DOCSLIB.ORG

Breastfeeding and Breast Cancer: Managing Lactation in Survivors and Women with a New Diagnosis

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Breastfeeding and Breast Cancer: Managing Lactation in Survivors and Women with a New Diagnosis Ann Surg Oncol (2019) 26:3032–3039 https://doi.org/10.1245/s10434-019-07596-1 ORIGINAL ARTICLE – BREAST ONCOLOGY Breastfeeding and Breast Cancer: Managing Lactation in Survivors and Women with a New Diagnosis Helen M. Johnson, MD1, and Katrina B. Mitchell, MD2 1Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC; 2Breast Surgical Oncology, Presbyterian Healthcare Services – MD Anderson Cancer Network, Albuquerque, NM ABSTRACT initiatives improve breastfeeding rates, surgeons increas- Background. Supporting breastfeeding is a global health ingly will be faced with managing the intersection of priority, yet few clinical guidelines exist to guide surgical lactation and breast cancer treatment.5,6 oncologists in managing lactation during or after breast This review will delineate evidence-based recommen- cancer treatment. dations for managing lactation in breast cancer survivors Methods. The literature was reviewed to identify evi- and breastfeeding women with a new breast cancer diag- dence-based strategies for managing lactation during nosis. Nearly all of the available evidence comes from multidisciplinary breast cancer treatment or among breast observational studies (Table 1), and there are multiple gaps cancer survivors. in knowledge. Recommendations should be utilized in the Results. The majority of the evidence is from observa- context of shared decision-making with the patient, tional studies, with some higher levels of evidence, including discussion of the limitations of the available data. including systematic reviews and meta-analyses. Several significant gaps in knowledge remain. SUPPORTING LACTATION IN BREAST CANCER Conclusions. This review serves as a comprehensive SURVIVORS resource of evidence-based recommendations for managing lactation in breast cancer survivors and breastfeeding Due to the anatomic and physiologic impacts of their women with a new breast cancer diagnosis. cancer treatment on lactation, breast cancer survivors who wish to breastfeed may face challenges. Support is essen- tial, because the inability to produce sufficient breastmilk The relationship between breastfeeding and breast can- has been shown to be independently associated with sig- cer is multifaceted. While a longer duration of nificant long-term psychological stress among women breastfeeding is associated with multiple health benefits diagnosed with breast cancer and other cancers during and a decreased lifetime risk of breast cancer, postpartum pregnancy.7 Survivors may benefit from an antepartum women are at risk for particularly aggressive breast can- visit with an International Board Certified Lactation Con- cers.1–3 A growing body of evidence supports several sultant (IBCLC) and/or breastfeeding medicine physician, hypotheses regarding the biologic mechanisms underlying as well as close postpartum support.8,9 These women may these observations.4 However, a paucity of literature exists derive significant psychosocial value from tailored peer-to- to guide clinical management of lactation during or after peer support groups; if none exist, they may find some breast cancer treatment. As national and global health overlap between their unique challenges and those of women who are breastfeeding after breast reduction surgery.10 Although multiple survey studies report that many Ó Society of Surgical Oncology 2019 breast cancer survivors fear that breastfeeding increases the First Received: 27 January 2019; risk of recurrence or a new primary breast cancer, no Published Online: 24 July 2019 evidence exists to support this concern.11–14 K. B. Mitchell, MD e-mail: [email protected] Breastfeeding and Breast Cancer 3033 TABLE 1 Major sources, with levels of evidence, for key recommendations for lactation management strategies during multidisciplinary breast cancer care Recommendation Source Level of evidence General considerations Breastfeeding is protective against breast cancer, Collaborative Group on Meta-analysis independent of the effect of parity on cancer risk Hormonal Factors in Breast Cancer2 Imaging Ultrasound should be the first-line imaging modality for diFlorio-Alexander et al.34 Expert consensus lactating women with a breast mass guidelines Lactation-related changes on breast magnetic resonance Espinosa et al.39 Retrospective imaging do not preclude detection of breast lesions Oh et al.40 descriptive studies Breast conservation therapy BCT impairs future lactational ability in most women, Leal et al.17 Systematic review (BCT): lumpectomy and via