DISORDERS OF
THE BREAST
Breast Abscess
Definition
Breast
Fibroadenoma
Common benign
neoplasm most
freq. in young
women. Rarely
occurs after
menopause unless
patient is receiving
HRT
Painful, often
multiple bilateral
masses of the
breasts
Fibrocystic
disease
Mastitis
Parenchymatous
infection of the
mammary glands
Pathophysiology Physical Exam
Findings
Infection is
Redness
generally
Tenderness
caused by Staph Induration
aureus and is
common in
lactating
women during
nursing
In the nonlactating breast,
consider
inflammatory
carcinoma
(Incision
&biopsy
indicated to r/o
malignancy)
10-15% women Round, rubbery, very
More frequently discrete, relatively
in African
mobile, non-tender
Americans
mass
1-5 cm
Diagnostic
test/Exam
Clinical dx in
lactating women.
Incision and biopsy
is necessary to r/o
malignancy in nonlactating women
Treatment (First
Line)
Needle or
catheter drainage
is often adequate,
but surgical
incision and
drainage may be
necessary
Treatment
(second line)
For abscess or
cellulitis in nonlactating breast
that does not
promptly
resolve with
antibiotics,
incision and
biopsy of
indurated tissue
with small piece
of erythematous
skin are
indicated
U/S
Biopsy to
differentiate solid
mass from cystic
mass
None
Excision and
pathologic
examination if
necessary
Often fluctuates
in size and
tenderness with
menstrual cycle
related to
estrogen.
EtOH may
increase risk.
Staphylococcus
aureus is usually
the causative
agent.
Inflammation is
generally
unilateral, and
U/S
Mammogram
Suspicious lesions
should be biopsied
Gamolenic acid
If mass does not
(3g PO 2x/day)
resolve it should
Vitamin E,
be excised.
Danazol for severe
pain, Tamoxifen….
stop HRT if on it
Pain can persist
until
menopause
Clinical dx unless
nonlactating.
antibiotics
effective against
penicillin-resistant
staphylococci
(dicloxacillin 500
mg orally every 6
hours or a
Leads to
abscess in
about 10% of
lactating
women.
Rarely,
inflammatory
Ages 30-50
Asymptomatic to
painful mass or
masses
+/- serous nipple
discharge
Rapid fluctuation in
mass size
Begins about 3 mos
after delivery.
Begins w/ engorged
breast, sore or
fissured nipple
Cellulits in affected
area
Prognosis
An abscess
tends to recur
after aspiration
unless area is
explored during
a quiescent
interval with
excision of the
involved
lactiferous duct
or ducts at base
of nipple
STRUCTURAL
ABNORMALITIES
Cystocele
Herniation of
bladder into
anterior vagina that
may or may not
involve the urethra
women nursing
for the first time
are more often
affected.
Erythema
Fever
Chills
Weakened
pelvic support
most commonly
attributed to
childbirth,
aging, obesity,
pelvic surgery
Sensation of bulge or
protrusion in vagina
Urinary incontinence
Dyspareunia
Graded by BadenWalker system and
Pelvic Organ Prolapse
Quantification
System (POP-Q)
Surface of bulge is
textured
Sensation of
fullness/sitting on a
ball
Presence of reducible
mass bulging into
vagina
Increased bulging
with valsalva
Back pain/pelvic pain
Urinary symptoms
Bulging of introitus
Thin-walled
protrusion of the
rectovaginal septum
Bulge surface is
smooth
Uterine prolapse
Descent or
herniation of the
uterus into or
beyond the vagina
Weakness of
muscles
ligaments and
fascia most
commonly r/t
vaginal
childbirth and
aging
Rectocele
Herniation of
posterior vaginal
wall
Vaginal
childbirth
Obesity
Chronic heavy
lifting
Weakened
pelvic support
cephalosporin for
10–14 days) and
regular emptying
of the breast by
nursing or by
using a
mechanical
suction device
carcinoma of
the breast can
be mistaken for
mastitis.
Pelvic exam with
speculum
Stress test with
valsalva
Rectal exam
Pelvic U/S
MRI for grading
U/S
Only cure is
Corrective
surgery:
Hysterectomy
with vaginal vault
suspension
Kegel exercises
Pessaries
Weight
reduction
Reduce
constipation w/
high fiber diet
Vaginal estrogen
Residual urine
may lead to
infections.
Stress
incontinence
may persist.
Pelvic exam with
speculum
Stress test with
valsalva
Rectal exam
Pelvic U/S
MRI for grading
U/S
Only cure is
Corrective
surgery:
Hysterectomy
with vaginal vault
suspension
Kegel exercises
Pessaries
Weight
reduction
Reduce
constipation w/
high fiber diet
Vaginal estrogen
Irritation from
contact of
uterus with
clothing in case
of extensive
prolapse
Pelvic exam with
speculum
Stress test with
valsalva
Rectal exam
Pelvic U/S
MRI for grading
U/S
Only cure is
Corrective
surgery:
Hysterectomy
with vaginal vault
suspension
Kegel exercises
Pessaries
Weight
reduction
Reduce
constipation w/
high fiber diet
Vaginal estrogen
Outlet delay
and incomplete
emptying in
elderly
Ovarian torsion
Twisting of the
ovarian pedicle
Risk factors:
Ovarian cyst or
mass
Adolescent
>50 yo
Severe adnexal
pain from
ischemia of the
ovary
Sudden moderate to
severe unilateral
lower abdominal or
pelvic pain that
worsens with a
change in position
Pain may radiate to
groin, back, or flank.
May involve
preceding physical
activity
Vomiting
Tenderness over the
mass
Serum HCG
U/S with Doppler,
but negative
imaging does not
rule out torsion
PE
CT to rule out other
abdominal
etiologies
Admit
Surgical
consultation for
laparoscopy or
laparotomy to
untwist viable or
remove necrotic
ovary
Oophoropexy if
recurrent
torsion or single
ovary
involvement
Excellent
prognosis if
urgent
diagnosis
Infarcted
torsion and
significantly
reduced fertility
if delayed
diagnosis