosmetic result by segmental
excision
total mastectomy, with or without reconstruction, is
an alternative.
More radical procedures generally are not warranted
Perform axillary lymph node dissection only for
clinically suspicious nodes. However, virtually all of
these nodes are reactive and do not contain
malignant cells.

64. FIBROCYSTIC DISEASE

65. FIBROCYSTIC DISEASE
This is the most common lesion of the female
breast.
Cystic lobular hyperplasia & fibrocystic
disease of the breast are the two common
acceptable description.
Cystic hyperplasia is a variant of normal cyclic
changes in the breast that occur with
menstruation.
This hyperplasia usually presents bilaterally in
the upper outer quadrant of the breast & is
most painful in the premenstrual period

66. Fibrocystic Breast Disease
Most benign breast condition
Incidence-varying, related to age
Menstruating years-20%
30-50% in premenopausal years
Synonyms-
Mammary dysplasia,
Cystic disease,
Cyclic Mastopathy,
Cystic Hyperplasia

67. Pathophysiology of fibrocystic disease
The exact cause of fibrocystic disease is unkwon
Hormonal basis
Oestrogen & Progesterone
Prolactin
Thyroid
Methylexanthiones
Trauma- NOT A CAUSE

68. Pathophysiology of fibrocystic disease
Oestrogen & Progesterone
Oestrogen predominance over progesterone is
considered causative
Serum levels of Oestrogen high
Luteal phase is shortened
Progesterone level decreased to 1/3 normal, and women
with progesterone deficiency carry a five fold risk of
premenopausal breast cancer
Corp. Lut. Deficiency / Anovulation in 70%
Patients with Pre Menstrual Tension syndrome more
likely to develop FDB

69. Pathophysiology of fibrocystic disease
Prolactin-
levels are increased in 1/3 of women with FDB
Probably due to Oestrogen dominance on pituitary
Thyroid –
Suboptimal levels sensitize mammary epithelium to
Prolactin stimulation
Methylexanthiones-
Increased intake of coffee, tea, cold drinks chocolate
is associated with development of FDB

70. Pathomorphology
Oestrogens stimulate proliferation of
connective and epithelial tissues.
The polymorphism of fibrocystic disease
is documented by :
fibrosis,
cyst formation,
epithelial proliferation,
and lobular-alveolar atrophy

72. Clinical Course of fibrocystic disease
FDB represents a clinical problem in approximately 30% of
patients.
Predominantly afflicted are
women with menstrual abnormalities
nulliparous women
patients with a history of spontaneous abortions
nonusers of oral contraceptives and
women with early menarche and late menopause.
Early fibrocystic manifestations may occur between the age
of 20 and 25 years, but most patients (70% to 75%) are in
their mid 30s and 40s.

73. Clinical Course of fibrocystic disease
Incidence of FBD
60%
50%
40%
30%
50%
20%
10% 20%
10%
0%
Under 21 Years Menstrual years Pre-menopausal

74. Clinical Course of fibrocystic disease
Clinically, three phases of fibrocystic disease
can be recognized-
Phase I - Moderate stromal fibrosis, beginning
hardness of breast tissue and premenstrual breast
tenderness
Phase II - Progressive fibrosis leading to increased
hardening and tenderness, cyst formation, moderate
modularity
Phase III - Pronounced fibrosis and tenderness,
macrocyst formation

75. Diagnosis of fibrocystic disease
triple assessment
 Symptoms and Signs -
Fibrocystic disease has a history of many months to
several years.
Fibrocystic disease is rare in ovulating women,
multiparous women, and patients using oral
contraceptives.
Breast pain (mastodynia) and/or tenderness is
observed in the majority of patients.
In 40% to 60% of patients these are associated
with irregular menses, dysmenorrhea,
menometrorrhagia, or ovarian cysts.

76. Diagnosis of fibrocystic disease
Nipple secretion-
In one third of patients with FDB, discharge is
spontaneous or secretion can be expelled from the
nipple. The cytological features may include
amorphous material (fat, proteins), ductal cells,
erythrocytes, and / or foam cells. the fluid is straw
yellow, greenish, or bluish. In 2-3% carcinoma is
diagnosed
Bloody Nipple secretion- when present
50-60% due to intra ductal proliferation (Papilloma)
30-40% due to carcinoma ( 64% after age 50).

77. Diagnosis of fibrocystic disease
Mammography –
Patients with early fibrocystic change
show small areas of increased
density on the mammographic
film.These are irregular and
scattered, with varying degrees of
density. As disease progresses,
dark areas may occur along with
the whitish grey areas, and
microcalcifications may also
become prominent. These
calcifications can be single or
multiple small flecks located in
intraductal or periductal stroma or
in entire lobules.

