Comprehensive Review of Common Breast Conditions:: MSRA
- examiner mla
- 3 days ago
- 2 min read
🔴 Paget’s Disease of the Nipple
Definition: A rare form of breast cancer presenting with nipple/areola involvement.
Clues: Chronic eczematous changes (itching, scaling, erythema), unilateral, may bleed or ooze.
Associated with: Underlying DCIS or invasive carcinoma.
Management: Breast-conserving surgery with nipple-areolar complex removal ± oncoplastic repair. Mastectomy for extensive disease.
Exam Trigger: Unilateral eczema-like nipple lesion unresponsive to treatment.
🔴 Breast Abscess
Etiology: Bacterial infection (commonly Staph aureus) following mastitis in lactating women.
Features: Painful, red, fluctuant swelling + fever, purulent discharge.
Management:
Oral flucloxacillin
Warm compresses
Continue breastfeeding
If abscess confirmed via ultrasound: Incision and drainage
MSRA Clue: Painful red lump with fever in lactating woman → Abscess, not cellulitis.
🟡 Mastitis (Lactational)
Timeline: Typically occurs within first 6 weeks postpartum, but can occur at any point during lactation, including 6 months or later.
Why It Happens Later:
Milk stasis due to reduced feeding frequency (e.g., weaning, longer sleep intervals)
Poor latch or ineffective drainage
Cracked nipples allowing bacterial entry
Fatigue or immune suppression in the mother
Missed feeds or irregular breastfeeding patterns
Symptoms: Unilateral red, swollen, tender breast + systemic signs (fever).
Management: Continue breastfeeding + oral flucloxacillin. If unresolved, suspect abscess.
MSRA Trigger: Febrile woman postpartum with red breast → Treat mastitis, not wean.
🧴 Galactorrhoea
Definition: Milky nipple discharge not related to childbirth or nursing.
Causes:
Hyperprolactinemia (pituitary adenoma)
Hypothyroidism
Medications (e.g., antipsychotics, metoclopramide)
Investigations: Prolactin levels, TSH, MRI brain (if no drug cause).
Buzzword: Milky discharge in non-lactating woman → Check prolactin!
🧪 Intraductal Papilloma
Definition: Benign intraductal growth.
Presentation: Unilateral blood-stained discharge from a single duct.
Management: Triple assessment; surgical excision due to risk of atypia or malignancy.
Exam Clue: Painless bloody nipple discharge, single duct.
🟢 Fibroadenoma
Common in: Women <30 years.
Description: Firm, mobile, painless mass ("breast mouse"), typically "slips under fingers."
Management:
Reassure if <3 cm and classic features
Excise if large, growing, or patient preference
Buzzword: Mobile, slippery lump in young female.
🔢 Phyllodes Tumor
Similar to: Fibroadenoma but grows rapidly.
Histology: Leaf-like projections.
Management: Wide local excision due to recurrence/malignancy potential.
Buzzword: Large, fast-growing mass with leaf-like histology.
🔶 Fat Necrosis
Cause: Post-trauma or surgery.
Presentation: Firm, irregular mass ± skin retraction; mimics cancer.
Imaging: Oil cysts, calcifications.
Diagnosis: Requires triple assessment.
Clue: Breast lump post-trauma with suspicious imaging.
💢 Mondor’s Disease
Definition: Thrombophlebitis of superficial breast veins (esp. lateral thoracic).
Symptoms: Painful, cord-like structure under skin.
Cause: Post-surgery or trauma.
Management: Self-limiting; treat with NSAIDs.
Trap: Mistaken for breast cancer or cellulitis.
📌 Radiology Clues Table
Imaging Feature | Diagnosis |
Microcalcifications | DCIS |
Spiculated mass | Malignancy |
Smooth, well-defined | Benign (e.g., fibroadenoma) |
Oil cysts | Fat necrosis |
🔠 Mnemonics
"GAP" for Nipple Discharge:
Green = Duct ectasia
Always blood = Intraductal papilloma
Pure white = Prolactinoma / Pituitary
"Feeding ABCs" for Breast Infection:
Abscess = Fluctuant, needs drainage
Bacterial mastitis = Fluclox
Continue feeding
📄 References
NICE Clinical Guideline [CG80]: Early and locally advanced breast cancer: diagnosis and management. https://www.nice.org.uk/guidance/cg80
NHS UK: Breast conditions and symptoms. https://www.nhs.uk/conditions/breast-lump/
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