DISEASE OF BREAST

 

Disease of Breast

            1) Acute Mastitis / Breast Abscess

- Acute inflammation of breast tissue is called acute mastitis.Collection of pus in breast tissue is called breast abscess.

Aetiology/Causes

✓ Most common in lactating mother

✓ Crack or fissure of the nipple 

✓ Retracted nipple 

✓ Infected haematoma 

Causative Agent

- Staphylococcus aureus

Clinical Features

- Severe pain in breast

- Breast is swollen , tense , tender and warm to touch 

- High grade fever

- Chills and rigors 

- Anorexia

- Throbbing type pain (due to abscess)

Investigations

- Blood Hb , TC , DC , ESR , Leucocytosis Neutrophilia

- Neddle aspiration ; pus

Treatment

(A) Stage of cellulitis (Acute mastitis)

√ don't feed the child in the affected side 

√ antibiotics ; Cloxacillin 500 mg×6hourly×7-10 days 

√ antiinflammatory drug ; Ibuprofen 400mg × 8 hourly × po × 3 days 

√ good support to the breast

(B) Breast Abscess

√ incision and drainage under the umbrella of antibiotic

√ support breast

√ antibiotics

√ anti-inflammatory drugs

√ high protein diet

Complications of Acute Mastitis

- Breast Abscess

- Toxaemia

- Skin necrosis 

- Antibioma ; due to antibiotic treatment without proper evacuation of pus

Post operative care 

- NPO 6 hours 

- Antibiotics

- Anti-inflammatory drugs 

Complications

- Haematoma

- Wound infection

        2) Carcinoma of the Breast

It is the most commonly malignancy in the female. It is the major killer of middle aged women in western countries.

Aetiology

✓ Racial common in western race 

✓ Genetic ; common in female with family history of breast cancer

✓ Dietary ; 

      - saturated fatty acids

      - deficiency of vitamin A

      - alcohol intake

✓ Endocrine

      - nulliparous women 

      - early menarche and late menopause

      - prolonged oral contraceptive user women

✓ Age 

      - advanced age (40-60 years of age)

✓ Sex 

     - Female >Male 

Clinical Features

Symptoms

- Painless lump in the breast

- Retraction of nipple 

- Discharge

- Skin dimpling 

- Breast asymmetry 

- Erythema over skin or nipple 

- Symptoms of metastasis

             Bone pain 

             Headache

             Breathlessness 

             Jaundice

Signs 

- Hard irregular mass 

- Fixed to skin or underlying tissue 

- Erythema

- Paget disease of nipple

- Supraclavicular nodes palpable 

- Signs of metastasis

        Jaundice

        Hepatomegaly

        Ascites

        Pleural effusion

        Bone tenderness

        Pathological fracture

        Papillo-oedema 

Cardinal Signs 

✓ stony hard irregular lump 

✓ tethering or fixation of the lump

✓ palpable axillary lymph nodes

Investigation

√ Hb , TC , DC , ESR

√ Chest x-ray , rule out metastasis

√ USG of breast - to detect cystic or solid mass 

√ Abdominal USG - to rule out liver metastasis

√ Mammography ; irregular edges , calcification , distortion of architecture

Treatment

A) Surgery

     ✓ Lumpectomy

     ✓ Simple mastectomy

     ✓ Modified radical mastectomy

     ✓ Radical mastectomy

     ✓ QUART (Quandrantectomy , axillary clearance with radiotherapy

B) Chemotherapy and radiotherapy

C) Hormonal therapy