both anatomic and histopathologic effects radiation Chemotherapy Breastfeeding is contraindicated during chemotherapy, Pistilli et al.44 Narrative review with rare exceptions It may be possible to safely breastfeed between cycles in Anderson49 Expert opinion some cases Breastfeeding success may be diminished in women who Stopenski et al.24 Prospective cohort receive chemotherapy during pregnancy study Endocrine therapy Aromatase inhibitors are contraindicated in lactation The InfantRisk Center25 Expert opinion It may be safe to defer or interrupt tamoxifen therapy to Cardoso et al.28 Expert consensus complete breastfeeding POSITIVE trial guidelines (NCT02308085) https://c Randomized clinical linicaltrials.gov trial (in recruitment phase) Radiation therapy (RT) Breastfeeding during RT may increase the risk of skin Shachar et al.64 Expert opinion toxicity Irradiated breasts may produce milk with altered Green22 Case report biochemical composition Guix et al.23 Case report Surgery A full milk supply can be achieved and maintained by a Michaels and Wanner15 Observation single breast Lactating women undergoing breast surgery appear to Dominici et al.52 Retrospective cohort have similar risks of wound complications as non- study lactating women An interruption in breastfeeding of up to 24 h may be The InfantRisk Center25 Expert opinion advisable after dual-tracer sentinel lymph node biopsy Giammarile et al.57 Expert consensus guidelines Patients may benefit from perioperative lactation support Rieth et al.62 Retrospective programs descriptive study History of Mastectomy History of Breast Conservation Therapy (BCT): Lumpectomy and Radiation Therapy Due to removal of the breast parenchyma, lactation would not be expected on the affected breast after a simple, A systematic review concluded that patients who have skin-sparing, or nipple-sparing mastectomy. Women who undergone breast conservation therapy (BCT) may later have undergone mastectomy should be counseled that produce milk, but volume is significantly reduced in the unilateral breastfeeding can produce milk sufficient for not majority of cases.17 Both surgery and radiation can impact only a singleton infant, but also for twins.15 Patients may lactational ability (Fig. 1). benefit from antenatal hand expression as well as post-feed Surgery involving the subareolar region may sever ter- milk expression (hand expression and/or pumping) to minal ducts and obstruct outflow of breastmilk. upregulate milk production in the early postpartum per- Additionally, periareolar incisions may impact nipple iod.16 To prevent nipple trauma that could impact lactation innervation and potentially affect the milk ejection reflex on a single breast, optimal infant latch should be achieved. and regulation of milk production.18 Rodent models have 3034 H. M. Johnson, K. B. Mitchell demonstrated recanalization of ducts, and anecdotal evi- lactogenesis II, but its effects on established milk produc- dence supports both recanalization and reinnervation after tion are unknown.26,27 The European Society of Breast nononcologic breast surgery; however, the effects of radi- Cancer Specialists advises that tamoxifen therapy may be ation likely prevent these phenomena after BCT.19 interrupted for pregnancy and/or breastfeeding.28 Results Histopathologically, irradiated breasts exhibit epithelial of the Pregnancy Outcome and Safety of Interrupting atypia in the terminal ductal-lobular units, atypical stromal Therapy for women with endocrine responsIVE breast fibroblasts, fibrosis with or without atrophy, and non- cancer (POSITIVE) trial will provide much-needed data on specific vascular changes; these changes appear to be this topic.29 This study seeks to enroll 500 women from age irreversible.20,21 Decreased nipple-areolar complex (NAC) 18–42 years who have completed 18–30 months of endo- elasticity and radiation-induced changes in milk composi- crine therapy; it will allow for an interruption in therapy of tion, including increased sodium levels, may result in a up to 2 years for pregnancy and/or breastfeeding. Prelim- strong infantile preference for the unaffected breast.17,22,23 inary results for the primary outcome of breast cancer free interval are anticipated in June 2020. Chemotherapy MANAGING LACTATION IN BREASTFEEDING Chemotherapy may cause irreversible histopathologic WOMEN WITH A NEW BREAST CANCER changes that impact breastmilk production.21 An observa- DIAGNOSIS tional cohort study reported that among women treated for cancer during pregnancy, those who received chemother- Lactating women diagnosed with breast cancer will apy reported a significantly lower rate of breastfeeding require support whether they continue to breastfeed during success (34% vs. 91%), particularly if they underwent more treatment or actively wean. Therefore, the multidisci- cycles (5.5 vs. 3.8).24 Women who initiated chemotherapy plinary treatment team should include a lactation expert, earlier in gestation reported significantly more difficulties, such as an IBCLC
