MASTALAGIABY

PROF/ GOUDA ELLABBAN

MASTALGIA

BREAST PAIN

Most women experience some form of breast pain or discomfort during their lifetime.

The pain may be • cyclic or not• focal or diffuse.

MASTALGIA

WITH LUMP• CYCLICAL NODULARITY• CYST• ABSCESS (USUALLY LACTATIONAL)• PERIDUCTAL (PLASMA-CELLED)

MASTITIS• CARCINOMA (RARE)

MASTALGIA

WITHOUT LUMP• CYCLICAL MASTALGIA

(INCLUDING PREMENSTRAL TENSION)

• NON-CYCLICAL MASTALGIA• PREGNANCY MASTITIS

Cyclical mastalgia

• Described as a heaviness or tenderness• Usually bilateral, affects upper outer quadrant and

radiate to the inner surface of the upper arm• Average age of onset is 24 years • No consistent hormonal abnormality • Prolactin levels may be increased • Essential fatty acid profiles may be abnormal • In those with no palpable mass no imaging is

required

Treatment • 80% require no treatment other than

reassurance • Treatment should be considered if: • Symptoms for more than 6 months • For >7 days per cycle 1. Evening primrose oil (EPO) • first line treatment• Require treatment for at least 4 months 2. Danazol for severe breast pain3. Bromocriptine

Non-cyclical mastalgia

• Occurs in premenopausal and in postmenopausal women

• It is described as burning, stabbing, or drawing and frequently occurs in the subareolar area or medial aspect of the breast

• Treatment• Evening primrose oil is the first-line treatment • followed by danazol for severe pain • An injection of lidocaine and prednisolone into the

tender spot is helpful in some patients.

• Accumulation of pus in the breast• Breast abscess divide into :

1. Bacterial mastitis

2. Subareolar masitis

3. Chronic intramammary abscess

4. Chronic subareolar abscess

BREAST ABSCESS

Bacterial mastitis• Usually due to Staph. aureus • The affected breast, or more usually mainly one

part of it , presents the classical signs of acute inflammation , and what is aptly called ‘the cellulitic stage ‘ of a breast abscess has been reached .

• Treatment during the cellulitic stage :• Bacterial culture of the milk• if no pus -Give antibiotic appropriate for a

pencillin resistance staph.• Continue breast feeding using uninfected

breast

If pus present consider repeated aspiration or incision and drainage

• Antibiotic should not given if pus already present

• In such circumstances, if an antibiotic is given the pus in the abscess frequently becomes sterile and a large brawny oedematous swelling remains in the breast and takes many weeks to resolve (antibioma)

Chronic intramammary abscess

• Which follow inadequate drainage or injudicious antibiotic treatment

Subareolar mastitis

• Not a true mastitis• Infected sebaceous gland ,or furuncle on or

near the areola• Occur 30- 60 years • More common in

smokers

• Repeated aspiration is the treatment of choice

• Drain through small incision if non-resolving

• Spontaneous discharge or surgical excision can result in mammary fistula (chronic subareolar abscess)