Breasts

Lipoma

Benign tumor of the breast. It is a collection of fat cells. The etiology is unknown and is more common in the larger breast. Usually asymptomatic, painless, movable, and well delineated. Mammograms and ultrasounds only reveal lipomas 3-21% of the time, but when the mammogram and ultrasound also does not show anything suspicious at the site that would indicate a malignancy. This is also a benign condition with a good prognosis. Treatment is usually not necessary unless the lesion becomes bothersome to the patient, then it may be surgically removed

Fibrocystic Breasts

Changes in both breasts, fluctuating breast lump sizes, nodules, areas of thickening, tenderness, pain, swelling, and possible non-bloody nipple discharge which may be milky, yellow or green in color. The symptoms tend to decrease after menstruation. Upon palpation these hyperplastic changes are noted to be bilateral, occur in multiples, and are painful. Once the changes are confirmed by breast exam, a mammogram or ultrasound should be done to determine what type it is. If the mass is palpable, symptomatic and/or complex, a fine needle aspiration or breast biopsy is done and sent to cytology if needed. If the fluid is bloody or any residual mass is left after the aspiration then an excisional biopsy is required 50-80% of women experience changes to the physiologic nodularity and tenderness of the breast throughout their menstrual cycle.

Estrogen and breast development

Estrogen controls the duct growth. Puberty and the influence of estrogen, begins the rebuilding of the ductal systems. With each menstrual cycle the adult woman will continue to experience lobule changes and further branching and glandular development will occur, with the final differentiation needed to secrete milk, only occurring during pregnancy

Fibroadenomas

Hyperplastic lesions that form during menarche and tend to grow slowly to 1- 2 cm in size. Commonly found in women under age of 30, although they may be discovered in women aged 30 to 50 due to changes in the surrounding breast tissue with involution or weight loss. They change very little due to menstrual cycle, although they may grow rapidly in adolescence, pregnancy, and lactation and regress in size during perimenopause. Simple fibroadenomas and complex fibroadenomas without atypia are associated with a nonsignificant increased risk for breast cancer. Patient reports small pea or marble size, painless lump in one breast, which may have been present for months or years. Usually found in upper quadrant of the breast, but may occur anywhere in the breast. No associated symptoms, such as nipple discharge or retraction, dimpling, or other skin changes are reported. Physical exam of breast reveals a discrete, solitary, firm, mobile, well- circumscribed, nontender mass without supraclavicular or axillary lymph node swelling. Usually rubbery, but may feel firmer in the older patient. In 20% of cases, multiple lesions occur, either in the same breast or bilaterally. Dx: Mammography Ultrasound: along with clinical examination, may be diagnostic of fibroadenomas in woman under 30 years of age. Core Needle Biopsy recommended if a mass is found as solid on imaging. Serial examinations and imaging at 6 month intervals for 1 to 2 years is recommended to ensure stability.

Abscess/Mastitis

Inflammation of the breast that may be caused by tight clothing, missed infant feedings, poor drainage of the duct and alveolus, or an infecting organism such as S. aureus, E. coli, Streptococcus. Infection may be transmitted from lactiferous ducts to a secreting lobule, from a nipple fissure to periductal lymphatics, or by hematogenic means. Woman may report flu-like symptoms, including malaise, fever, and chills. She may also describe a tender, hot, red, painful area or lump in the breast. Physical exam is usually sufficient for diagnosis. Assess vital signs. Fever is often high; tachycardia common. Examination of breast reveals increased warmth, redness, tenderness, and swelling. The affected lobule is often in the outer quadrant and wedge shaped; the nipple may be cracked or abraded; and the breast distended with milk. Suspect a breast abscess if there is no resolution of symptoms after several days of antibiotic therapy. If an abscess is formed, pitting edema is possible and fluctuation may be felt over the affected area. An abscess usually requires both antibiotics and drainage for resolution; therefore the client should be referred to a physician for further treatment. Dicloxacillin Sodium 250-500 mg q6h x 10 days.

Progesterone and breast development

Progesterone controls the glandular growth. Half way through the menstrual cycle progesterone begins to stimulate milk gland formation and is believed to be responsible for the changes in their breast women feel just prior to menstruation (swelling, pain, and tenderness). In pregnancy, progesterone maintains pregnancy, prevents the egg from maturing in the ovary, inhibits menstruation and stimulates growth of breasts (Harris, 2014). Progesterone is also responsible for the textural changes in the breast, in preparation for pregnancy the milk glands begin to grow. During pregnancy, progesterone stimulates the breast changes that are often the first sign of pregnancy (darkening of the areola, swelling, tenderness, soreness of the nipples).

Inflammatory Breast Cancer

Rare but rapid changes in the appearance of one breast in day or weeks, thickness, heaviness, or visible enlargement of one breast, unusual warmth at the affected breast, dimpling or ridges in the skin of the affected breast (like an orange peel), tenderness, pain, or aching, itching, enlarged lymph nodes under the arm, above or below the collarbone, and flattening or inversion in the nipple.

Composition of breasts.

The breast is composed of two types of epithelial tissue: glandular and secretory. Stromal (adipose or connective) tissue is interspersed between glandular and secretory. The two types of tissue are present in roughly equal amounts in breasts of women who are not pregnant or lactating. During lactation and pregnancy glandular tissue proliferates and becomes the predominant breast tissue. As women age, breast become mostly fat. Glandular tissue is organized into 15 to 20 lobes made up of clusters of 10 to 100 alveoli referred to as lobules.

Paget's Disease

Underlying intraductal carcinoma that arises from the main excretory ducts of the breast extending to the nipple and areola. This mainly affects 50-60 year olds. Flaky or scaling on the nipple, crusty, oozing, or hardened skin resembling eczema on the nipple, areola, or both, redness, itching, a burning sensation, straw colored or bloody nipple discharge, affected areas beyond the nipple and areola, a distinct lump underneath the nipple and areola, skin and nipple changes usually in one breast, fluctuating skin changes early on (as if your skin is healing).