Fibroadenosis

Fibroadenosis (fibrocystic change)

Risk

—  presents in the reproductive age of a women – 25 to 35 or 40 years.

—  usual common presentation is breast lump or pain in the breast (mastalgia)

—  pain or lump may occur just before the menstrual periods and then disappear

—  this cyclical presentation is due to the influence of the sex hormones on the breast tissue of the women.

—  Coarse, nodular, tender and lumpiness, multiple, irregular, firm, bilaterally at upper outer quadrant.

—  Nipple discharge – serous or green

Breast cysts

Breast cysts

Risks

—  Occur most commonly in the last decade of reproductive life (peak at forties and early fifty) as a result of a non-integrated involution of stroma and epithelium, they develop from lobules and are fluid-filled space—larger cyst.

Features

§  They are distended, involuted lobules and are most frequently seen in perimenopausal period

§  Clinically, they are smooth discrete, round palpable lumps that can be painful and fluctuant.

Treatment

Symptomatic palpable cysts are treated by aspiration, provided the fluid is not blood stained, and if so, it require excision to exclude an associated intracystic cancer

Fibroadenoma

Fibroadenoma

Risks

—  Usually arise in the fully developed breast between 15-25 years old

Features

—  Presented with painless lump in the breast

—  Smooth, round bordered, firm to hard in consistency and freely mobile – Breast Mouse.

—  Undergo involution in perimenopausal years but can persist into old age and calcified

Giant fibroadenomas

—  Occasionally during puberty

—  Rapidly growing and >5cm

—  Similar to usual fibroadenomas

·         Enucleation can be done through submammary incision

Acute Mastitis

Acute Mastitis

• Due to
•  lactational mastitis.
• Infection of a hematoma
• Non-lactational breast abcesses – in pt with duct ectasia and periductal mastitis
• common complaint in nursing women. 
• Develops when bacteria gain access to the breast tissue through the ducts:
• Through fissures in the nipples
• Various forms of dermatitis involving the nipple
• Inspissations of secretions, causing blockage of the duct system

Organism responsible is always Staph aureus

—  During the cellulitic stage of mastitis, the pt should be treated with antibiotics: flucloxacillin or co-amoxiclav ( amoxicillin + clavulanic acid )

—  If started too late, tissue damage and accumulating polymorphs cause multiple loculi of pus to form à treated by surgical drainage

—  The breast should be incised & drained if the infection did not resolve within 48 hours or if after being emptied of milk, there was an area of tense induration or other evidence of underlying abscess

—  Clinical features:

—  Severe breast pain

—  Swollen, tense, tender and warm to touch (sx of cellulitis stage)

—  Once abcess develops, there is high grade fever with chills and rigors