Breast

Question 1

In terms of benign breast disease, what is a fibroadenoma?

Answer 1

• hypertrophy of a breast lobule

Question 2

In terms of benign breast disease, what is a duct ectasia?

Answer 2

• central ducts become dilated with ductal secretions -> secretions may leak into periductal tissues and cause an inflammatory reaction = periductal masititis

Question 3

What are the risk factors of benign breast disease?

Answer 3

• changes in hormone levels
• trauma -> fat necrosis occurs secondary to trauma
• not traking OCP -> less common in patients on the OCP

smoking -> a risk factor for periductal mastitis

Question 4

What are the presenting symptoms of benign breast disease?

Answer 4

• History of breast discomfort or pain (may be cyclical)
• Swelling or lump
• Nipple discharge -> if it is bloody, malignancy should be suspected

Question 5

What must be assessed in a patient presenting with symptoms of benign breast disease?

Answer 5

• CANCER
• is there blood in nipple discharge, family history, oestrogen exposure, enlarged axillary lymph nodes

Question 6

What are the general signs of benign breast disease on physical examination?

Answer 6

Focal or diffuse nodularity of breast

Question 7

What 3 classic features of breast cancer will not be present on examination in benign breast disease?

Answer 7

• Dimpling
• Peau d’orange
• Enlarged axillary lymph nodes

Question 8

What are the signs of fibroadenoma on physical examination?

Answer 8

• smooth, well circumscribed and mobile lumps -> aka a ‘breast mouse’

Question 9

What are the signs of duct ectasia on physical examination?

Answer 9

• yellow/green discharge

Question 10

What are appropriate investigations for benign breast disease?

Answer 10

o Patients usually undergo TRIPLE ASSESSMENT:

• clinical examination
• imaging = mammography (benign lumps are less likely to be calcified) or ultrasound (in younger patients (< 35 yrs))
• cytology/histology = fine needle aspiration and/or excision biopsy

Question 11

What the possible complications of benign breast disease?

Answer 11

• Pain
• Recurrence - coomon

Question 12

What are the 2 main forms of breast abscess?

Answer 12

Lactational

Non-Lactational

Question 13

What is the regular pathology of breast abscesses?

Answer 13

o Caused by INFECTION - organisms defer based on whether the abscess is:

• lactational = staphylococcus aureus

non-lactational = staphylococcus aureus, anaerobes

Question 14

What are the risk factors for breast absesses?

Answer 14

SMOKING

Lactation

Mammary duct ectasia

Periductal mastitis

Wound infections (e.g. from breast surgery)

Question 15

What are the presenting symptoms of a breast abscess?

Answer 15

Breast discomfort

Painful swelling

Generally unwell and feverish

Non-lactational - tend to present with a history of previous infections with less pronounced systemic upset

Question 16

What are the signs of breast abscesses on physical examination?

Answer 16

o Local

• swollen, warm and tender area of the breast
• overlying skin may be inflamed
• nipple may be cracked
• for non-lactational scars or tissue distortion from previous episodes and signs of duct ectasia (e.g. nipple retraction)

o Systemic

• pyrexia
• tachycardia

Question 17

What are appropriate investigations for breast abscesses?

Answer 17

• ultrasound
• MC&S of pus samples

Question 18

What is the management plan for breast abscesses?

Answer 18

o Medical = antibiotics (lactational: flucloxacillin or non-lactational: flucloxacillin + metronidazole)

o Surgical

• lactational: Incision and drainage
• non-lactational: open drainage avoided - duct system is excised once the infection has settled

Question 19

Identify possible complications of breast abscess.

Answer 19

Mammary fistula

Overlying skin may (rarely) undergo necrosis