Breast
Breast Disease
Breast

Breast Disease

Benign, malignant, lactation, age-based workup.

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◆Benign breast masses

  • •Fibrocystic changes: cyclic pain + bilateral nodularity in premenopausal; 'blue-domed' cysts on aspiration; no cancer risk
  • •Fibroadenoma: solitary mobile rubbery painless mass in young women; most common benign tumor
  • •Intraductal papilloma: #1 cause of unilateral bloody nipple discharge; surgical excision
  • •Phyllodes tumor: large breast mass + 'leaf-like' projections histology
  • •Galactocele: milk-filled retention cyst in lactating women; aspiration
  • •Fat necrosis: post-trauma/surgery; can mimic malignancy on imaging

◆Infectious / inflammatory

  • •Lactational mastitis: unilateral erythema + induration + fever; Staph aureus through nipple trauma
  • •Treat: dicloxacillin or cephalexin + continue breastfeeding/pumping
  • •Breast abscess: fluctuant mass — needs I&D or FNA + abx
  • •Inflammatory breast cancer: peau d'orange + rapid progression

◆Malignant

  • •Peau d'orange → inflammatory breast cancer
  • •Eczematoid nipple lesion → Paget disease (associated DCIS/invasive)
  • •ER/PR positive → SERMs (tamoxifen) or aromatase inhibitors (anastrozole)
  • •HER2 positive → trastuzumab (reversible CM); doxorubicin (irreversible CM)
  • •Lymph node involvement is the MOST predictive prognostic factor
  • •Clustered pleomorphic microcalcifications on mammography = classic DCIS
  • •Chronic lymphedema (post-axillary dissection) → lymphangiosarcoma (purplish ulcer)

◆Diagnostic algorithm

  • •Palpable mass + age <30 → ultrasound first (± mammogram)
  • •Palpable mass + age ≥30 → mammogram + ultrasound
  • •Negative mammogram + palpable mass → core needle biopsy
  • •US solid mass → core needle biopsy
  • •US cystic mass → FNA
  • •Bloody FNA fluid → cytology + core needle biopsy

◆Breast cancer in pregnancy

  • •Core needle biopsy is gold standard; don't delay for pregnancy
  • •Avoid RT and chemo in first trimester
  • •Surgery typically in second trimester
  • •Mets sites: bone, liver, lungs, brain
  • •ER/PR positive: copper IUD for contraception (hormones contraindicated)

◆Lactation

  • •Exclusively breastfed infants → vitamin D supplementation from day 1
  • •Preterm + breastfed → iron supplementation
  • •SSRIs and dicloxacillin generally safe
  • •Avoid combined OCPs for first 6 weeks postpartum (estrogen ↓ milk protein)
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