Breast abscess is a firm, tender mass. This patient with a breast abscess is being prepared for surgical drainage of the abscess. A biopsy will be done to exclude carcinoma.
The physiologic changes associated with pregnancy and lactation make it difficult to recognize, diagnose, and treat new breast pathology.
Breast infections fall along a spectrum of severity from cellulitis to mastitis to breast abscess. Infections mainly occur during the first month after delivery and are likely to affect young, inexperienced mothers who do not practice proper hygiene. Staphylococcus aureus is the most common organism. Cellulitis responds rapidly to antibiotics and does not require drainage. Abscesses are localized collections of pus which may respond to antibiotic therapy or may require aspiration or surgical drainage.
Breast abscess is a firm, tender mass. This patient with a breast abscess is being prepared for surgical drainage of the abscess. A biopsy will be done to exclude carcinoma.
Because milk is an excellent culture medium, the breast must be kept empty. Breast feeding from the contralateral side may usually be continued; suckling from the affected breast has been reported to cause pneumonia in the infant and should be avoided.
These simple milk-filled cysts probably form because of ductal obstruction. The patient complains of a tender mass, usually peripheral in the breast. Needle aspiration is both diagnostic and curative.
These benign tumors often increase in size during pregnancy, sometimes dramatically. Occasionally the lesion outgrows its blood supply and infarcts. Both rapid growth and infarction may be associated with pain and a mass difficult to distinguish from cancer.
Mammograms of older women often show "popcorn" calcifications like these in fibroadenomas. Such calcifications may be the remnants of asymptomatic infarcts.
Also benign, these tumors are quite similar to fibroadenomas; sometimes they become quite large causing significant breast asymmetry.
This is the gross appearance of a typical mammary hamartoma. The yellow color is due to the high fat content, which may result in a characteristic mammographic appearance.
Often these uncommon lesions are diagnosed for the first time after pregnancy, when post-lactational involution allows the surrounding breast parenchyma to shrink. Excision is the treatment of choice when a mass or breast asymmetry is present.
Nodular lactational hyperplasia and lactating adenomas are benign focal lesions that may be single or multiple. The clinical presentation and appearance is similar to fibroadenoma.
Occasionally the normal breast enlargement accompanying pregnancy becomes massively exaggerated. The breasts often regress postpartum, but recurrence may occur with subsequent pregnancies. Reduction mammoplasty is an option.
The physiologic proliferative changes of pregnancy occasionally cause bloody nipple discharge to appear during the second or third trimester. Cytology may be misleading due to the amount of normal proliferative changes present. Observation and reassurance are appropriate and further studies are generally not advised unless the condition persists more than two months after delivery.
Sometimes normal breast tissue infarcts during pregnancy. The palpable, often tender, mass that results must be distinguished from cancer. Biopsy may be necessary.
Approximately 1-2% of breast cancers in women are diagnosed during
pregnancy. It is likely that this number will increase as the
tendency to defer childbirth results in more pregnancies in older
women.
A baseline breast exam at the time of the first obstetrical visit is
crucial. Evaluation of mass lesions becomes much more difficult as
pregnancy progresses. Mammography is of limited benefit because of
the increased breast mass, density, and vascularity. Ultrasound may
help to distinguish cystic from solid lesions.
Delay in diagnosis is common due to the difficulty in feeling masses
and a reluctance to biopsy. Stage for stage, survival is identical to
the general breast cancer population. However, over 75% of pregnant
women diagnosed with breast cancer have nodal metastases, far more
than the general population.
This shows the histology of a highly invasive breast cancer with lymphatic invasion.
Biopsy can be performed safely using a cutting needle or open biopsy technique with suitable precautions to avoid hemorrhage (due to increased vascularity), hematoma formation, and milk fistula (during lactation).
Management of the pregnant patient with breast cancer is complex but can be accomplished safely using a multidisciplinary team approach. Generally the rule is to treat the cancer and allow the pregnancy to proceed to term, but there are occasional exceptions. Radiation therapy is not feasible because of excessive exposure to the developing fetus; hence the generally accepted treatment is modified radical mastectomy. Staging studies are performed very selectively or deferred until after delivery. The decision to use chemotherapy must be made after weighing all factors.
Patients who are clinically free of disease are not adversely affected by pregnancy. Current recommendations are to allow pregnancy to proceed if a woman becomes pregnant after successful treatment of breast cancer.
Scott-Conner CEH, Schorr SJ. The Diagnosis and Management of Breast Problems During Pregnancy and Lactation. American Journal of Surgery Volume 170; October 1995, pages 401-405.
Scott-Conner CEH. Diagnosing and Managing Breast Disease During Pregnancy and Lactation. Medscape Women's Health 2(5), 1997.
See related Patient Textbooks about Obstetrics and Gynecology.
See related Patient Topics Breast, Breast Diseases, Breast Feeding, Food, Nutrition and Metabolism, Immune System/AIDS, Infections, Infections and Pregnancy, Obstetrics and Gynecology, Pregnancy, Pregnancy and Reproduction or Women's Health.
See related Provider Textbooks about Obstetrics and Gynecology.
See related Provider Topics Breast, Breast Feeding, Food, Nutrition and Metabolism, Immune System/AIDS, Infections, Obstetrics and Gynecology, Pregnancy, Pregnancy and Reproduction or Women's Health.
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