Benign Breast Diseases

Dr  S. FLORET, M.S

Embryology Of Breast

• In 5th or 6th week Two ventral bands of thickened epithelium (milk lines)develops

• Extending from axilla to inguinal region,where paired breast develops

• Polymastia or polythelia occurs along milk lines and ridges disappear

• Ectodermal ingrowth into mesenchyme appears and formation of lactiferous ducts and sinus formed

• Proliferation of mesenchyme makes the pit into a future nipple

Developmental disorders

• Amastia

• Polands syndrome

• Symmastia

• Polythelia(renal agenesis,HT,Conduction defects,pyloric stenosis,Epilepsy,Ear Abnormality)

• Supernumery Breast(turners and Fleishers syndrome)

Functional Anatomy of Breast

It contains 15 to 20 lobesSuspensory lig of breast inserts into dermisExtending from 2nd to 6th ib ,sternum to ant axillary lineUpper outer quadrant has great volume of tissueNipple areolar complex,is pigmented with corrugationsContains seb glands,sweat glands,montogomerytubercles and smooth muscle bundles,Rich sensory innervations 

Blood Supply

Perforating branches of Internal Mammary ArtLateral Branches of Posterior Intercostal ArtBranches from Axillary art,the Highest Thoracic,Lateral thoracic,Pectoral Branches of Thoraco Acromial vesselsMedial Mammary Art2‐4th Anterior Intercostal PerforatorsVeins follow the arteries and Batson plexus around vertebra ext from base of skull to sacrum may provide bony mets

Blood supply

Innervation

• Lateral Cutaneous Branches of 3rd to 6th

Intercostal nerves

• Intercostobrachial nerve

• Ant branch of Supreaclavicular nerve

Lymphatic supply

• Anterior  along lateral thoracic

• Central group

• Lateral along axillary vein

• Posterior along subscapular

• Apical

• Rotters nodes

• Internal mammary  nodes

Lymph

Classification

• Congenital

• Injury

• Inflammation

• Infection

• ANDI

• Pregnancy Related

Congenital

• Inverted nipple

• Super numery breast/nipple

Non‐ Breast Disorder

• Tietzes Disease

• Sebaceous Cyst  , Etc..

Injury

• Hematoma

• Traumatic Fat necrosis

Infection

• Acute Intramammary Mastitis

• Chronic Intramammary Mastitis

• Subareolar Mastitis

• Chronic Subareolar Mastitis

• Retromammary abscess

• Breast Abscess

• TB ,Syphilis,Actinomycosis

• Mondors Disease

ANDI

It’s a spectrum of Benign diseases related to normal process of reproductive life to involutionFibrosisCyst formationHyperplasiaPapillomatosisFibroadenomasScelrosing lesionsDuct ectasiaPeriductal mastitis

ANDI Normal Disorder DiseaseEarlyReproductive years(15‐25)

Lobular development

Stromal development

Nipple Eversion

Fibroadenoma

AdolescentHypertrophyNipple Inversion

Giant FiroadenomaGigantomastiaSubareolar abscessMammary duct fistula

Later Reproductive years(25‐40)

Cyclical Changes ofMenstruationEpithelila Hyperplasia of Pregnancy

Cyclical MastalgiaNodularityBlood stained Nipple dischargeMacrosystsSclerosing lesions

Incapacitating Mastalgia

Involution(35‐55)

Lobular InvolutionDuct Involution ‐Dilatation‐Sclerosis

Epithelial turnover

Duct EctasiaNipple RetractionEpithelial Hyperplasia

Periductal MastitisEpithelilaHyperplasia with atypia

Breast Abscess

• Lactational

Cracked Nipple 

Fissure Nipple

Child Teeth

Commencement Of Feeding

Weaning

Organism – Staph. Auer

• Non‐Lactational

Peri‐ductal Ectacia

Peri‐areolar Region

Recurrence

Organism – Anerobic Strep & Entero

Clinical Features

• Breast engorgement

• Pain

• Fever

• Treatment – Aspiration ,Antibiotics, I&D

Gynaecomastia

Gynaecomastia refers to enlargment of breast in malesPhysiological in neonate,adolescence and old Estrogen cause(testicular tumours,adrenaltumours,hyper or hypothyroidism,hepaticdiseaseAndrogen deficiency like klienfilters,kallmansyndrome,ACTh deficiencySecondary testicular failureDrugs like cimetidine,phenytoin,spironolactone,digoxin,d

Gynaecomastia

Nipple Discharge

• Milk Discharge

• Serous Discharge

• Blood Discharge

• Greenish Discharge

• Black Discharge

• Pus

• Creamy discharge

Nipple Inversion and Retraction

• Congenital

• Duct ectasia,carcinoma  or post surgical causes nipple retraction.

• Other disease of nipple are cracked nipple,chancre,eczema,and pagets disease of nipple.

Benign Neoplasms

• Fibroadenoma

• Cystosarcomaphylloides

• Duct papilloma

• Neurofibroma

• Papillary cystadenoma

• Lipoma

Duct Papilloma

• True polyp from epithelium lining the duct of the breast

• Types – Solitary ( Sub‐areolar)‐Multiple ( Peripherally Located, increased 

tendency to become malignant, Fibrovascular pore covered with epithelium, Area of necrosis & Infarction, Epithelial Hyperplasia)• CF – Nipple Discharge

‐ Commonest cause for bloody discharge‐ Lump

….Cont

• Investigation 1. FNAC – Lump2. Cytology ‐ Smear  Study3. Mammography 4. Ductography

• Treatment‐ Surgical Excision send for biopsy               

Mondor’s Disease

• Thrombophlebitis of superficial veins adjacent to breast

• Precipitated by – Infection‐ Repetitive movement of upper limb‐ Surgical Procedure

• Vessel – Lateral Thoracic‐ Thoraco Epigastric

• Pain• Examination – Tender  , Firm Cord in the direction of the vessel

…Cont

• Treatment – Rest 

‐ Analgesics

‐ If necessary ligation of the vessel at both

ends