Benign Breast Disease

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Anatomy

Blood supply Internal thoracic artery

Intercostal arteries

Axillary artery

Batson plexus

Lymphatics Axilla (75%)

Internal mammary (25%)

Rest , accompany other arteries

Hormones Estrogen

Progesteron

Prolactine

Nerves: Long thoracic nerve of Bell(Serratus anterior)

Intercostobrachial(2nd intercostal)

Nerve to Latissimus dorsi

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• Benign breast diseases are related to the normal process of

reproductive life and involution.

• ANDI (Aberration of Normal Development and Involution)

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Functional Anatomy

• 15-20 lobules

• Coopers suspensory ligaments

• Axillary tail (Spence)

• Nipple and areola Mongomery’s tubercles

• Lobe Lactiferous ducts

• Lactiferous sinus

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Developmental Anomalies

Milk line ( super numeri nipples )

Accessory nipples (Polythelia)

Infant mammary pit (Inverted nipple)

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AmastiaAccessory breasts Polymastia) Symmastia

Lymphatic Drainage

Groups

Axillary vein (lateral)

Anterior pectoral

Posterior (scapular)

Central

Subclavicular (apical)

Interpectoral (Rotter's)

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Axillary L.N Levels (in relation to pectoralis minor)

• Level 1 Lateral or below

• Level 11 Superior or deep

• Level 111 Medial or above the upper border

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Gynecomastia

Physiological: Neonatal (Witch’s milk)

Adolescence

Senescence

Acquired:

Increased Estrogen levels

Decreased Androgen levels

Decreased Estrogen metabolism

Bilateral No increased risk of cancer

Kleinfilters syndrome Increased risk of cancer

Diseases: Liver cirrhosis

Drugs: Digitalis, Spironolactone, Antideppresents…etc

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Others• Hydradenitis suppuritiva

• Mondor’s Disease (Lateral thoracic vein) Benign

Self limited (4-6 weeks)

• Teitze syndrome

• Costochondritis, 2nd rib, usually left side

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Fibroadenoma:

• Early age

• Usually 1-2 Cm

• <1Cm can be considered normal

• Sometimes multiple ( more than 5 in one breast )

• Giant (more than 3 Cm.)

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Mastalgia:

• Cyclical Premenestrual

• nodularity considered normal

• Cyclical pronounced : mastalgia with painful nodularity that last for

more than a week.

• Trigger point

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Non proliferative disorders

• 1. Breast cysts

• 2. Duct ectasia

• 3. Periductal mastitis

• 4. Benign calcifications

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Breast cysts

• Simple cyst

• Cysts with a solid component

• Galactocele

• Galactorrhoea (Prolactine hormone )

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Management of breast cysts

• Aspiration

• Record the volume and color

• Examine for residual mass

• Aspiration is preferably done with USS

• If aspirate is bloody, it should be sent for cytology

• If there is a solid component, it should have USS guided biopsy

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Duct ectasia

• Normal diameter 2-4 mm

• Lactiferous sinus

• Orifice 0.4 – 0.7 mm

• Presentation: Breast pain

• Nipple discharge (Light greenish , paste-like )

• Recurrent infections ,sinuses or fistulas

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Periductal Mastitis (Zuska’s Disease)

Sometimes called plasma cell mastitis

Recurrent breast infection and abscesses mainly

retroareolar area

Might result in sinuses or fistulas

Treated by Antibiotics ,recurrent drainages

For fistulas, fistulotomy or fistulectomy

Advanced complicated cases , subareolar mammary ducts excision (Hadfield operation)

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Benign calcifications

• Cellular secretions and debris

• Trauma

• Inflammation

• Should be differentiated from cancer calcification

• Microcalcifications Less than 0.5 mm

• Fine

• Linear

• May show branching

• Spiculed

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Adenoma

• Well circumscribed

• Benign epithelial tissue

• Spare stroma

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Adenolipoma

• Consist of sharply circumscribed nodules of fatty tissue that contain

normal breast lobules and ducts

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Fibrocystic disease

• Fibrocystic changes

• Also referred to Cystic myopathy

• Chronic cystic mastitis

• Coopers disease

• Schimmelbuschs disease

• Mid thirties

• Premenestrual pain that ease with the flow

• Nodularity

• Treatment: Analgesia

• Advise to reduce salt and coffee intake

• Comfortable bra

• Primrose oil

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Nipple inversion

• Unilateral or bilateral

• Treated by surgery (eversion or elevation)

• Should be distinguished from retracted nipple seen in malignancy

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Intraductal papilloma

• Affect major ducts

• Usually affect premenauposal women

• Size is generally <5mm but it can reach 5 Cm.

• Present with serous but mainly bloody nipple discharge

• Grossly, pinkish , friable with thin stalk

• Rarely undergo malignant change

• Treatment is microchodectomy

• Precaution before surgery not to be compressed or squesed by the patient or examining Doctors

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Breast abscess

• Commonly in lactating women

• Pain and swelling

• Redness of the overlying skin with tenderness

• Commonest organisms Staph. Aureus and Streptococcus sp.

• Treated by aspiration (USS guided )

• Antibiotocs

• Surgical drainage (Tissue biopsy to be obtained )

• Chronic infection ( TB )

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