breast swelling
TRANSCRIPT
Breast swelling
Maryam AL-Qahtani
Learning objectivesDefinition of breast swellingShort anatomy of breast Differential Diagnosis of breast
swellingClinical Evaluations
History Physical ExaminationsInvestigations
Management
Definition
is an enlargement of the breast or both breasts
compared to the regular breast size and may be accompanied by other
symptoms like tenderness (soreness), pain, lump(s), changes of the areola or
nipple and any secretion from the nipple.
Definition
Breast swelling
DDx
DDx
Female
Physiological Pathological
Pathological
Puberty
Menstruation
Pregnancy
Breastfeeding Contraceptives
Menopause
PubertySx
• Increasing breast size• Androgenic hair (pubic
hair and/or hair of the armpits)
• Onset of menstruation (menarche)
• Fat accumulation on the thighs, buttocks and/or lower abdomen.
Ddx• Use of oral
contraceptives.
No reason to worry unless the pain becomes unbearable.
MenstruationSx
• Irritability and mood changes
• Bilateral breast swelling and tenderness prior to menses
• Menstrual pain• Discomfort or cramping• Headache• Vaginal discharge
Ddx• Use of oral
contraceptives.
The tenderness usually diminishes within the first few days of the menstruation cycle or when it is over.
PregnancySx
• Breast tenderness• Amenorrhea • Nausea and vomiting
(morning sickness)• Clear vaginal discharge• Darkening and/or
enlargement of the areola • Headache, Fatigue.
Ddx• Use oral contraceptives• Gonadotropin
releasing hormone drugs .
• Premature ovarian failure.
• Menopause.
BreastfeedingSx
• Milk production and secretion
• Tender or sore breasts• Palpable nodules in the
breast.
Ddx• Would only be considered
if there are other signs and symptoms like :
• Excessive pain• Unilateral (one-sided)
breast swelling • pus secretion from the
nipple.
MenopauseSx
• Amenorrhea • Breast tenderness• Weight gain• Hot flushes/flashes• Mood changes.
Ddx• Pregnancy• Premature ovarian failure• Gonadotropin releasing
drugs• Hormone replacement
therapy (HRT).
Contraceptives
• Women who use oral contraceptive pills can experience problems with their breasts because of
the hormonal imbalance that pills can cause. • This is usually not a reason for concern, but if it
happens with unusual bleeding, bloating, headache and uneasiness,
the woman should seek immediate medical care.
DDx
Female
Physiological Pathological
Physiological
Fibroadenoma
Fibroadenosis
Mastitis
Fat Necrosis Breast abscess
Duct ectasia
Benign Malignant Malignant
FibroadenomaDefinition
• are the most common breast lesions
• commonly found in women under the age of 30.
Sx• Painless
FibroadenosisDefinition
• Fibrosis is firmness in the connective tissues, and cysts are fluid-filled sacs.
• These changes often are affected by hormones.
Sx• Areas of lumpiness,
thickening• Tenderness• Nipple discharge• Pain
MastitisDefinition
• Bacterial infection and can cause inflammation around the nipple
• Often occurs when breastfeeding.
Sx• Breast pain• Fever• Tenderness/soreness• Redness• Heat or warmth of
affected area.
Fat NecrosisDefinition
• After surgery or an injury to the breast heals and leaves scar tissue that can feel like a lump.
Sx• pain and tenderness• Some drainage may occur
in the nipple of the breast with the lump or the skin may dimple.
Duct ectasia
• This happens when a milk duct becomes dilated, the walls thicken and then the duct fills with fluid.
• most often affects women in their 40s and 50s
Sx• Nipple discharge(green, black, thick, or
sticky) • redness of the nipple
and area around the nipple
• Tenderness • Or inflammation near
the blocked duct.
Definition
Breast abscess Definition
• Is a collection of pus within the breast tissue.
Sx• Severe breast pain• Fever, chills• Redness, heat/warmth• Discharge of pus• Deviated nipple• Visible lump
DDx
Female
Physiological Pathological
Physiological
Benign Malignant Benign
Breast Cancer
Breast cancer
Most common type of breast cancer :
Inflammatory breast cancer
Symptoms and signs:
painless lump in the breast.
Changes in the size or shape of a breast.
Dimpling or thickening of some of the skin
on a part of a breast.
The nipple becoming inverted (turning in).
Rarely, a discharge occurring from a nipple
redness and warmth
The most commonly used tool that doctors use to describe tumor stage is the TNM system. TNM is an abbreviation for
tumor (T), node (N), and metastasis (M).
