Breast Problems

Breast Development

• Contains mainly fat tissue, connective tissue and glands

• 15-25 ducts• Breast tissue extends

into axilla (“tail”)• Smallest, day 4-7

Quadrants

• Breast is divided into quadrants

• Upper-Outer quadrant has the greatest mass

• UOQ is the site of about half of all breast cancers

Supernumerary Breasts

• Relatively common• Found along “milk

line”• Most identified during

pregnancy/lactation• Most common in axilla• Not dangerous

Supernumerary Nipples

• More common than supernumerary breasts

• Found along milk line• May darken during

pregnancy• Not dangerous

Inverted Nipples

• Often will evert with stimulation

• Mostly a cosmetic issue

• Successful breastfeeding is usually possible.

Adolescent Breast Problems

• Assymetric growth is the rule rather than the exception.

• Mammary hypertrophy: Postpone surgical intervention until all growth has occurred

• Breast masses are ~100% benign and surgery or FNA is almost never warranted (disturbs breast architecture and may be disfiguring

Pregnancy Changes

• 1st TM: Tender breasts and nipples• 2nd TM: Non-tender breasts enlarge• 2nd-3rd TM: Steady darkening of nipples and

prominent Montgomery’s glands

Puerperal Mastitis• Rapid onset of red, hot,

swollen, tender breast• High fever• Prompt treatment

(Amox, Diclox, Erythromycin, Azithromycin

• Abscess needs drainage• Keep breast-feeding

Nipple Laceration

• Keep clean and dry.• Stop breastfeeding that side and allow to heal• Antibiotics usually not necessary

Cyclic Breast Pain

• Worst just before menses• Thick, tender, nodular breasts• Not dangerous but annoying• Rx: OCPs (cyclic or continuous)• Rx: Danazol (extreme cases)• Reduce caffeine? Vitamin E?

Non-Cyclic Breast Pain

• Often due to trauma (breast or chest wall)• May be due to muscle strain• May be due to increased levels of estrogen• Usually not due to cancer• Examine and refer if cause is not obvious.

Nipple Discharge• Normal nipple discharge is

clear, milky or green-tinged.

• If bloody, needs surgical evaluation

• If it stains the inside of the bra each day, that is galactorrhea and will need thyroid and pituitary evaluation.

Fat Necrosis• Tender, thickened, bruised area of breast• Follows trauma• Benign• Resolves spontaneously over weeks to months• Atypical cases should have FNA

Breast Cyst• Smooth, unilateral mass• Feels like a cyst• Infrequently associated

with malignancy• Aspirate• Watch for reforming of cyst• Recurring cysts are more

worrisome

Paget’s Disease• Crusty, flaking lesion• Gradual onset over

months or years• Associated with

underlying breast malignancy

• Diagnosis confirmed by needle biopsy

Breast Mass• Dominant mass• Unilateral• Persists through the

menstrual cycle• Usually biopsied

(FNA or excisional)• Can wait weeks but

not months

Fibroadenoma• Common• Benign• Solid, rubbery, non-tender• Round or oval• Rarely grow > 2-3 cm• FNA or excisional Bx• Observe in adolescents

Breast Cancer• 30% of all cancers in women• Treatment is successful in 3/4• Rare before age 25• Steadily increasing frequency with increasing

age• Affects 1/9 women reaching age 90.

Breast Cancer Risk Factors• Strong family history• Menopause after age 55• No term pregnancy prior to age 35• Most (80%) of breast cancer occurs in women not

at increased risk.