Breast Problems

Wahyu NS

Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

Slide 1

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

Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

Slide 2

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

Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

Slide 3

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

Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

Slide 4

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

Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

Slide 5

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

Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

Slide 6

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

Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

Slide 7

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

Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

Slide 8

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

Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

Slide 9

Nipple Laceration

Keep clean and dry.

Stop breastfeeding that side and allow to heal
Antibiotics usually not necessary
Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

Slide 10

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.

Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

Slide 11

Nipple Discharge
Normal nipple discharge is
clear, milky or greentinged.
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.
Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

Slide 12

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

Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

Slide 13

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

Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

Slide 14

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

Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

Slide 15

Fibroadenoma

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

Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

Slide 16

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.
Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

Slide 17

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.

Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

Slide 18

Breast Examination

Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

Slide 19