Breast disorders
-
Upload
niyaz-mohammed -
Category
Health & Medicine
-
view
74 -
download
0
Transcript of Breast disorders
BREAST DISORDERS
Dr. Mohammed Niyaz MEM RESIDENTMIMS-K
Common breast complaints
Breast pain Breast mass Nipple discharge Infection Postoperative complications
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
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
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
PHYSIOLOGY AND DISORDERS OF LACTATING BREAST
ABNORMAL LACTATION Inappropriate secretion of milky discharge –
Galactorrhea Prolactinomas- galactorrhoea, amenorrhea,
hirsuitism, facial acne , visual defects , headache
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
• Endemic mastitis , occurs few weeks to months postpartum
• Staphylococcus (40 %), E.coli and Streptococcus
INFLAMMATORY BREAST CONDITIONSDifferential Diagnosis
Infectious Mastitis Ruptured breast cyst Inflammatory neoplasm Metastatic cancer Tuberculosis Paget disease
MASTITISSigns 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
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.
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
HYDRADENTIS SUPPURATIVA Chronic inflammatory disease involving obstruction
of sweat glands Recurrent multiple abscesses, sinsus tracts and
scarring of breast folds Treatment : Incision and drainage
ANTIBIOTICS
Dicloxacillin 250 mg four times a day x 10-14 daysOr Cephalexin 500 mg four times a day x 10-14 daysOr Clindamycin 300 mg four times a day x 10-14 daysOr TMP-SMX , 80/160 mg twice a day
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
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
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
SKIN AND NIPPLE ABNORMALITIESMONDOR DISEASE : Thrombophlebitis of superficial thoracoepigastric
vein Cord like mass in the breast, common in lower
quadrant Breast pain, skin changes Treatment – NSAIDs
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
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