Breast Diseases

Last updated On August 26th, 2021

Anatomy and Development

  •  The breasts are large, modified sebaceous glands contained within the superficial fascia of the anterior chest wall.
  • The average weight is 200–300 g during the menstruating years.
  • Composed of 20% glands and 80% fat and connective tissue.
  • Breast tissue is sensitive to the cyclic changes in hormonal levels – women often experience breast tenderness and fullness during the luteal phase of the cycle. Premenstrual symptoms are produced by an increase in blood flow, vascular engorgement, and water retention.
  • Nearing the onset of puberty, the first change in the breast is the formation of the breast bud. The areola subsequently enlarges, and then the nipple begins to grow outwards.
  • Estrogen is responsible for the initial stages of breast development, but further development requires adult levels of progesterone.

Physical Examination

  • A comprehensive breast examination is particularly important when symptoms are present.
  • Inspection is the first step. This is usually done with the arms raised overhead, then with tension on the pectoralis muscles (by having the patient place her hands on her hips and press inward), and finally with the patient relaxed and leaning forward. These maneuvers accentuate skin and contour changes such as retraction, edema, or erythema, and nipple changes such as retraction, eczema, or erosion.
  • Palpation is best performed with the patient in both sitting and supine positions. The examination is done in concentric circles, starting with the outermost breast tissue. The physician should attempt to elicit nipple discharge and examine the axilla carefully for adenopathy. Begin breast disease Fibrocystic changes

Definition-

Exaggeration of the normal physiologic response of breast tissue to the cyclic levels of ovarian hormones.

Frequency-

The most common of all benign breast conditions.

Symptoms and signs-

Cyclic bilateral breast pain, increased engorgement and density of the breasts, excessive nodularity, rapid change and fluctuation in the size of cystic areas, increased tenderness, and occasionally spontaneous clear nipple discharge.

Physical Examination –

Marked tenderness of well-delineated, slightly mobile, cystic nodules or thickened areas.

Diagnosis –

A wide variety of histopathologic findings (cysts, adenosis, fibrosis, duct ectasia).

Treatment –

Well-fitting brassieres and light, loose clothing; decreased intake of coffee, chocolate, tea; smoking cessation. Oral contraceptives or progestins are helpful in up to 90% of patients. Danazol is effective for severe symptoms.

Fibroadenomas

 Definition –

Firm, rubbery, freely mobile, solid, usually solitary masses.

Frequency –

The second most common type of benign breast disease.

Symptoms and signs –

Typically a young woman in her 20s discovers the painless mass accidentally while bathing. Growth of the mass is usually extremely slow, but occasionally can be quite rapid.

Physical examination –

Average size is 2.5 cm; multiple lesions are found in 15–20% of women.

Diagnosis –

Mammography is rarely indicated in a woman under age 30. Ultrasound may be helpful to distinguish a solid from a cystic mass.

Treatment –

If the etiology cannot be established by fine-needle aspiration (FNA), surgical removal is indicated. Any mass that rapidly increases in size should be removed, as should any solid mass in a woman over age 30. Other benign conditions

Mastodynia (breast pain)

It is a common symptom affecting women. The reduction of dietary fat can result in significant improvement.

Galactorrhea (milky discharge)

It usually results from medication (hormones, phenothiazines) side effects, but may suggest a prolactin secreting tumor.

Intraductal papilloma

It is usually solitary and often causes a serous or bloody discharge.

Duct ectasia

It results from subareolar dilation and periductal mastitis.

Fat necrosis

It usually results from trauma and is the only benign lesion that causes skin dimpling.