Load more

Recommended publications
  • Common Breast Problems Guideline Team Team Leader Patient Population: Adults Age 18 and Older (Non-Pregnant)
    Guidelines for Clinical Care Quality Department Ambulatory Breast Care Common Breast Problems Guideline Team Team leader Patient population: Adults age 18 and older (non-pregnant). Monica M Dimagno, MD Objectives: Identify appropriate evaluation and management strategies for common breast problems. General Medicine Identify appropriate indications for referral to a breast specialist. Team members Assumptions R Van Harrison, PhD Appropriate mammographic screening per NCCN, ACS, USPSTF and UMHS screening guidelines. Medical Education Generally mammogram is not indicated for women age <30 because of low sensitivity and specificity. Lisa A Newman, MD, MPH “Diagnostic breast imaging” refers to diagnostic mammogram and/or ultrasound. At most ages the Surgical Oncology combination of both imaging techniques yields the most accurate results and is recommended based on Ebony C Parker- patient age and the radiologist’s judgment. Featherstone, MD Key Aspects and Recommendations Family Medicine Palpable Mass or Asymmetric Thickening/Nodularity on Physical Exam (Figure 1) Mark D Pearlman, MD Obstetrics & Gynecology Discrete masses elevate the index of suspicion. Physical exam cannot reliably rule out malignancy. • Mark A Helvie, MD Breast imaging is the next diagnostic approach to aid in diagnosis [I C*]. Radiology/Breast Imaging • Initial imaging evaluation: if age ≥ 30 years then mammogram followed by breast ultrasound; if age < 30 years then breast ultrasound [I C*]. Follow-up depends on results (see Figure 1). Asymmetrical thickening / nodularity has a lower index of suspicion, but should be assessed with breast Initial Release imaging based on age as for patients with a discrete mass. If imaging is: November, 1996 • Suspicious or highly suggestive (BIRADS category 4 or 5) or if the area is assessed on clinical exam as Most Recent Major Update suspicious, then biopsy after imaging [I C*].
    [Show full text]
  • Approach to Breast Mass
    APPROACH TO BREAST MASS Resident Author: Kathleen Doukas, MD, CCFP Faculty Advisor: Thea Weisdorf, MD, CCFP Creation Date: January 2010, Last updated: August 2013 Overview In primary care, breast lumps are a common complaint among women. In one study, 16% of women age 40-69y presented to their physician with a breast lesion over a 10-year period.1 Approximately 90% of these lesions will be benign, with fibroadenomas and cysts being the most common.2 Breast cancer must be ruled out, as one in ten woman who present with a new lump will have cancer.1 Diagnostic Considerations6 Benign: • Fibroadenoma: most common breast mass; a smooth, round, rubbery mobile mass, which is often found in young women; identifiable on US and mammogram • Breast cyst: mobile, often tender masses, which can fluctuate with the menstrual cycle; most common in premenopausal women; presence in a postmenopausal woman should raise suspicion for malignancy; ultrasound is the best method for differentiating between a cystic vs solid structure; a complex cyst is one with septations or solid components, and requires biopsy • Less common causes: Fat necrosis, intraductal papilloma, phyllodes tumor, breast abscess Premalignant: • Atypical Ductal Hyperplasia, Atypical Lobular Hyperplasia: Premalignant breast lesions with 4-6 times relative risk of developing subsequent breast cancer;8 often found incidentally on biopsy and require full excision • Carcinoma in Situ: o Ductal Carcinoma in Situ (DCIS): ~85% of in-situ breast cancers; defined as cancer confined to the duct that
    [Show full text]
  • Breast Concerns
    Section 12.0: Preventive Health Services for Women Clinical Protocol Manual 12.2 BREAST CONCERNS TITLE DESCRIPTION DEFINITION: Breast concerns in women of all ages are often the source of significant fear and anxiety. These concerns can take the form of palpable masses or changes in breast contours, skin or nipple changes, congenital malformation, nipple discharge, or breast pain (cyclical and non-cyclical). 