Breast Disorders (CMPP)

Witches milk

secretion of milky material from infant nipples from maternal hormones

usually stops after 5 to 7 days

How does the breast change with onset of puberty (10-12 y/o)

Areola further enlarges and darkens

a mass of tissue develops beneath the areola

How does the breast change with onset of menses

Breasts are well developed, and the nipple projects forward

When do breasts finish developing

13-15 y/o

How does the breast change with menses

engorgement that occurs 3-5 days before menses,

increase in breast size,

density and nodularity of the breast

If trying to diagnose breast mass, what time of cycle should be avoided

3-5 days before menses

How does breasts change with pregnancy

the breasts become fuller and firmer,

the areola darkens,

the nipples become erect,

increased venous network,

third trimester colostrum is produced

How does breasts change with nursing

marked engorgement, after

breasts become softer and less nodular

How does breasts change with menopause

breasts decrease in size

become less dense with an increase in elastic tissue

How frequently are clinical breast exam looked

at least every three years (age 20-40);

yearly after age 40

What is the most important thing for clincial breast exam

Distinguishing benign lumps and malignancies

a lump that shrinks in size during one part of the month and swells during other times is likely

normal glandular tissue

What lymph nodes are palpated for breat exam

Axilla

Supraclavicular

Infraclavicular

Cervical

Most Common Benign Breast Condition

Fibrocystic Breast Changes

Presentation of Fibrocystic BReast Changes

Pain (Mastaglia) and Engorgement

Worst at menses

Multiple bilateral lesions

Larger cysts → fill like balloon with fluid

Who commonly gets fibrocystic breast changes

Premenopausal women

Test of Choice for Fibrocystic Breast Changes

Ultrasound

Management for Fibrocystic Breast Changes

breast support

Heat or ice on the breast

Gentle massage

NSAIDS and acetaminophen

restriction of salt, caffeine, and tobacco

When should we do aspirations of breast mass

Appears cystic

How does fibrocystic lesions appear with aspiration

Straw-colored, brown, or green fluid

When do we perform biopsy for breast mass

Mass persists after cycle

Cyst that doesn’t resolve from aspiration

Spontaneous nipple discharge

Abnormal mammogram

Clincal Concern

Fibroadenoma

most common benign tumor found in the breast

Characteristics of Fibroadenomas

painless,

freely movable,

firm and rubbery with distinct margins

average 2-3 cm in diameter

both glandular and fibrous tissue present

do not change during the menstrual cycle

usually slow-growing

Who commonly gets Fibroadenomas

Women < 35 y/o

Black

Pregnany

Management for Fibroadenoma

Repeat ultrasound and breast examination in 3-6 months

Can also be managed with a core biopsy

Excision ← enlarging on ultrasound

What should be ordered for serous / milky nipple discharge

Serum prolactin

Hyperprolactiemia + Galactorrhea is likely

Pituitary adenoma

Wat can cause milky breast discharge

Breast Stimulation

Psychotrophic medications

Renal Disease

Hypothyroidism

Pituitary ADenoma

Management for Purulent Breast Discahreg

Treat with Abx

drain abscesses

Re-evaluate

Most Common Cause of Bloody Nipple Discharge

Intraductal Papilloma

What can cause bloody nipple discharge

Intraductal papilloma

Breast Cancer

Work-Up for Bloody Nipple Discharge

Mammogram

US

Duct Excision

Biopsy

Most Common Cause of Green Nipple Discharge

Ductal ectasia

Causes of Green Nipple Discharge

Ductal Ectasia

Fibrocystic Changes

What should be done for unilateral nipple discharge

Eval for breast masses

Mammogram

Ductogram

Fine Needle Excision

Breat Biopsy

Mastitis

Infection of the breast secondary to infant pharynx

Most common pathogens for Mastitis

S. aureus

MRSA

Strep

H. flu

When does masitis typcially present

Several weeks postpartum while breastfeeding

Presentation of Mastitis

Fever and Chills

Malaise

General ache

Breast tenderness

Erythema and enlargement of breast quadrant

Management for Mastitis

Dicloxacillin / Cephalexin 500 mg QID x 10-14 days

Continue breastfeeding

Use cold or warm compress

NSAIDs / Acetaminophen

Why do we encourage breastfeeeding in cases of mastitis

It will decrease the enlargement and help resolve the condition quicker

If a masitits patient has persistent fever despite Abx, you should suspect

Breast Abscess

Breast abscess

Collection of pus in breast tissue

Risk Factors for Breast abscess

mastitis

Smoking

Common pathogens of Breast abscess

Staph

MRSA

Presentation of Breast abscess

Painful inflammation of breast

Fever

Malaise

Tender, Fluctuant, palpable mass

How is masititis dx?

Clinical

How are breast abscesses dx?

US

How are breast abscesses tx?

Needle aspiration under ultrasound guidance

Surgical drainage

Dicloxacillin / Cephalexin 500 mg QID x 10-14 days

Gynecomastia

Benign proliferation of glandular tissue of MALE breast

How much growth is considered gynecomastia

Greater than size of nipple and 2+ cm

New growths

What causes gyencomastia

Increased estrogen to androgen ration

Presentation of Gynecomastia

Enlargement of male breast tissue

Tenderness (Adolesnece)

dx method for Gynecomastia

Clinical

What tests are important to order on gynecomastia if cancer is a concern

Testosterone Level

Mammogram

Management fro Gyencomastia

Stop offending medications

Observation

Treat underlying condition

Androgens

Surgery

Intraductal papillomas

Polypoid epithelial tumors arising in the ducts of the breast

Characterisitics of Intraductal Papillomas

2-5 mm in size

Typically not palpable

Spontanous bloody, serous, or cloudy nipple discharge

Why are intraductal papillomas usually excised, despite being benign

They present too similar to carcinoma

Galactocele

Ductal obstruction and inflammation during or soon after lactation causes a milk retention cyst

Complications of Untreated Galatocele

Masitits

Breast Abscess

Managment of Non-Infected Galactocele

Needle Aspiration

Decompression of Ducts