Breast Problems

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Breast Problems
CAPT Mike Hughey, MC, USNR
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Breast Development

• Contains mainly fat tissue, connective tissue and
  glands
• 15-25 ducts
• Breast tissue extends into axilla (tail)
• Smallest, day 4-7

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Quadrants

• Breast is divided into quadrants
• Upper-Outer quadrant has the greatest mass
• UOQ is the site of about half of all breast
  cancers

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Supernumerary Breasts

• Relatively common
• Found along milk line
• Most identified during pregnancy/lactation
• Most common in axilla
• Not dangerous

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Supernumerary Nipples

• More common than supernumerary breasts
• Found along milk line
• May darken during pregnancy
• Not dangerous

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Inverted Nipples

• Often will evert with stimulation
• Mostly a cosmetic issue
• Successful breastfeeding is usually possible.

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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

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Pregnancy Changes

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

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Puerperal Mastitis

• Rapid onset of red, hot, swollen, tender breast
• High fever
• Prompt treatment (Amox, Diclox, Erythromycin,
  Azithromycin
• Abscess needs drainage
• Keep breast-feeding

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Nipple Laceration

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

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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?

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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.

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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.

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Fat Necrosis

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

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Breast Cyst

• Smooth, unilateral mass
• Feels like a cyst
• Infrequently associated with malignancy
• Aspirate
• Watch for reforming of cyst
• Recurring cysts are more worrisome

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Pagets Disease

• Crusty, flaking lesion
• Gradual onset over months or years
• Associated with underlying breast malignancy
• Diagnosis confirmed by needle biopsy

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Breast Mass

• Dominant mass
• Unilateral
• Persists through the menstrual cycle
• Usually biopsied (FNA or excisional)
• Can wait weeks but not months

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Fibroadenoma

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

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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.

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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.

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Breast Examination
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