Disorders of the Breast

Question 1

What is a breast abscess?

Answer 1

a pocket containing infection within the breast

• a progression from mastitis - symptoms are the same with the addition of localized mass and systemic signs of infection
• staphylococcus aureus is the most common cause

Question 2

What is the tx of a breast abscess?

Answer 2

I&D and anti-staph antibiotics

• regimen: nafcillin/oxacillin IV or cefazolin PLUS metronidazole
• alternative is vancomycin
• women should be encourage to continue breastfeeding following breast infection, even in the setting of incision and drainage

Question 3

What is a breast fibroadenoma?

Answer 3

the most common type of noncancerous breast tumor that most often occurs in young women

• these are usually solitary, mobile, masses with distinct borders
• small, firm, usually painless, well-circumscribed, completely round and freely mobile breast mass
• the classic description with respect to consistency is “rubbery”
• no changes with the menstrual cycle = does not usually wax and wane with menstruation

Question 4

How is a breast fibroadenoma dx?

Answer 4

diagnostic mammogram with ultrasound

• if indeterminate, fine-needle aspiration of the mass with pathology
• in women younger than 25 years, fibroadenomatous mass should be biopsied

Question 5

What is the tx of a breast fibroadenoma?

Answer 5

after the establishment of fibrocystic breast disease recommended treatments include

• avoiding trauma and by wearing a bra with adequate support
• combined oral contraceptive agents limit the severity of the cyclical changes in the breast tissue
• many patients report relief of symptoms after abstinence from coffee, tea, and chocolate

Question 6

What is fibrocystic disease?

Answer 6

commonly called fibrocystic breasts or fibrocystic change, is a benign (noncancerous) condition in which the breasts feel lumpy
-fibrocystic breasts aren’t harmful or dangerous, but may be bothersome or uncomfortable for some women

Question 7

What are the signs and symptoms of fibrocystic disease?

Answer 7

• multiple bilateral breast masses, well-circumscribed, round, discrete, relatively mobile, that increase in size and pain before menses
• wax and wane with period = pain before menses which usually resolves with the start of the menstrual cycle

Question 8

How is fibrocystic disease dx?

Answer 8

by breast cyst aspiration supplemented by ultrasound and/or mammogram
-straw-colored fluid with no blood

Question 9

What is the tx for fibrocystic disease?

Answer 9

treat with NSAIDs, heat, or ice, support bra, decrease caffeine, fat chocolate

• women should be encouraged to perform monthly self-breast exams one week after period when cysts are at their smallest
• oral contraceptives with low estrogenic activity and potent progestin, medroxyprogesterone acetate
• most resolve spontaneously = +/- fine needle aspiration for removal of fluid

Question 10

What is mastitis?

Answer 10

a regional infection of the breast from skin flora or oral flora of breastfeeding baby - organisms enter erosion or cracked nipple; the main reason is clogged milk ducts

• occurs mainly in breastfeeding women
• usually caused by nipple trauma

Question 11

What are the signs and symptoms of mastitis?

Answer 11

• unilateral erythema, tenderness, usually only one quadrant of the breast affected, fever and chills
• congestive (bilateral) vs infectious (unilateral)

Question 12

What is mastitis usually cased by?

Answer 12

S. aureus

Question 13

How is mastitis dx?

Answer 13

diagnosis is clinical - if an abscess is suspected and ultrasound may be warranted

Question 14

What is the tx of mastitis?

Answer 14

warm compresses to breast and analgesics

• if infectious treat with dicloxacillin, cephalexin, or erythromycin for staphylococcus aureus alternate is clindamycin
• continue to breastfeed on the affected side along with warm heat 4 times per day