Generous Breast Problems

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Kind Breast Problems Folake Falaki, MD PGY 2 Emory Family Medicine May 28, 2009

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Outline Introduction Anatomy Structure of the bosom Classification Initial way to deal with bosom issues Diagnostic workup Conclusion References

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Introduction Breast issues are a noteworthy motivation behind why ladies visit the essential care doctor Breast infections in ladies constitute a range of benevolent and dangerous issue The most widely recognized bosom issues for which ladies counsel a doctor are bosom torment, areola release and a substantial mass. Amiable bosom injury is a non-harmful sore. As per American Cancer society , when tissue biopsy is inspected under the magnifying instrument, nine out of each 10 ladies will have some kind of irregularity AAFP diary , April 15, 2000. Volume 61/No. 8

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Anatomy The bosom is a changed sweat organ with a mass of glandular, greasy and sinewy tissues on the pectoralis muscles in the mid-section divider It is appended to the mid-section divider by stringy strands called coopers tendons The glandular tissues of the bosom comprise of lobules, flaps and channels Fatty and sinewy tissues encompass the drain delivering framework ( lobules and pipes)

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Anatomy Major hormones in charge of bosom improvement are estrogen, progesterone and prolactin. The blood supply is through the inner mammary conduit, axillary corridor intercostal course Venous waste is through the Internal mammary vein, axillary vein and intercostal veins

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Anatomy Lymphatic seepage Majorly to the Axillary hubs Inter mammary and the supra clavicular lymph hubs. Three Lymph Node Levels Level I – Lateral and second rate compared to Pectoralis Minor Level II – Deep to Pectoralis Minor Level III – Medial to Pectoralis Minor Rotter's – Between Pectoralis Minor & Major Nerves Long Thoracic Nerve: Serratus Anterior m. Winged Scapula Thoracodorsal Nerve: Latissimus Dorsi Intercostobrachial Nerve

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Classification Based On Histologic Types Non Proliferative Lesion Simple Cyst Complex sore Proliferative Lesions – Without Atypia Ductal hyperplasia Fibroadenoma Intraductal papilloma Sclerosing Adenoma Radial Scars Atypical Hyperplasia Atypical ductal hyperplasia Atypical lobular hyperplasia Schnitt, SJ. Kind bosom infection and bosom malignancy chance: morphology and past. Am J surg pathology 2003;27:836

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Classification Based On Clinical Features Mastalgia Cyclic Non Cyclic Tumors and Masses Nodularity or glandular Cysts Galactoceles Fibroadenoma Sclerosing Adenosis Lipoma Harmatoma Diabetic Mastopathy Cystosarcoma Phylloides AAFP diary , April 15, 2000. Volume 61/No. 8

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Classification Based On Clinical Features (Cont'd) Nipple release Galactorrhea Abnormal areola release Breast contaminations and Inflammation Intrinsic mastitis Postpartum engorgement Lactation mastitis Lactation bosom boil Chronic intermittent subareolar sore Acute mastitis connected with macrocystic bosoms Extrinsic diseases Mondor's Disease Hidradenitis suppurativa J khosa, Benign bosom sickness including mastalgia ppt

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Classification Lesions with Increased Risk of Ca Ductal hyperplasia Sclerosing adenosis Complex fibroadenomas Atypical hyperplasia Radial scars Micheal S sabel .Overview of benevolent bosom infection. Uptodate 2008, November 14

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Classification Lesions with no Increased danger of Ca Fibrocystic disease Duct ectasia Solitary papillomas Simple fibroadenomas Mastitis or bosom boil Galactocele Fat putrefaction Lipoma

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Breast Pain (Mastalgia) Most normal bosom side effect for which ladies counsel the doctor More basic in premenopausal ladies than in post menopausal ladies Can be recurrent (physiological) or non patterned Micheal S Sabel. Introductory way to deal with the lady with bosom issues. 2008, November 6

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Breast Pain (Mastalgia) Cyclic Pain ( Physiologic) Usually Bilateral and inadequately limited. Happens in around 60% of premenopausal ladies aside from menopausal ladies on hormonal substitution treatment Often portrayed as weight , swelling or delicacy that transmits to the arm and axilla Associated with menstrual cycle , Most serious before period Has variable Duration and Resolve suddenly after menses Attributed to fibrocystic bosom changes Etiology obscure, thought to be identified with Gonadotrophic and ovarian hormones

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Mastalgia Non-Cyclic Pain Most basic in ladies 40 to 50 yrs of age Often one-sided Usually depicted as sharp, copying torment limited in the bosom Occasionally auxiliary to the nearness of Fibroadenoma and additionally sore Menstrual abnormality, passionate push, injury, MSK, scars from past biopsies and drugs have been related Micheal S Sabel. Introductory way to deal with the lady with bosom issues. 2008, November 6

