Define benign breast disease
- Breast tissue changes ranging from normal to abnormal, either in development, cyclical change or involution (shrinking down of an organ in old age) phases. Includes:
o Fibrocystic change
o Breast cysts
o Fibroadenomas - results from hypertrophy of abreast lobule
o Sclerosing adenosis - aberration of normal involution
o Intraductal papillomas - a small, benign tumour that forms in a milk duct
o Duct ectasia - when central ducts become dilated with ductal secretions. These secretions may leak into periductal tissues and cause an inflammatory reaction (periductal masititis)
o Periductal mastitis
o Fat necrosis
Explain the aetiology/risk factors of benign breast diseas
- Related to changes in hormone levels
- Fat necrosis occurs secondary to TRAUMA
- Risk Factors
(o May be less common in patients on the OCP
o SMOKING is a risk factor for periductal mastitis)
Summarise the epidemiology of benign breast disease
- VERY COMMON
- Diffuse fibrocystic changes are very common (60% of women)
- Fibroadenomas are more common in 15-35 yrs
Recognise the presenting symptoms of benign breast disease
- History of breast discomfort or pain (may be cyclical)
- Swelling or lump
- Nipple discharge
(o NOTE: if this is bloody, malignancy should be suspected ) - To assess risk factors for breast cancer, ask patient about:
(o Family history
o Exposure to oestrogen (age of menarche, menopause, number of kids, breastfeeding, use of OCP/HRT))
Recognise the signs of benign breast disease on physical examination
- Focal or diffuse nodularity of breast
- Fibroadenoma - smooth, well circumscribed and mobile lumps (known as a ‘breast mouse’)
- Duct Ectasia (a condition in which central ducts become dilated with ductal secretion due to a blockage of the lactiferous ducts) - causes yellow/green discharge
- Features of malignancy will be ABSENT in benign breast disease:
(o Dimpling
o Peau d’orange
o Enlarged axillary lymph nodes )
Identify appropriate investigations for benign breast disease
- Patients usually undergo TRIPLE ASSESSMENT:
o Clinical Examination
o Imaging
(* Mammography (two-view) - NOTE: benign lumps are less likely to be calcified
- Ultrasound - in younger patients (< 35 yrs) )
o Cytology/Histology
(* Fine Needle Aspiration - sent for cytological analysis - Excision Biopsy - sent for histological analysis )
Generate a management plan for benign breast disease
- Conservative
o Symptomatic treatment (e.g. analgesia for mastalgia)
o Fibroadenomas may be treated conservatively - Surgery
o Removal or excision biopsy of a breast lump
o Wide local incision if there is any suspicion of the lump not being benign
o Microdochectomy (surgical removal of a lactiferous duct) - performed for intraductal papillomas
o Hadfield’s Procedure (surgical removal of ALL lactiferous ducts under the nipple) - is used for duct ectasia
Identify possible complications of benign breast disease
- Pain
* Recurrence
Summarise the prognosis for patients with benign breast disease
- GOOD
* However, recurrence is common
Define breast abscess
- Abscess formation in breast tissues.
o TWO main forms: - Lactational
- Non-Lactational
Explain the aetiology/risk factors of breast abscess
- Caused by INFECTION
- Causative organisms defer based on whether the abscess is:
o Lactational - Staphylococcus aureus
o Non-Lactational - Staphylococcus aureus
- Anaerobes
* Risk Factors o Lactation o SMOKING o Mammary duct ectasia o Periductal mastitis o Wound infections (e.g. from breast surgery)
Summarise the epidemiology of breast abscess
- Lactational breast abscess are COMMON and tend to occur soon after starting breast feeding or weaning
- Non-lactational breast abscesses are more common in 30-60 yo smokers
Recognise the presenting symptoms of breast abscess
- Breast discomfort
- Painful swelling
- Generally unwell and feverish
- Non-lactational - tend to present with a history of previous infections with less pronounced systemic upset
Recognise the signs of breast abscess on physical examination
- Local
o Swollen, warm and tender area of the breast
o Overlying skin may be inflamed
o The nipple may be cracked
o Non-Lactational - Scars or tissue distortion from previous episodes
- Signs of duct ectasia (e.g. nipple retraction)
- Systemic
o Pyrexia
o Tachycardia
Identify appropriate investigations for breast abscess
- Ultrasound
* MC&S of pus samples
Generate a management plan for breast abscess
- Medical
o Antibiotics - Lactational: flucloxacillin
- Non-Lactational: flucloxacillin + metronidazole
- Surgical
o Lactational: Incision and drainage
o Non-Lactational: open drainage should be avoided. The involved duct system should be excised once the infection has settled
Identify possible complications of breast abscess
- Mammary fistula
* Overlying skin may (rarely) undergo necrosi
Summarise the prognosis for patients with breast abscess
- If untreated, a breast abscess may discharge onto the skin surface
- Non-lactational breast abscesses tend to recur
