Breast Disease and

Examination
Dr. Tim Coughlin
 Objectives

• Describe the main pathologies of

the breast
• Understand the predisposing
factors
• Describe the examination of the
breast
Inflammatory
Disorders
Mastitis / Abscess
• Associated with lactation and
S.aureus
• Initial infection causes acute
mastitis
• May develop into an abscess
• If unresolved may develop chronic
inflammation
 Mastitis Abscess
http://www.surgical-tutor.org.uk/pictures/images/breast/breast_abscess.jpg
http://www.faqs.org/nutrition/Kwa-Men/Mastitis.html
 Fat Necrosis

• Follows trauma (may be minor)

• Necrosis of adipose tissue and
inflammatory response
• Produces hard irregular breast lump
• Mimics breast carcinoma
Mammogram

http://www.gfmer.ch/selected_images_v2/detail_list.php?cat1=2&cat3=34&stype=d
 Duct Ectasia
• Dilatation of large ducts
• Parous women, peri-menopausal
• Inflammatory destruction of elastic
support tissues
• Firm lump or discharge
• Fibrosis and chronic inflammation
around ducts
• Common cause of periareolear
abscess
 Single Duct

http://www.wisc.edu/wolberg/breast.html
Multiple Ducts
Benign Proliferative
Diseases
Fibrocystic Change
• Common; 10% symptomatic and
40% asymptomatic in ALL women
• Incidence peak around menopause
• Hyperplastic overgrowth of
mammary unit
• Epithelial overgrowth of lobules /
ducts
• Range of solid and cystic nodules
http://www.gfmer.ch/selected_images_v2/detail_list.php?cat1=2&cat3=36&stype=d
 Fibroadenoma
• Benign localised proliferation of
ducts and stroma
• Rarely larger than 2 - 3 cm
• Incidence peak women aged 25 -
35
• Mobile lump, firm rubbery, well
defined
http://www.brooksidepress.org/Products/OBGYN_101/MyDocuments4/Text/Breast/fibroadenoma.htm
Neoplastic Breast
Disease
 Benign Breast
Tumors
• Lipoma / Leiomyomas
• Harmatomas
• Duct Papillomas
• Adenomas
• Phyllodes Tumors
Malignant Tumours
• Affects 1 in 12 women
• Usually occur over the age of 30
• Four common presentations:
• Palpable lump
• Mammography
• Incidental histological finding
• Metastatic disease
 Intraductal
Carcinoma
• Non invasive (CIS)
• Incidence peak 40 - 60 years
• Tumour fills and distends small and
medium ducts
• 30% become invasive if untreated
 Invasive Ductal
Carcinoma
• Most common
• Invade tissue with desmoplastic
response creating dense fibrous
stroma
• Most intermediate or high grade
poorly differentiated tumours
 Invasive Lobular
Carcinoma
• Often multifocal and frequently
bilateral
• Again desmoplastic response
• Tumour cells compressed into
narrow cords
 Paget’s Disease

• Pattern of spread of a ductal

carcinoma
• Thickening and reddening of skin of
nipple and areolear
• Resembles eczema
Causes of Breast
Cancer
• Geographical : 5x higher in west
• Familial: 5% associated with genetic
predisposition
• Early menarche: age 10 carries 3x
risk
• Late parity: age 35 carries 3x risk
• Late menopause: age 55 carries 3x
risk
• Exogenous hormones: HRT
• Dietary factors: obesity, high EtOH
Breast Examination
Images from: http://www.operationalmedicine.org/ed2/Enhanced/Breast.htm
 IPEEP
• Introduce yourself to the patient
• Ask Permission to perform the
examination and ask for chaperone
to be present
• Explain what you want to do
• Expose the patient adequately
• Position the patient
+ PAIN
correctly
 Inspection
• Position : Sitting
with arms by side
• Symmetry
• Visible masses
• Dimpling
• Redness
• Nipple retraction
 Inspection

• Ask patient to
raise arms and
place hands
behind head
• Watch for skin
tethering
 Inspection

• Ask patient to put

hands on hips
and push inwards
• Flexes pectorals
• Again look for
contour of breast
Palpation
 Palpation
• First examine
sitting
• Examine
‘normal’ side
first
• Place hand
behind head
• One quadrant at
a time
 Palpation

• Next palpate the

axilla
• Support patient’s
arm
• Lymphadenopath
y
 Palpation
• Examine lying
down
• Use one or two
hands to elicit
lumps
• If felt define
lump with
fingertips
 Palpation

• Finally palpate
nipple
• Stripping of the
ducts for
secretions
 Thankyou

http://web.mac.com/timcoughlin/