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Evaluation & Management of Breast Pain Mastalgia ought to be dealt with when: It is sufficiently extreme to meddle with a lady's way of life It happens more than a couple days consistently. History and Physical Diagnostic work up Mammogram Micheal S sabel .Overview of benevolent bosom malady. Uptodate 2008, November 14

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Management of Breast Pain Treatment Goals Alleviate torment Reduce or diminish inconsistency Rule out tumor of the bosom

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Management of Breast Pain Diet and Lifestyle Modification Elimination of Methylxanthines, Caffeine and Chocolates Reassurance Supportive Bra Low fat and high complex starch Vitamin E supplementation Evening Primrose oil Micheal S sabel .Overview of favorable bosom malady. Uptodate 2008, November 14

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Management of Breast Pain Pharmacological Treatment NSAIDs OCPs Danazol 100-400mg every day 75% of ladies with non cyclic agony will be side effect free SE: Weight pick up , menstrual abnormality , skin break out , hirsutism Tamoxifen 10mg Bromocriptine – prolactin opponent Surgery has no part in administration of bosom torment Micheal S sabel .Overview of benevolent bosom ailment. Uptodate 2008, November 14

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Evaluation & Management of Breast Pain AAFP diary , April 15, 2000. Volume 61/No. 8

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Breast Masses Normal glandular tissue of the bosom is nodular This is a general example or consistency of the bosom which incorporate tireless knottiness or nodularity which is for the most part not unusual when it is identified with the menstrual cycle. Overwhelming masses are described by ingenuity all through the menstrual cycle

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Breast Masses: Cysts Cystic Breast Mass Common reason for prevailing bosom mass May happen at any age, however phenomenal in post menopausal ladies Fluctuates with menstrual cycle Well outlined from the encompassing tissue Characteristically firm and versatile May be delicate Difficult to separate from strong mass Micheal S sabel .Overview of benevolent bosom malady. Uptodate 2008, November 14

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Breast Masses: Cysts Fibrocystic Breast Disease Most normal of all considerate bosom ailment Most basic between ages 20-50 half of ladies with Fibrocystic changes have clinical side effects 53% have histologic changes Believed to be related the Imbalance of progesterone and estrogen. May give two-sided cyclic torment, bosom swelling, discernable mass and largeness

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Fibrocystic Breast Disease Physical Examination Tenderness Increased engorgement and more thick bosom Increased knottiness/glandular Occasional unconstrained areola release Micheal Sabel .Overview of generous bosom infection. Uptodate 2008, November 14

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Mammogram Cystic framework No calcification No expanded thickness Ultra Sonogram Cyst Fine Needle Aspiration Outpatient technique Non bleeding liquid Cyst vanishes If grisly liquid, surgical biopsy of pimple is required Reexamination 4-6 weeks after goal Breast Cysts: Diagnostics

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Management of Breast Cysts AAFP diary , April 15, 2000. Volume 61/No. 8

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Breast Masses

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Breast Mass: Fibroadenomas Simple: Second most regular considerate bosom sore Benign strong tumors containing glandular and in addition sinewy tissue . Generally present too characterized, versatile mass Commonly found in ladies between the ages of 15 and 35 years Cause is obscure, thought to be because of hormonal impact May increment in size amid pregnancy or with estrogen treatment Giant: Fibroadenomas more than 10cm in size Excision is suggested Juvenile Variant of fibroadenomas Found in young ladies between the ages of 10 - 18. Differ in size from 5 - 20cm in distance across. Generally easy, singular, one-sided masses Excision is suggested

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Breast Mass: Fibroadenomas (Cont'd) Complex fibroadenomas contain other proliferative changes, for example, sclerosing adenosis, channel epithelial Hyperplasia, epithelial calcification. Connected with marginally expanded danger of malignancy Dupont, WD page, DL, parl, FF, et al. Long haul chance growth in ladies with fIbroadenoma. NEJM 1994;331:10 Carty, NJ, Carter, c, Rubin, C et al administration of fibroadenoma of the bosom. Chronicles of illustrious school of specialist England 1995:77:127 Micheal S sabel .Overview of amiable bosom malady. Uptodate 2008, November 14

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Breast Mass Phylloides Tumors: Rapidly growing One in four harmful One in Ten Metastasize Create cumbersome tumors that bend the bosom May ulcerate through the skin because of weight rot Treatment comprises of wide extraction unless metastasis has happened Fat Necrosis: Rare Secondary to injury frequently not recalled Tender, poorly characterized mass Occasionally skin withdrawal Treat with excisional biopsy

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Breast Mass Galactocele Milk filled pimple from over distension of a lactiferous conduit. Shows as a firm non delicate mass in the bosom, Commonly in upper quadrants past areola. Symptomatic desire is regularly healing. Conduit ectasia: Generally found in more established ladies. Dilatation of the subareolar conduits can occ