GynecomastiaRisk factorsDefinition
•Is swelling of the breast tissue in boys or men, caused by an imbalance of the hormones estrogen and testosterone.
•Older age•obese•Use of anabolic steroids or androgens to enhance athletic performance•Certain health conditions, including liver and kidney disease, thyroid disease, hormonally active tumors, and Klinefelter syndrome
SHOULD BE CLEARLY DIFFERENTIATED FROM ENLARGED PECTORAL MUSCLES
IN MUSCULAR MALES.
Simon Cowell
Break Time
Clinical evaluation
Risk Factors
Family history
History of
trauma
Family history
Associated symptoms
Gynaecological
history
Medications
Medical comorbidities
History taking
Risk Factors
Previous history of breast cancer.
Family history of breast cancer in a first-degree
relative
Age Never having borne a child or first child after the age of 30
Not having breast-fed Not having breast-fed
Continuous combined HRT Radiation to chest
Being overweight after the menopause
Physical examination
Risk Factors
Two part
Inspection Palpation
Inspect with the patient sitting and then with their hands raised above head.
Inspection
Look for:lumpVariations in breast size and
contour.nipple :Locationnipple retraction discharge
if so, is it unilateral or bilateral?Overlying skin changes: Any oedema Redness or retraction of the skin.Dimpling of the skin (called peau
d'orange)
Palpation
Don't forget
Tenderness
Family history
Discharge
Location
Regularity
Lymphadenopathy
Mobility
Important aspects of the examination include:
Clinical features of palpable breast masses
Malignant breast masses Benign breast massesConsistency: hard Consistency: firm or rubbery
Painless (90%) Often painful (consistent with benign breast conditions)
Irregular margins Regular or smooth margins
Fixation to skin or chest wall Mobile and not fixed
Skin dimpling may occur Skin dimpling unlikelyDischarge: bloody, unilateral Discharge: no blood and bilateral
discharge. Green or yellow colour
Nipple retraction may be present No nipple retraction
Mass fixed to the skin or chest wall
Stony hard, irregular mass
Skin dimpling
Matted or fixed axillary lymph nodes
Bloody nipple discharge
Thickened, erythematous skin
Red flags
Investigation
Mammogram. This is a special X-ray of the breast tissue.Ultrasound scan of the breast.MRI scan of the breast. This is more commonly performed on younger women, who may have denser breast tissue.
Radiological imaging
Investigation
-to confirm the diagnosis
• Biopsy
Investigation
The BRCA gene test is a blood test that uses DNA analysis to identify harmful changes (mutations) in either one of the two breast cancer susceptibility genes — BRCA1 and BRCA2. Women who have inherited mutations in these genes face a much higher risk of developing breast cancer
• DNA analysis
Investigation
Human epidermal growth factor receptor 2 (HER2). This tumor marker is a specialized protein on breast cancer cells that helps control cancer growth and spread
• Blood Marker Tests
Investigation
an ultrasound scan of the liverchest X-ray,a bone scan or other types of scan.
• Assessing the extent and spread
Management
• Treatment options for breast swelling vary depending on the underlying etiology.
Treatment
• Physiological causes
• Antibiotics• tamoxifen
(Soltamox)• Raloxifene
• Trastuzumab
• Radiation • Chemotherapy
• Liposuction. • Mastectomy• Lumpectomy• Fine-needle
aspiration
No need for treatment
Pharmacologic Therapy
Addition treatment may
do with surgery
Surgical Interventions
Angelina Jolie
Break Time
• 61-year-old woman who presents to her internist alarmed by a lump in her right breast that she discovered while showering. She report painless, swelling, and skin changes. She has not experienced fever, weight loss, headache, nausea, vomiting, dizziness, or bone pain.
• PMH (past medical history): SM is moderately overweight, but otherwise in good health. experienced menopause at age 55. She took hormone replacement therapy from age 54 until age 59.
• FH (family history): history of malignancy in first-degree relatives.
CASE SCENARIO
Summary
Most of causes are self-limited and benign.
Physiological : premenstrual syndrome is
a common cause of breast swelling.
Pathological : fibroadenoma is the most
common breast lesion.
The initial approach to the adolescent
patient with a breast mass includes a careful
history and physical examination.
Imaging may be necessary to differentiate
ReferencesUptodate ; Overview of breast masses in
children and adolescents.Healthline; breast-swelling.Patient education website ; Breast cancer. The Merck Manual, Professional Edition.National Cancer Institute; Breast Cancer. American Cancer Society ;Breast Cancer. Medlineplus; Premenstrual breast
changes.Med-health; Swollen Breast.
Thank you