1. Palpable breast masses may represent cysts, fibroadenomas or cancer. a. Cysts are fluid-filled masses that can be found in women of all ages, and frequently develop due to hormonal fluctuation. They often change in relation to the menstrual cycle. b. Fibroadenomas are benign sold tumors that are caused by abnormal growth of the fibrous and ductal tissue of the breast. More common in adolescence or early twenties but can occur at any age. A fibroadenoma may grow progressively, remain the same, or regress. c. Masses that are due to cancer are generally distinct solid masses. They may also be merely thickened areas of the breast or exaggerated lumpiness or nodularity. It is impossible to diagnose the etiology of a breast mass based on physical exam alone. Failure to diagnose breast cancer in a timely manner is the most common reason for malpractice litigation in the U.S. Skin or nipple changes may be visible signs of an underlying breast cancer. These are danger signs and require MD referral. 2. Non-spontaneous or physiological discharge is fluid that may be expressed from the breast and is not unusual in healthy women. 3. Galactorrhea is a spontaneous, multiple duct, milky discharge most commonly found in non-lactating women during childbearing years.
    [Show full text]
  • Gynecomastia-Like Hyperplasia of Female Breast
    Case Report Annals of Infertility & Reproductive Endocrinology Published: 25 May, 2018 Gynecomastia-Like Hyperplasia of Female Breast Haitham A Torky1*, Anwar A El-Shenawy2 and Ahmed N Eesa3 1Department of Obstetrics-Gynecology, As-Salam International Hospital, Egypt 2Department of Surgical Oncology, As-Salam International Hospital, Egypt 3Department of Pathology, As-Salam International Hospital, Egypt Abstract Introduction: Gynecomastia is defined as abnormal enlargement in the male breast; however, histo-pathologic abnormalities may theoretically occur in female breasts. Case: A 37 years old woman para 2 presented with a right painless breast lump. Bilateral mammographic study revealed right upper quadrant breast mass BIRADS 4b. Wide local excision of the mass pathology revealed fibrocystic disease with focal gynecomastoid hyperplasia. Conclusion: Gynecomastia-like hyperplasia of female breast is a rare entity that resembles malignant lesions clinically and radiological and is only distinguished by careful pathological examination. Keywords: Breast mass; Surgery; Female gynecomastia Introduction Gynecomastia is defined as abnormal enlargement in the male breast; however, the histo- pathologic abnormalities may theoretically occur in female breasts [1]. Rosen [2] was the first to describe the term “gynecomastia-like hyperplasia” as an extremely rare proliferative lesion of the female breast which cannot be distinguished from florid gynecomastia. The aim of the current case is to report one of the rare breast lesions, which is gynecomastia-like hyperplasia in female breast. Case Presentation A 37 years old woman para 2 presented with a right painless breast lump, which was accidentally OPEN ACCESS discovered 3 months ago and of stationary course. There was no history of trauma, constitutional symptoms or nipple discharge.
    [Show full text]
  • Common Breast Problems BROOKE SALZMAN, MD; STEPHENIE FLEEGLE, MD; and AMBER S
    Common Breast Problems BROOKE SALZMAN, MD; STEPHENIE FLEEGLE, MD; and AMBER S. TULLY, MD Thomas Jefferson University Hospital, Philadelphia, Pennsylvania A palpable mass, mastalgia, and nipple discharge are common breast symptoms for which patients seek medical atten- tion. Patients should be evaluated initially with a detailed clinical history and physical examination. Most women pre- senting with a breast mass will require imaging and further workup to exclude cancer. Diagnostic mammography is usually the imaging study of choice, but ultrasonography is more sensitive in women younger than 30 years. Any sus- picious mass that is detected on physical examination, mammography, or ultrasonography should be biopsied. Biopsy options include fine-needle aspiration, core needle biopsy, and excisional biopsy. Mastalgia is usually not an indica- tion of underlying malignancy. Oral contraceptives, hormone therapy, psychotropic drugs, and some cardiovascular agents have been associated with mastalgia. Focal breast pain should be evaluated with diagnostic imaging. Targeted ultrasonography can be used alone to evaluate focal breast pain in women younger than 30 years, and as an adjunct to mammography in women 30 years and older. Treatment options include acetaminophen and nonsteroidal anti- inflammatory drugs. The first step in the diagnostic workup for patients with nipple discharge is classification of the discharge as pathologic or physiologic. Nipple discharge is classified as pathologic if it is spontaneous, bloody, unilat- eral, or associated with a breast mass. Patients with pathologic discharge should be referred to a surgeon. Galactorrhea is the most common cause of physiologic discharge not associated with pregnancy or lactation. Prolactin and thyroid- stimulating hormone levels should be checked in patients with galactorrhea.
