Download - 3 mastalgia s
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)