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Breast Problems

Breast Problems. CAPT Mike Hughey, MC, USNR. 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

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Breast Problems

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  1. Breast Problems CAPT Mike Hughey, MC, USNR

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

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

  4. Supernumerary Breasts • Relatively common • Found along “milk line” • Most identified during pregnancy/lactation • Most common in axilla • Not dangerous

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

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

  7. 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

  8. 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

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

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

  11. 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?

  12. 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.

  13. 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.

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

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

  16. Paget’s Disease • Crusty, flaking lesion • Gradual onset over months or years • Associated with underlying breast malignancy • Diagnosis confirmed by needle biopsy

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

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

  19. 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.

  20. 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.

  21. Breast Examination

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