    [Show full text]
  • Evaluation of Nipple Discharge
    New 2016 American College of Radiology ACR Appropriateness Criteria® Evaluation of Nipple Discharge Variant 1: Physiologic nipple discharge. Female of any age. Initial imaging examination. Radiologic Procedure Rating Comments RRL* Mammography diagnostic 1 See references [2,4-7]. ☢☢ Digital breast tomosynthesis diagnostic 1 See references [2,4-7]. ☢☢ US breast 1 See references [2,4-7]. O MRI breast without and with IV contrast 1 See references [2,4-7]. O MRI breast without IV contrast 1 See references [2,4-7]. O FDG-PEM 1 See references [2,4-7]. ☢☢☢☢ Sestamibi MBI 1 See references [2,4-7]. ☢☢☢ Ductography 1 See references [2,4-7]. ☢☢ Image-guided core biopsy breast 1 See references [2,4-7]. Varies Image-guided fine needle aspiration breast 1 Varies *Relative Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate Radiation Level Variant 2: Pathologic nipple discharge. Male or female 40 years of age or older. Initial imaging examination. Radiologic Procedure Rating Comments RRL* See references [3,6,8,10,13,14,16,25- Mammography diagnostic 9 29,32,34,42-44,71-73]. ☢☢ See references [3,6,8,10,13,14,16,25- Digital breast tomosynthesis diagnostic 9 29,32,34,42-44,71-73]. ☢☢ US is usually complementary to mammography. It can be an alternative to mammography if the patient had a recent US breast 9 mammogram or is pregnant. See O references [3,5,10,12,13,16,25,30,31,45- 49]. MRI breast without and with IV contrast 1 See references [3,8,23,24,35,46,51-55].
    [Show full text]
  • Clinical Management of BCCCP Women with Abnormal Breast
    Follow-up of Abnormal Breast Findings E.J. Siegl RN, OCN, MA, CBCN BCCCP Nurse Consultant January 2012 Abnormal Breast Findings include the following: CBE results of: Nipple discharge, no palpable mass Asymmetric thickening/nodularity Skin Changes (Peau d’ orange, Erythema, Nipple Excoriation, Scaling/Eczema) Dominant Mass ? Unilateral Breast Pain Mammogram results of ACR 0 – Assessment Incomplete ACR 4 – Suspicious Abnormality, ACR 5 – Highly Suggestive of Malignancy Abnormal CBE Results Nipple Discharge Third most common breast complaint by women seeking medical attention after lumps and breast pain During breast self exam, fluid may be expressed from the breasts of 50% to 60% of Caucasian and African-American women and 40% of Asian-American women Nipple Discharge cont. Palpation of the nipple in a woman who does not have a history of persistent spontaneous nipple discharge - not recommended Rationale: Non-spontaneous nipple discharge is a normal physiological phenomenon and of no clinical consequence Infections (E.g. abscess) should be treated with incision and drainage or repeated aspiration if needed (consider antibiotics) Nipple Discharge is of Concern if it is: Blood stained, serosanguinous, serous (watery) with a red, pink, or brown color, or clear 90% of bloody discharges are intraductal papillomas; 10% are breast cancers) appears spontaneously without squeezing the nipple persistent on one side only (unilateral) a fluid other than breast milk Nipple Discharge cont. Non-lactating women who present with a unilateral,
    [Show full text]
  • Pseudoangiomatous Stromal Hyperplasia of the Breast: a Rare Finding in a Male Patient
    Open Access Case Report DOI: 10.7759/cureus.4923 Pseudoangiomatous Stromal Hyperplasia of the Breast: A Rare Finding in a Male Patient Lynsey M. Maciolek 1 , Taylor S. Harmon 2 , Jing He 3 , Sarfaraz Sadruddin 1 , Quan D. Nguyen 1 1. Radiology, University of Texas Medical Branch, Galveston, USA 2. Radiology, University of Florida College of Medicine, Jacksonville, USA 3. Pathology, University of Texas Medical Branch, Galveston, USA Corresponding author: Quan D. Nguyen, [email protected] Abstract Pseudoangiomatous stromal hyperplasia (PASH) in male patients is a rare condition that represents a hormonally-induced proliferation of mesenchymal tissue of the breast. This benign pathology is often undiagnosed due to many reasons. When PASH presents as a breast mass, it appears innocent, developing as a smooth and well-circumscribed tumor. Furthermore, it does not elicit suspicious findings on imaging. These points often halt further investigation of many breast abnormalities. Breast masses are statistically most likely to be gynecomastia when they arise in men. However, they are important to investigate because, although