1. BREAST DISEASES

2. OUTLINE INTRODUCTION ANATOMY BREAST ANOMALIES
INFLAMMATORY/ INFECTIOUS BREAST DISEASES
OTHER BREAST DISORDERS/ DISEASES
BENIGN TUMORS OF THE BREAST

3. INTRODUCTION
The breast is an organ for infant feeding, pleasure and sorrow!
It is the birth right of all mammals to posses breast. The breasts are in pairs; the number depends on the specie.
The breast contain epithelial and connective tissue elements that secretes milk and provides support.
It therefore contains fat, ducts, glands, fibrous tissue, blood vessels and lymphatics.
These are potential sites of disease.

4. INTRODUCTION CONTD
Majority of breast diseases occur in females but the male sex is not exempt.
Most breast diseases in the young are benign, but with advancement of age, benign problems of the breast give way to malignant conditions.
Women with benign breast lumps are apprehensive that the mass might actually turn out to be a cancer.
Careful counseling supported by confirmed histological diagnosis often relieves this anxiety.

5. ANATOMY OF THE BREAST

6. ANATOMY CONTD

7. ANATOMY CONTD

8. ANATOMY CONTD

9. BREAST ANOMALIES
Amastia
Hypoplasia
Polymastia
Athelia
Polythelia

10. BREAST ANOMALIES CONTD

11. BREAST ANOMALIES CONTD

12. BREAST ANOMALIES CONTD
Poland’s syndrome

13. INFLAMMATORY/ INFECTIOUS BREAST DISEASES
Lactational Mastitis
The common organism is Staphylococcus aureus
Delay in recognition is the rule due to associated mammary congestion
Resolution is often quick but inadequate treatment could lead to chronicity

14. INFLAMMATORY/ INFECTIOUS BREAST DISEASES CONTD
Mondor’s Disease
This variant of thrombophlebitis involves the superficial veins of the anterior chest wall and breast.
Rarely bilateral
Presents as acute pain in the lateral aspect of the breast
A tender firm cord follows the distribution of the vein
Usually resolves within 4-6 weeks
Treatment: Medications, warm compress, support, excision in refractory cases

15. Mondor’s Disease

16. INFLAMMATORY/ INFECTIOUS BREAST DISEASES CONTD
Hidradenitis Suppurativa
A chronic inflammatory condition that originates within the accessory areolar glands of Montgomery or axillary sebaceous glands
Mimics Paget’s disease of the nipple, breast cancer
Treatment: Antibiotic therapy, I&D, excision

17. GYNAECOMASTIA Refers to an enlarged breast in the male
Usually bilateral, but could be unilateral
Aetiology: - Physiological
- Pathological
Treatment: Depends on the cause

18. GYNAECOMASTIA CONTD

19. ABBERATIONS OF NORMAL DEVELOPMENT AND INVOLUTION(ANDI)
Spectrum of breast conditions that range from normal to disorder to disease.
Common between 20 and 45 years
Highest incidence between 30 and 40 years
Usually bilateral
More common in nulliparous women
Pathogenesis is uncertain but probably hypersensitivity of developing breast epithelium to circulating hormones especially estrogen.

20. ABBERATIONS OF NORMAL DEVELOPMENT AND INVOLUTION CONTD
Pathologically: Adenosis, cyst formation, epitheliosis and fibrosis
Clinical Features: Pain, lump(s), nipple discharge
Differentials: Breast cancer, Tietze’s syndrome, Fibroadenoma

21. ABBERATIONS OF NORMAL DEVELOPMENT AND INVOLUTION CONTD

22. ABBERATIONS OF NORMAL DEVELOPMENT AND INVOLUTION CONTD
Treatment
Reassurance
Topical NSAIDS
Primrose oil
Danazol
Tamoxifen
Bromocriptine
Excision

23. BENIGN BREAST TUMORS Galactocele Fibroadenoma Traumatic fat necrosis
Duct Ectasia
Duct Papilloma
Cystosarcoma Phyllodes
Nipple Adenomas
Lipoma
Harmatomas

24. GALACTOCELE Milk- containing cyst
Develops during lactation but may occur up to 6-10 months after breastfeeding according to Haagensen.
Thought to be due to blockage and dilatation of the lactiferous duct
Presents as painless, soft or tense, well circumscribed, flunctuant mass
Diagnosis: Aspiration
Treatment: Spontaneous resolution, aspiration, excision

25. FIBROADENOMA Constitutes 75% of all benign breast tumours
An aberration of the developing terminal lobular unit due to hormones
Develops during the reproductive period
Composed of stromal and epithelial elements
Clinical types: - Pericanalicular
- Intracanalicular
Subtypes: - Giant Fibroadenoma
- Juvenile Fibroadenoma

26. FIBROADENOMA CONTD Pericanalicular Commoner than intracanalicular
Occurs between 14-30years with a peak incidence between 21-25years
Usually round or oval and 1-3cm in diameter

27. FIBROADENOMA CONTD Intracanalicular Occurs between 30-50 years
Grows less slowly
Usually up to about 10cm
Treatment: - Reassurance
- Excision

28. TRAUMATIC FAT NECROSIS
Supposed to be traumatic in origin, a history of trauma is unobtainable in most patients
May perhaps be due to micro trauma
Presents as painless hard, irregular surface breast mass
Mimics breast cancer
Diagnosis: Histology
Treatment: Excision biopsy

29. TRAUMATIC FAT NECROSIS

30. DUCT ECTASIA Commonest cause of nipple discharge
Dilatation of subareolar lactiferous ducts
Common between years
Presentation: Recurrent pain/ discomfort, nipple discharge, retraction, palpable mass, mammilary fistula
Diagnosis: Galactography
Treatment: Excision, Microdochectomy, Fistulostomy/(ectomy)

31. DUCT ECTASIA CONTD

32. DUCT PAPILLOMA
Arises from the epithelium of a lactiferous duct near its termination at the nipple
Can be single or multiple
Multiple papillomatosis is premalignant
Most common symptom is blood stained nipple discharge
Diagnosis: Galactography
Treatment: Excision biopsy

33. CYSTOSARCOMA PHYLLODES
Rare variant of intracanalicular fibroadenoma
Common between 35 and 50years
It is rapidly growing
Pathologically: Benign(60%), borderline(15%), malignant(25%)
Axillary nodes are not involved
Diagnosis: Histology
Treatment: - Wide local excision
- Total Mastectomy

34. CYSTOSARCOMA PHYLLODES CONTD

35. NIPPLE ADENOMAS This is an ulcerating lesion on the nipple.
Presents as a lump in the nipple or as nipple discharge.
Biopsy is required to establish the diagnosis.
Treatment is wide excision.
It is usually possible to save the nipple.

36. NIPPLE ADENOMAS

37. BREAST LIPOMA
It is uncommon

38. HAMARTOMA
A hamartoma is a discrete nodule that contains closely packed lobules and prominent, ectatic extralobular ducts.
Uncommon, they are also known as fibroadenolipomas.
On physical examination, mammography, and gross inspection, a hamartoma is indistinguishable from fibroadenoma.
Excision is curative.