78. Diagnosis of fibrocystic disease
Ultrasonography -
Particularly useful in delineating solid from cystic
breast masses.
Ultrasound of cystic masses characteristically defines a
mass with a uniform outer margin demonstrating no
asymmetry or unusual thickness of the wall. The central
part of the mass shows no echoes, and there is
posterior wall enhancement.

79. Diagnosis of fibrocystic disease
Needle aspiration biopsy –
Indicated in patients with breast mass, a lump like
structure,, a hard dense area or any abnormal tissue
areas, as defined by clinical examination,
mammography or USG.
In patients at high risk of breast cancer, needle
aspiration should be performed when the slightest
suspicion arises.
In women with fibrocystic disease, ductal epithelium
consists of cohesive cells with a scant rim of
cytoplasm and round or oval small, slightly hyper
chromatic nuclei. Connective (fibrous) tissue is
usually predominant.

80. Treatment of fibrocystic disease
 Medical-  Surgical-
Goal-
Intervention indicated
To stop progression when-
To relieve pain
FBD is increasing in
To reverse changes size
Soften breast tissue Serous /
Indicated when- Serosanguineous /
FDB not increasing in bloody discharge
size occurs
No nipple discharge Patients are
No psychological pshychologicaly
effect disturbed

81. Treatment of fibrocystic disease
 Medical- Hormones
Danazol
OC pills-
Remains the most
Users are protected from
effective therapy
FBD
Progestogen potency Basis- ovarian supression
should be high Dose-200-600mg/day
Progestogens -
To be given in the luteal
phase for 9-12 months
About 80% get relief but
40% require restart of
therapy

82. Treatment
 Medical-
Ineffective modalities Hormones-
Diet therapy-Caffeine Low Oestrogen
restriction
Diuretics Combined OC pills
Iodine containing Progestogens in the
agents
luteal phase
Thyroid hormone
Evening Primrose oil Antioestrogens-
Vitamin E & B6 Tamoxifen
Dihydroergotamine Androgens-Danazol
Antiprolactin drugs
82

83. Treatment of fibrocystic disease
 Medical- Hormones - Danazol
Efficacy of Danazol
100%
90%
80% 90%
70% 81.40%
60% 75%
50%
40%
30% 47%
20%
10%
0%
200mg 400mg 100-800mg 200-400mg

84. Surgical treatment
surgical removal of lumps, in most severe
cases of benign fibrocystic breast disease

85. MASTITIS

86. MASTITIS
Breast mastitis is an infection that commonly
affects women who are breast-feeding
(especially during the first two months after
childbirth) but can occur in all women at any
time.
Mastitis is a benign condition that can usually
be treated successfully with antibiotics.
Inflammation can be caused by many types of
injury including :
infectious agents and their toxins,
physical trauma
or chemical irritants

87. SIGNS AND SYMPTOMS OF MASTITIS
Part or all of the breast is intensely:
painful,
hot, tender, red, and swollen.
Some patients can pinpoint a definite area
of inflammation, while at other times the
entire breast is tender. - feel tired, run down,
achy, have chills .feel like flu .
A breastfeeding mother who thinks she has
the flu probably has mastitis.

88. SIGNS AND SYMPTOMS OF MASTITIS
chills or feel feverish, or temperature 38c or
higher. These symptoms suggest an infection.
Feeling progressively worse, the breasts are
growing more tender, and the fever is becoming
more pronounced.
Other signs of mastitis:
cracked or bleeding nipples,
stress or getting run down,
missed feedings or longer intervals between
feedings.

89. SIGNS AND SYMPTOMS OF MASTITIS

90. TREATMENT OF MASTITIS
Mastitis usually requires treatment.Treatment for
mastitis may require the following:
Antibiotics are usually prescribed by a physician to
help clear up the infection.
Use warm water on the infected area of the breast
before breast-feeding to help stimulate let-down (the
milk ejection reflex).
Breast-feed or pump frequently, using both breasts.
Lactation consultants recommend first breast-
feeding from the unaffected breast until let-down
(milk ejection reflex) occurs and then switch to the
breast with mastitis.
Breast-feed only until the breast is soft.
Apply icy compresses to the breasts after breast-
feeding to relieve pain and swelling.
Drink fluids and get enough rest.
Analgesia to control the pain.