rare, breast cancer can occur in men. Furthermore, the benign conditions of the breast that commonly affect women can also impact male patients. It is oftentimes overlooked that men too can experience hormonal stimulation of the breast tissue. The following case describes this rare but important instance of a male patient diagnosed with PASH following a previous diagnosis of infiltrative ductal carcinoma in situ of the contralateral breast. Categories: Pathology, Radiology, Oncology Keywords: breast masses, interanastomosing, mammogram, breast angiosarcoma, breast radiology, pseudoangiomatous stromal hyperplasia, male breast cancer, invasive ductal carcinoma, gynecomastia, benign hypoechoic masses Introduction Approaching breast masses in male patients is often deemed unchartered territory, without a well-defined clinical algorithm.
    [Show full text]
  • Management of Common Breast-Feeding Problems Joy Melnikow, Ml), MPH, and Joan M
    Clinical Review Management of Common Breast-feeding Problems Joy Melnikow, Ml), MPH, and Joan M. Bedinghaus, MD Sacramento, California, and Cleveland, Ohio The benefits of breast-feeding have been well docu­ Poor weight gain in the infant is managed by more mented in the literature: it reduces morbidity from frequent nursing. Neonatal jaundice or infant gastro­ many illnesses and is considered the ideal nutrition for enteritis rarely requires discontinuation of breast-feed­ the newborn infant. This paper reviews common breast­ ing. feeding problems that family physicians may be called Although physicians frequently recommend that upon to manage: maternal problems, infant problems, women discontinue breast-feeding because of the ad­ and problems related to the need for maternal medica­ ministration of some maternal medications, maternal ill­ tion. ness can often be managed with medications that do not Ensuring proper position of the infant at the breast interfere with nursing. and attention to the let-down reflex is the recom­ Given proper advice and support, many mothers con­ mended method for prevention and treatment of nipple tinue to breast-feed even after returning to work. soreness. Prompt identification and treatment of blocked ducts, mastitis, and mondial infection of the Key words. Breast-feeding; hyperbilirubinemia; mastitis; nipple can prevent complications and allow uninter­ abscess, review literature. rupted nursing. ( / Fam Pract 1994; 39:56-64) Breast-feeding, which is recognized as the ideal nutrition offer little guidance
    [Show full text]
  • Inverted Nipple Repair Revisited: a 7-Year Experience
    Breast Surgery Aesthetic Surgery Journal 2015, Vol 35(2) 156–164 Inverted Nipple Repair Revisited: A 7-Year © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: Experience [email protected] DOI: 10.1093/asj/sju113 www.aestheticsurgeryjournal.com Daniel J. Gould, MD, PhD; Meghan H. Nadeau, MD; Luis H. Macias, MD; and W. Grant Stevens, MD Abstract Background: Nipple inversion in females can be congenital or acquired. Women who desire treatment for this condition often report difficulty with breastfeeding and interference with their sexuality. However, data are limited on the demographics of patients who undergo surgery to repair inverted nipples and the associated recurrence rates and complications. Objectives: The authors assessed outcomes of a 7-year experience with an integrated approach to the correction of nipple inversion that minimizes ductal disruption. Methods: A retrospective chart review was performed for 103 consecutive patients who underwent correction of nipple inversion. (The correction tech- nique was initially reported in 2004 and entailed an integrated approach.) Complication rates, breastfeeding status, and patient demographics were docu- mented. Results: Among the 103 patients, 191 nipple corrections were performed. Nine patients had undergone previous nipple-correction surgery. Recurrence was experienced by 12.6% of patients, 3 of whom had bilateral recurrence. Other complications were partial nipple necrosis (1.05%), breast cellulitis (1.57%), and delayed healing (0.5%). The overall complication rate was 15.74%. Fifty-seven percent of the patients had a B-cup breast size, and 59% were 21 to 30 years of age. Conclusions: Results of the authors’ 7-year experience demonstrate the safety and effectiveness of their technique to correct inverted nipples.
