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Benign Breast Diseases

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Benign Breast Diseases Benign Breast Diseases Dr S. FLORET, M.S Embryology Of Breast • In 5th or 6th week Two ventral bands of thickened epithelium (milk lines)develops • Extending from axilla to inguinal region,where paired breast develops • Polymastia or polythelia occurs along milk lines and ridges disappear • Ectodermal ingrowth into mesenchyme appears and formation of lactiferous ducts and sinus formed • Proliferation of mesenchyme makes the pit into a future nipple Developmental disorders • Amastia • Polands syndrome • Symmastia • Polythelia(renal agenesis,HT,Conduction defects,pyloric stenosis,Epilepsy,Ear Abnormality) • Supernumery Breast(turners and Fleishers syndrome) Functional Anatomy of Breast y It contains 15 to 20 lobes y Suspensory lig of breast inserts into dermis y Extending from 2nd to 6th ib ,sternum to ant axillary line y Upper outer quadrant has great volume of tissue y Nipple areolar complex,is pigmented with corrugations y Contains seb glands,sweat glands,montogomery tubercles and smooth muscle bundles, y Rich sensory innervations Blood Supply y Perforating branches of Internal Mammary Art y Lateral Branches of Posterior Intercostal Art y Branches from Axillary art,the Highest Thoracic,Lateral thoracic,Pectoral Branches of Thoraco Acromial vessels y Medial Mammary Art y 2‐4th Anterior Intercostal Perforators y Veins follow the arteries and Batson plexus around vertebra ext from base of skull to sacrum may provide bony mets Blood supply Innervation • Lateral Cutaneous Branches of 3rd to 6th Intercostal nerves • Intercostobrachial nerve • Ant branch of Supreaclavicular nerve Lymphatic supply • Anterior along lateral thoracic • Central group • Lateral along axillary vein • Posterior along subscapular • Apical • Rotters nodes • Internal mammary nodes Lymph Classification • Congenital • Injury • Inflammation • Infection • ANDI • Pregnancy Related Congenital • Inverted nipple • Super numery breast/nipple Non‐ Breast Disorder • Tietzes Disease • Sebaceous Cyst , Etc.. Injury • Hematoma • Traumatic Fat necrosis Infection • Acute Intramammary Mastitis • Chronic Intramammary Mastitis • Subareolar Mastitis • Chronic Subareolar Mastitis • Retromammary abscess • Breast Abscess • TB ,Syphilis,Actinomycosis • Mondors Disease ANDI y It’s a spectrum of Benign diseases related to normal process of reproductive life to involution y Fibrosis y Cyst formation y Hyperplasia y Papillomatosis y Fibroadenomas y Scelrosing lesions y Duct ectasia y Periductal mastitis ANDI Normal Disorder Disease Early Lobular development Fibroadenoma Giant Firoadenoma Reproductive Gigantomastia years(15‐25) Stromal development Adolescent Subareolar abscess Hypertrophy Mammary duct Nipple Eversion Nipple Inversion fistula Later Cyclical Changes of Cyclical Mastalgia Incapacitating Reproductive Menstruation Nodularity Mastalgia years(25‐40) Epithelila Hyperplasia of Blood stained Nipple Pregnancy discharge Macrosysts Sclerosing lesions Involution(35‐ Lobular Involution Duct Ectasia Periductal Mastitis 55) Duct Involution Nipple Retraction Epithelila ‐Dilatation Epithelial Hyperplasia Hyperplasia with ‐Sclerosis atypia Epithelial turnover Breast Abscess • Lactational Cracked Nipple Fissure Nipple Child Teeth Commencement Of Feeding Weaning Organism – Staph. Auer • Non‐Lactational Peri‐ductal Ectacia Peri‐areolar Region Recurrence Organism – Anerobic Strep & Entero Clinical Features • Breast engorgement • Pain • Fever • Treatment – Aspiration ,Antibiotics, I&D Gynaecomastia yGynaecomastia refers to enlargment of breast in males yPhysiological in neonate,adolescence and old yEstrogen cause(testicular tumours,adrenal tumours,hyper or hypothyroidism,hepatic disease yAndrogen deficiency like klienfilters,kallman syndrome,ACTh deficiency ySecondary testicular failure yDrugs like cimetidine,phenytoin,spironolactone,digoxin,d Gynaecomastia Nipple Discharge • Milk Discharge • Serous Discharge • Blood Discharge • Greenish Discharge • Black Discharge • Pus • Creamy discharge Nipple Inversion and Retraction • Congenital • Duct ectasia,carcinoma or post surgical causes nipple retraction. • Other disease of nipple are cracked nipple,chancre,eczema,and pagets disease of nipple. Benign Neoplasms • Fibroadenoma • Cystosarcomaphylloides • Duct papilloma • Neurofibroma • Papillary cystadenoma • Lipoma Duct Papilloma • True polyp from epithelium lining the duct of the breast • Types – Solitary ( Sub‐areolar) ‐ Multiple ( Peripherally Located, increased tendency to become malignant, Fibrovascular pore covered with epithelium, Area of necrosis & Infarction, Epithelial Hyperplasia) • CF – Nipple Discharge ‐ Commonest cause for bloody discharge ‐ Lump ….Cont • Investigation 1. FNAC – Lump 2. Cytology ‐ Smear Study 3. Mammography 4. Ductography • Treatment ‐ Surgical Excision send for biopsy Mondor’s Disease • Thrombophlebitis of superficial veins adjacent to breast • Precipitated by –Infection ‐ Repetitive movement of upper limb ‐ Surgical Procedure • Vessel –Lateral Thoracic ‐ Thoraco Epigastric • Pain • Examination – Tender , Firm Cord in the direction of the vessel …Cont • Treatment –Rest ‐ Analgesics ‐ If necessary ligation of the vessel at both ends .
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