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