    [Show full text]
  • Agenesis of Lactiferous Duct of Breast – a Case Presentation
    Agenesis of Lactiferous Duct of Breast – A Case Presentation Daniel Burchette*, Robert Mcgovern*, K Hemalatha**, M Paul Korath***, K Mohandass****, K Jagadeesan+ Introduction the presence of numerous macrophages and neutrophils on a thick eosinophilic background, galactocoele is a benign breast lesion consistent with the an infected cystic lesion. The Aconsisting of a cyst containing thick, patient had no past medical history of mastitis. On milky fluid with a high fat content, most closer examination of the nipples, duct openings were commonly seen in a young lactating women.1 absent from the 9 o’clock to 11 o’clock positions on A blocked lactiferous duct, generally as a the right side, consistent with the positioning of the galactocoele. Pits in this region were explored using a result of fibrosis from previous infection, is 3-0 lacrimal duct probe (Fig. 1), but all were blind normally the cause. Patients usually present ending. Cranio caudal and medio lateral oblique views with a painless palpable lump in the breast on mammography demonstrated lactating breast with which is freely mobile. Treatment is complete galactocoele in right breast and significant right aspiration, which is generally successful. axillary lymphadenopathy – BI-RADS category II and Recurrence is common following successive agenesis of ducts in the right upper outer quadrant (Fig. 2A,2B). Imaging of the lactiferous ductal systems pregnancies. We present a young primiparous of both breasts using high resolution ultrasound woman with a galactocoele caused by an identified an absence of lactiferous ducts in the upper agenesis or atresia of lactiferous ducts. segment of the right breast (Fig.
    [Show full text]
  • Inflammatory Breast Disease
    Diagnostic and Interventional Imaging (2015) 96, 1045—1064 CONTINUING EDUCATION PROGRAM: FOCUS. Inflammatory breast disease: The radiologist’s role D. Lepori Réseau lausannois du sein et imagerie du Flon, rue de la Vigie 5, 1000 Lausanne, Switzerland KEYWORDS Abstract Mastitis is the inflammation of breast tissue. From a pathophysiological point of view, Breast; mastitis reflects a variety of underlying etiologies. It can be due to non-infectious inflamma- Mammography; tion, infection (generally of bacterial origin) but can also be caused by inflammation resulting Ultrasound; from malignant tumor growth. Mastitis always manifests clinically by three cardinal signs of MRI; inflammation, which are redness, heat and pain. Breast specialists examining women with mas- Inflammation titis should proceed as follows: first, it is important to distinguish between cancer-related and non-cancer-related breast inflammation, since their clinical presentation can be misleading. Cancer-related mastitis reflecting the presence of aggressive cancer is less commonly observed than other forms of mastitis but its diagnosis, which can sometimes be difficult, needs to be made, or excluded, without delay. Once cancer-related mastitis has been excluded, the causes of inflammation should be elucidated to enable rapid treatment and patient recovery. © 2015 Éditions franc¸aises de radiologie. Published by Elsevier Masson SAS. All rights reserved. Radiological presentation of inflammation The breast is a superficial organ. The clinical signs of breast inflammation are therefore obvious. They include redness, heat and pain. The patient should be questioned as to how inflammation appeared, and notably whether it occurred suddenly or not. Any cases of inflammation that occurred progressively should be regarded as atypical.
    [Show full text]