Breast Problems CAPT Mike Hughey MC USNR Operational

Breast Problems CAPT Mike Hughey, MC, USNR Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide

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 • 1 st TM: Tender breasts and nipples • 2 nd TM: Non-tender breasts enlarge • 2 nd-3 rd TM: Steady darkening of nipples and prominent Montgomery’s 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

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? Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 11

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 12

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. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 13

Fat Necrosis • Tender, thickened, bruised area of breast • Follows trauma • Benign • Resolves spontaneously over weeks to months • Atypical cases should have FNA Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 14

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 15

Paget’s 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 16

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 17

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 18

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 19

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 20

Breast Examination Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 21

Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 22