This document discusses common breast disorders and their management. It covers topics such as breast masses, pain, nipple discharge, infections, lactation complications, mastitis, abscesses, inflammatory and non-inflammatory painful conditions. Diagnosis involves history, examination and investigations like ultrasound and mammography. Management depends on the condition and may include antibiotics, analgesia, drainage procedures or surgery. Benign and malignant breast conditions are also differentiated.

1. BREAST
DISORDERS
Dr. Mohammed Niyaz
MEM RESIDENT
MIMS-K

2. Common breast complaints
 Breast pain
 Breast mass
 Nipple discharge
 Infection
 Postoperative complications

3. Pathophysiology
 Normal breast tissue – glandular tissue
 Anterior chest wall
 Sternocostal junction  Midaxillary line
 2nd to 6th ribs in midclavicular line
 Arterial supply – internal mammary, lateral thoracic,
thoracodorsal and subscapular arteries

4. History
 Onset of mass or pain, location and duation
 Complaints varying with menses – benign
 Presence of symptoms on contralateral side – benign
 Colour and consistency of nipple discharge
 Family history
 50 % breast cancers - age > 65 years

5. Physical examination
 Supine position with ipsilateral hand behind the head.
 Upper outer quadrant – origin of half of breast Ca
 Asymmetry in glandular consistency, nodules
 Nipple areolar complex, axilla , anterior and posterior neck

6. PHYSIOLOGY AND
DISORDERS OF LACTATING
BREAST

7. ABNORMAL LACTATION
 Inappropriate secretion of milky discharge – Galactorrhea
 Prolactinomas- galactorrhoea, amenorrhea, hirsuitism, facial
acne , visual defects , headache

9. Complications of Lactation
 Breast engorgment – 3rd to 5th postpartum day
 Carbohydrate rich milk  bacterial overgrowth
colonization of Candida in lactiferous ducts Obstruction of
flow
 Topical application - Nystatin

10. • Endemic mastitis , occurs few weeks to months postpartum
• Staphylococcus (40 %), E.coli and Streptococcus

11. INFLAMMATORY BREAST
CONDITIONS
Differential Diagnosis
 Infectious Mastitis
 Ruptured breast cyst
 Inflammatory neoplasm
 Metastatic cancer
 Tuberculosis
 Paget disease

12. MASTITIS
Signs and Symtoms
 Erythematous area on breast with well localized pain
 Fever, chills , myalgias, flu like symptoms
 Investigatiions : Ultrasound to r/o abscess
 Treatment : Analgesia and antibiotics, Surgery follow up

13. BREAST ABSCESS
Signs and Symtoms
 Erythematous area on breast with well localized pain
 Fever, chills , myalgias, flu like symptoms
Treatment :
 US guided needle aspiration for abscesses < 3 cm
 Analgesia and antibiotics
 General anesthesia for larger periareolar or retroareolar
abscess.

14. PERIDUCTAL MASTITIS
 Plasma cell mastitis or Mammary duct ectasia
 Benign disorder with dilated or ectatic ducts with retained
secretions
Signs and symptoms :
 Younger women – cellulitis or recurrent subareolar abscesses
 Perimenopausal and post menopausal – nipple discharge,
nipple retraction or subareolar mass
Treatment : Analgesia, antibiotics and follow up with surgeon

15. HYDRADENTIS
SUPPURATIVA
 Chronic inflammatory disease involving obstruction of sweat
glands
 Recurrent multiple abscesses, sinsus tracts and scarring of
breast folds
 Treatment : Incision and drainage

16. ANTIBIOTICS
 Dicloxacillin 250 mg four times a day x 10-14 days
Or
 Cephalexin 500 mg four times a day x 10-14 days
Or
 Clindamycin 300 mg four times a day x 10-14 days
Or
 TMP-SMX , 80/160 mg twice a day

17. INFLAMMATORY BREAST
CANCER
 Highest mortality and longest delay from initial presentation
 Breast enlargement , warmth, tenderness, edema, eythema
and discolouration of overlying skin
 Erythema and edema – Peau d’ orange appearance
 Mammography and biopsy

18. NON INFLAMMATORY
PAINFUL BREAST
DISORDERSMASTODYNIA :
 Discomfort- cyclic , waxing or waning with menstrual cycle
 Pain – bilateral and more in upper outer quadrant
 Examination – tender, nodular breasts
Treatment :
 Reassurance and supportive measures.
 Reduction in dosage of HRT
 Flaxseed oil and diclofenac 2 % topical gel
 Persistent pain – increased risk for breast cancer

19. Nipple Discharge
 Purulent : Infection, Periductal mastitis
 Milky (Galactorrhea) : Pregnancy, Prolactinoma, Pituitary
adenoma, Drugs- hormones, Psychotropics phenothiazines),
antiemetics, antihypertensives
 Serous or serosanguinous : Intraduct papilloma, Ductal
ectasia, cancer
 Watery : Papilloma, Cancer
 Green, gray, black or tan : Duct ectasia

20. SKIN AND NIPPLE
ABNORMALITIES
MONDOR DISEASE :
 Thrombophlebitis of superficial thoracoepigastric vein
 Cord like mass in the breast, common in lower quadrant
 Breast pain, skin changes
 Treatment – NSAIDs

21.  NIPPLE IRRITATION :
 Repeated friction from clothing or sun burn
 Indicative of atopic dermatitis , erosive adenomatosis or
Pagets disease
 Petroleum jelly or use of protective pads
 FIBROCSTIC DISEASE :
 Breast nodularity and tenderness
 Mammography and follow up
 Recurrent symptoms, skin changes, solid masses, nipple
abnormalities- Possibility of cancer
 Family history, endogenous estrogens, nulliparity or biopsy
confirmed atypical hyperplasia- increase risk of cancer

22. PERIOPERATIVE AND POST
OPERATIVE COMPLICATIONS
 BREAST HEMATOMA :
 1.5 L of blood can extravasate
 Expanding hematoma – evacuation or ligation of vessels
 Late presentation – conservative management
 WOUND INFECTION :
 First generation cephalosporins