91. BREAST ABSCESS

92. BREAST ABSCESS
This condition is usually found during
lactation . as role the infecting organism is :
staphylococcus aureus, and less commonly
streptococcus pyogenes .
the usual mode of infection is via the nipple,
the infection being carried by suckling infant
in the nasopharynx.
The infection is at first limited to the segment
drained by the lactiferous duct but it may
subsequently spread to involve other areas of
the breast.

93. BREAST ABSCESS
CAUSES :
Staphylococcus aureus and streptococcal
species are the most common organisms
isolated in puerperal breast abscesses.
Nonpuerperal abscesses typically contain
mixed flora (S aureus, streptococcal
species) and anaerobes.

94. BREAST ABSCESS
CLINICAL FEATURES
SYMPTOM
Localized breast area edematous,
erythematous, warm, and painful
History of previous breast abscess
Associated symptoms of fever, vomiting, and
spontaneous drainage from the mass or nipple
May be lactating

95. BREAST ABSCESS
CLINICAL FEATURES
SIGNS
Localized breast area erythematous, hot, edematous,
and extremely painful
Most commonly found in the areolar or periareolar
area
Fluctuance of the mass
May have associated fever or axillary
lymphadenopathy
Discharge with palpation from nipple or mass
Nipple inversion

96. Investigations
1-Ultrasound: used to localize the abscess
2. FNAC: used to exclude underlying carcinoma
especially in chronic Breast abscess where the
abscess become encapsulated with a thick fibrous
capsule & the condition can’t be distinguished from
a carcinoma without a biopsy.
3. Needle Aspiration: to confirm presence of pus.
4. Mammogram: to exclude underlying carcinoma.

97. BREAST ABSCESS
MANAGEMENT
1- If the patient present in the cellulitis stage the patient should
be treated with an appropriate Antibiotic.
2- Breast rested with feeding on the opposite side only.
3- The milk should be expressed from the healthy segments of
the affected breast.
4- Support of the breast
5- Local heat & analgesia to relive the pain.
6- If the infection doesn’t resolve within 48 h, the breast should
be incised & drained.
N.B. if antibiotics used in the presence of undrained pus, an
Antibioma form. This is a large sterile brawny edematous
swelling which takes many weeks to resolve.

98. BREAST ABSCESS
MANAGEMENT
7.If pus is present at the time of presentation, which can
be confirmed by Needle aspiration, Incision & Drainage
is done which can be achieved by :
 Simple Needle Aspiration: using a wide pore needle under local
anesthesia.
 Guided drainage: under image control with radiological or
ultrasound techniques a tube drain can be inserted & left until
the cavity has collapse.
 Surgical drainage: it is the most certain method, not only can all
loculi be reached, but also dead tissue can be removed. The
cavity is then dressed regularly & left open to heal by 2ry
intention.
 Excision of all of the major ducts in case of Periductal Mastitis .

99. BREAST ABSCESS
 Prevention
 Taking care of Breasts during pregnancy &
Lactation
 Stop lactating from cracked nipple.
 Treating Mastitis in its early stages with
appropriate medication & duration.
 Drainage of Post-traumatic Hematoma.
 Excision of Sebaceous Cyst.
 Self Examination for any masses or
tenderness.
 Control of concomitant disease that increase
the tendency to get infections such as DM

100. MANAGEMENT

101. BREAST ABSCESS
Lactational breast abscess Non-lactational breast abscess
Usually due to Staph. aureus Occur in periareolar tissue
Usually peripherally situated Culture yield - Bacteroides, anaerobic strep,
Surgery may be pre-empted by early enterococci
diagnosis Usually manifestation of duct ectasia / periductal
Attempt aspiration mastitis
If no pus - antibiotics Occur 30- 60 years , More common in smokers
If pus present consider repeated Often give history of recurrent breast sepsis
aspiration or incision and drainage Repeated aspiration is the treatment of choice
Consider biopsy of cavity wall Metronidazole and flucloxacillin
Continue breast feeding from Drain through small incision if non-resolving
opposite breast Definitive treatment when quiescent with
No need to suppress lactation antibiotic prophylaxis
Usually a major duct excision = Adair's operation
Spontaneous discharge or surgical excision can
result in mammary fistula

102. CONCLUSION
Benign breast disorders & diseases are common
The aetiopathogenesis is complex and not fully
understood
Lump and pain are the most common complaints
Evaluation is done by Triple assessment
Histological risk factors for future malignancy are
relative and not absolute risk factors
Treatment is based on the natural history of clinical
problems
Treatment must be tailored to individual needs