1. BREAST LUMPS IN PREGNANCY
Prof. M.C.Bansal
MBBS.,MS. FICOG. MICOG.
Ex Principal & controller
Jhalawar Medical College and Hospital. Jhalawar
MGMC7Hospital Sitapura Jaipur

2. Physiological changes in Breast
in Pregnancy
 Breast lobules becoming more prominent.
 Enlarged Montgomery’s tubercles.
 Thickening and enlargement of an area of the
breast.
 Accessory breast tissue in axilla is a common
anatomical anomaly. It may cause little
discomfort and may be perceived as a serious
problem by some patients.
 Both breast may be of unequal size.

3. Differential Diagnosis Of Breast
Lump In Pregnancy
 Due to increased “breast awareness” now days
women are much worried about any breast lump
noticed By themselves on routine self breast
examination . It has lead to cancer phobia on
one side but early detection of breast cancer on
the other hand.
 Pregnant women may become more conscious
of their breast and may present with some
changes in pre existing lesions like
Lipomas,Sebaceous cyst , Neurofibromas
,fibroadenoma or haemangiomas.

4. Differential Diagnosis of Breast
Lump In Pregnancy
 Physiological.
 Prominent breast lobule
 Montgomery’s tubercle.
 Accessory breast tail.
 Lipoma.
 Sebaceous cysts.
 Neuro fibroma.
 Haemangioma.
 Intra mammary lymphnode.
 Fibroadenoma.
 Cyst
 Lactating nodule
 Galactocoele
 Mastitis / abscess.
 Cancer.

16. Fibrocystic disease of breast
 It does not occur in pregnancy.
 It has been labeled as ‘Benign breast change
syndrome’ , symptoms of which include cyclic
pain and thickening of breast tissue particularly
in upper outer quadrant . Biopsy reveals it as
fibrocystic disease due to cyclic proliferative
features and sclerotic features that are
perceived to be the basis of mild inflammation.
 It requires only assurance to patient.

17. Fibro adenoma
 Common benign lump in breast . More common
in 2nd and 4th decade of life.
 They are rubbery in consistency ,irregular or
boss elated surface and move freely mobile
‘wandering mouse in breast’
 Initially they enlarge over a period of months
and then remain unchanged even for years. In
late age they shrink and calcification at certain
area.
 In pregnancy They may enlarge to cause concern
, or infarct .Infarct may require a surgical
excision.

18. Lactating Nodule
Commonly known as ad enosis of pregnancy different
from fibrocystic disease of non pregnant women .
All breast tissues under go marked proliferation
during pregnancy and many women may note one
particular area to be more thickened than the rest.
Presence of an asymmetrical swelling or well
defined lump need imaging /biopsy.
Imaging may define it as a solid lump but of similar
ecumenicity while the pathologist may describe as
norme4al tissue of pregnancy .As other type of
benign lesions seen in pregnancy ,it also resolve to
excision biopsy which should be avoided.

19. Cyst And Galactocoele
 A simple breast cyst may be large compared to the
multiple tint cysts of fibrocystic disease.
 It may present as a lump of sudden on set.
 They are often found multiple when scanned.
 Most common in thirties., the child bearing decade in
present era.
 They are more common in non pregnant women as
compared to pregnant ones ., as it is due to
degenerative changes, while breast under goes
proliferative changes in pregnancy.
 Galactocoeles are more common in pregnancy and
present as spherical shape with smooth surface .
 Diagnosis , for both , is confirmed by FNAC.

20. Breast Abscess
 More common in lactating woman than the
pregnant one.
 Localized pain, tenderness and hot and redness of
the overlying skin.
 The main difficulty is in differentiating an abscess
from mastitis , the former is associated with
throbbing pain and fluctuation may be elicited.
 Broad spectrum antibiotic , Nsaids, local hot
fomentation, Sumac dressing will give relief in cases
of mastitis while abscess requires incision and
drainage.

21. Carcinoma Breast
Irregular hard lump with presence of induration, which may be freely
mobile or fixed and painless. Painful lump is to be differentiated
from acute mastitis.
Examination of both the breasts and axilla is mandatory followed by
FNAC.
One should refer such case to the oncologist , if following criteria's are
full filled—
1.Asymmetry of breasts.
2. A subtle dimpling of skin.
3. Apparent inflammation but without the commensurate tenderness.
4. Nipple retraction.
5. An ill-defined lump.
6. pureed-orange skin.
7. felicity.
Useful website– www.breascancercare.org

22. Carcinoma breast
 This is a disastrous diagnosis for any young women
but in pregnancy it is doubly difficult.
 If diagnosed in early stage of disease and confirmed
by immediate scanning and biopsy, management of
cancer breast in pregnancy is similar to that in case
of non pregnant state.
 Pregnancy to be managed , depending on
gestational age ,obstetric history, no of living
children and willingness to have this baby or not.
 It has been reported that prognosis is same as that
of non pregnant women having same stage of
cancer breast.