benign breast disorders

UNIVERSIDAD DE GUADALAJARA CENTRO UNIVERSITARIO DE CIENCIAS DE LA SALUD

BREAST

Brenda de la Torre Aguayo 209340718MCPA

Dr. Benjamín Robles Mariscal Dr. Héctor Manuel Virgen Ayala

Clínicas Quirúrgicas

ANATOMY

The normal breast

A “teardrop” shape

The asymmetry is common

Vascular supply:

medial and central portion:

perforating branches from the internal mammary artery

laterally

lateral thoracic

fascial envelope

Suspensory ligaments of Cooper

Histology Breast tissue

has two histologically distinct tissues: lobular & ductal

The lobule

-is the functional unit of the breast

Alveoli are terminal elongated tubular ducts

Around 10-100 alveoli coalesce to form larger lobular ductal units

BENIGN BREAST DISORDERS

Fibrocystic disease

• Refers to women with severely symptomatic breast

• S&S• Mastodynia • Breast masses • Nipple discharge

Radiographic

Clusstered micricalcifications on MMG

Treatment

Reassurance

Fibroadenoma

It is the most common breast common tumor in adolescents and young women

Patients will have multiple fibroadenomas in 10% -15% of cases

Characteristics

A painless, slow growing mass found on self-breast examination

Several cm.

Changes with mestrual cycle

Well circumscribed

Firm rubbery texture Diagnosis MMG popcorn calcification when degeneration Ultrasound evaluation

Treatment

Based on probability of missing a primary breast CA

-30. observation

Removal if enlarges

+30 FNA

Surgery indicated in changes

Giant fibroadenomas

+ 5 cm

Radial scar

Radial sclerosing lesions

In MMG shows a stellate, irregular spiculated mass lesion

A tissue diagnosis is required to differentiate from cancer

Fat necrosis

Inflamatory necrosis related to trauma

Macrophages laden with fat lobules. Or foreign body giant cells

Treatment

Involves reassurance without excision

Periductal mastitis Uncommon disease

dilated mammary ducts with inspissated secretions and marked periductal inflammation

S&S

include noncyclicla mastodynia; nipple retraction; thick, white creamy nipple discharge; as sterile subareolar abscesses.

History

Difficulty with breast-feeding

Treatment

Reassurance

Surgical incision and drainage

Infectious mastitis

80% are associated with breast-feeding

The most common pathogen is Staphylococcus aureus

Nonlactating women

chronic infections (actinomycosis, tb, syphilis)

autoimmune diseases (lupus erythematosus)

Most infections

begin as skin cellulitis

may be treated with antibiotics safe for feeding the infant

Galactoceles

Are breast cysts that are filled with milk

Almost exclusively seen after breast-feeding and represent silated obstructed breast ducts

Treatment

Ranges from simple aspiration to surgical incision and drainage

Mondor´s disease

Trombophlebitis of superficial veins of the breast

This affects the lower outer quadrant, presents as a pakoable, cord-like mass, burning pain

Treatment

NSAIDs

Intraductal papilloma

Most common cause of bloody nipple discharge

Lesions: small, nonpalpable, close to the nipple

Dx. Ductography

Tx. Subareolar excision

Nipple discharge

Bloody: intraductal papilloma & breast ca

Purulent: subareolar infection

Milky white: galactorrhea

Green/yellow or brown: fibrocystic disease

Mastodynia

2 types

Cyclie mastodynia

Continuous mastodynia

Tx

NSAIDS

Changes in life style