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Webb Timmons posted an update 5 months, 4 weeks ago
During pregnancy and lactation, breast vascularity increases and edema occurs in the breast . As a consequence, rate of complications of breast biopsy and surgery like bleeding, infection, delayed healing and wound dehiscence is expected to be higher. Milk fistula is a rare event that may complicate surgery or needle biopsy of the breast in a breastfeeding woman, or in late stages of pregnancy . Suppression of lactation has been proposed in the literature as both a preventive and a therapeutic step. However, the advantages of nursing for both mother and child are numerous, and the author do not propose it as a preventive measure nor as a must in treatment of milk fistula. Prevention and management of milk fistula are discussed in this chapter.Surgery in the form of both mastectomy and breast conservation is the main step in the treatment of breast cancer. Numerous studies have shown an equivalent long-term survival for breast conserving surgery (BCS) and mastectomy . Patients desire and tumor characteristics, especially size and multicentricity, are the key factors that affect the decision between these two types of surgery . Patients with any contraindication for radiotherapy or previous history of radiation to the breast field are not suitable for BCS . There are few absolute contraindications for BCS , and early pregnancy is listed among them; mastectomy is preferred in the first trimester of pregnancy to avoid the impact of delaying radiation therapy on outcome of the cancer.Breast cancer in pregnancy is a rare entity generally presenting as a persistent breast mass, but is often a delayed finding due to the expected physiologic changes in the breast related to pregnancy and lactation. The preferred diagnostic workup of a persistent breast mass involves a combination of mammographic and ultrasonographic evaluation in addition to tissue diagnosis via core biopsy ; breast MRI is not recommended. Surgical excision should be reserved for definitive treatment in order to minimize fetal exposure to anesthesia. Evaluation for distant metastatic spread can be performed using radiographs and ultrasound to limit fetal radiation exposure . Similar to the non-pregnant patient, prognosis is primarily driven by tumor biology, however, there is limited and conflicting data regarding the impact of pregnancy on breast cancer outcomes with a distinct difference in survival among patients with breast cancer during pregnancy compared to those diagnosed postpartum.Breasts are one of the most common sites of neoplastic lesions in women during pregnancy and lactation. This chapter reviews carcinomas of the breast during pregnancy and lactation while focusing on histologic features, biomarker profiles and some involved molecular pathways. Also, a brief review of previous studies on this field is performed.Breast cancer diagnosed during pregnancy or lactation up to 1 year post-partum is often referred to as pregnancy-associated breast cancer (PABC) , although the definition varies with length of post-partum period. The incidence rate has been reported to range from 17.5 to 39.9 per 100,000 births, but the rate is substantially lower during pregnancy (ranging from 3.0 to 7.7) than during the post-partum period (ranging from 13.8 to 32.2). Smad pathway The PABC incidence rate is increasing in many populations, and higher maternal age at birth is a likely explanation. Linkable population-based data on pregnancies and cancer are required to obtain reliable estimates of PABC incidence. In studies comparing outcomes in women with PABC to other young breast cancer patients, it is crucial to adjust for age, since the age distribution of PABC depends both on age at pregnancy and age at breast cancer. Large studies have shown similar prognosis for women with PABC compared to other young women with breast cancer, when accounting for differences in age, stage and other tumour characteristics.Papillomas, atypical hyperplasias, and lobular carcinoma in situ of the breast are not malignant tumors, but present serious management challenges when they are diagnosed in a breast biopsy . Upgrading after excision and increased possibility of future cancer are risks that accompany these lesions. While some features have been defined as high-risk for upgrading, many practitioners now recommend conservative non-surgical treatment and vacuum-assisted biopsy . However, the challenge gets worse when the patient is pregnant or breastfeeding because of the limitations in imaging and treatment in relation to the fetus. This chapter deals with these problems, although the best management strategy cannot be defined because of lack of evidence at present.Breastfeeding is immunoprotective and World Health Organization recommends exclusive breastfeeding for about six months with continuation of breastfeeding for one year or longer as mutually desired by mother and infant. But the target for duration of exclusive breastfeeding has not been reached in a significant number of women. It may be due to inflammatory breast disease such as milk stasis or lactational mastitis.In this chapter we discuss the most common complications of breastfeeding including milk stasis, mastitis, and breast abscess. Also idiopathic granulomatous mastitis, a less common condition, is discussed due to its confusing characteristics and not universally-accepted treatment strategies .Breastfeeding mastitis is inflammation of the breast that can be infectious or non-infectious. With proper diagnosis and treatment of this condition, more severe complications like breast abscess could be avoided, so that breastfeeding could be continued in some circumstances.Benign cystic or solid lumps frequently occur in the breasts of young women, and consequently can also be seen during pregnancy and lactation. Simple cysts do not increase the risk of malignancy. The current management is routine follow-up. Complex cysts are thick walled or contain a mass, and should be followed by a US-guided biopsy and then treated similar to any non-gravid, non-lactating patient.Galactoceles can be detected during the last trimester of pregnancy and during or after stopping lactation. Aspiration can be done to confirm the content. Co-existence of galactocele and malignancy is extremely rare, and the key is to follow up until it resolves.Fibroadenoma is the most frequent lesion found during pregnancy and lactation. Management is usually conservative after triple assessment. Surgery is usually not recommended in pregnant and lactating women unless rapid increase in size occurs or there is discordance in the triple assessment.Lactating adenomas are sometimes interpreted as a variant of fibroadenoma .
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