What is mastitis and what Is it caused by?
Mastitis is inflammation of the breast tissue and caused by infection - Staph Aureus
What 2 types of mastitis are there?
- Lactational mastitis
seen in women breastfeeding
present during first 3 months
Associated with cracked nipples and milk stasis - Non lactational mastitis
Risk factors –> smoking and Duct ectasia
What are the clinical features and management of mastitis?
Clinical features
- Tenderness, swelling and erythema, induration
Management
- Abx - cephlaxin (beta lactam - cell wall inhibitor)
- In lactational mastitis - continued milk drainage and feeding is recommended
What are breast cysts and clinical features?
Breast cysts are epilthelial lined, fluid filled sacs, which form lobules when distended due to blockage
occurs in perimenopausal age
clinical Features:
- one or more lesions
- one or both breasts
- smooth, fluid filled masses
- can be tender
How do breast cysts appear on investigations
and give management?
Mammogram - Halo shape
Ultrasound - to confirm diagnosis
Aspiration - if persisting or symptomatic, or undeterminable
- if the fluid is free from blood or the lump disappears - cancer may be excluded
Management
- self resolving
- aspiration for aesthetic reasons or patient reassurance
What are the complications of breast cysts?
2-3x greater risk of developing breast cancer in the future
- Fibroadenosis (benign - fibrocystic change) - tenderness and asymmetry
What is mammary duct ectasia and what are the clinical features?
Duct ectasia is the shortening and dilation of the major lactiferous ducts.
It occurs in perimenopausal women
Clinical features
- Green or yellow nipple discharge
- Palpable mass
- Nipple retraction
What are the investigations and management for duct ectasia?
Investigations
- mammogram - Dilated calcified ducts without any malignant features
- Biopsy - multiple plasma cells
Management
- Conservative
- Duct excision - unremitting nipple discharge
What is fat necrosis and the clinical features?
Acute inflammation of the breast leading to ischaemic necrosis of the fat lobules
- associated with trauma
- previous surgical or radiological intervention to the breast
- usually asymptomatic
- Lump
- Less commonly - fluid discharge, skin dimpling, pain and nipple inversion
What investigations are used in fat necrosis and management?
Positive traumatic history Ultrasound - hypererchoic
Core biopsy - to rule out malignancy
Management
- self limiting
- analgesics and reassurance
What benign breast tumours are there?
Fibroadenoma
Adenoma
Papilloma
Lipoma
What is the most common benign growth in the breast?
Fibroadenoma
What age women get fibroadenomas?
Women of reproductive age more likely get fibroadenomas
What is a fibroadenoma and how does it appear?
Fibroadenomas are prolferations of stromal and epithelial tissue of the duct lobules
- high mobile lesions
- well defined and rubbery, smooth
- <5cm
- can be multiple and bilateral
What is the management of fibroadenoma?
There is a low malignancy potential
Can be left in situ with routine follow up appointments
- core biopsy or fine needle aspiration
What is an adenoma?
Benign glandular tumour (older female population)
Nodular lesions
- Easily mimic malignancy
- Most cases with escalate for triple assessment
What is a breast triple assessment?
- History + exam
- Imaging
- Histology
What is a papilloma?
Intraductal papillomas are benign breast lesions
- 40-50 yrs
biopsy
risk of breast cancer with multiductal papillomas
What are the general features of benign lesions?
- more mobile
- smoother borders
- can get multiple lumps
What are general features of malignant lesions?
Craggy surfaves
Firm consistency
Fixed to tissue
Single mass
subareolar region
blood or clear nipple discharge
require biopsy die to similarity to ductal carcinomas
What is gynaecomastia?
Development of breast tissue in males.
Due to the imbalance of Oestrogen and Androgens - delayed testosterone at puberty
Usually benign disease but breast cancer can develop in 1% cases
What is the difference between physiological and pathological gynaecomastia?
Physiological
- Occurs in adolescence
- Delayed testosterone surge relative to oestrogen at puberty
Pathological
- results from changes in the oestrogen:androgen ratio due to:
- Lack of testosterone - Klinedelte’s syndrome, renal disease
- Inc oestrogen levels - hyperthyroidism, obesity
- Medication - anabolic steroids, metronidazole, spironolactone
What are the clinical features of gynaecomastia?
Insidious onset (gradual and subtle )
- Rubbery or firm mass > 2cm
- Starts from underneath the nipple and spreads outwards over the breast region
What are the investigations and management of Gynaecomastia?
Investigations
- ask about associated symptoms and co morbidities
- if cause is unknown
do LFT’s, U&E’s, Hormone profile
Management
- If reversible cause - treatment of cause should allow for resolution of gynaecomastia
- Tamoxifen - helps alleviate tenderness
