Snapshot A 13-year-old boy presents to his pediatrician due to noticing a lump under the nipple of his left chest. He reports mild pain when touched. There is no breast discharge or changes in the skin. On physical examination, pubic hair is Tanner stage IV and has a testicular volume of 9 mL bilaterally. Palpation of the left chest shows a 3.5 cm mass beneath the nipple. (Pubertal gynecomastia) Breast Abscess Clinical definition pus accumulation in breast tissue that can result from mastitis or cellulitis that does not respond to treatment Epidemiology incidence 0.4-11% in lactating mothers can also occur in non-lactating women Presentation symptoms localized pain of the breast malaise physical exam fever palpable mass that is fluctant and tender Treatment drainage of abscess antibiotic therapy empiric therapy should cover Staphylococcus aureus Mastalgia Clinical definition breast pain Etiology cyclical mastalgia typically diffuse and bilateral causes include physiologic pharmacologic hormonal agents noncyclical mastalgia typically unilateral causes include inflammatory breast cancer ductal ectasia mastitis/abscess Treatment symptomatic well-fitting brassiere warm compresses, cold packs, and massage medication acetaminophen nonsteroidal antiinflammatory drug (NSAID) danazol FDA approved for mastalgia Fat necrosis Clinical definition breast lesion that can be seen after breast trauma or surgical intervention can be confused for malignancy on physical exam and on mammography Management with any palpable mass, breast cancer must be excluded ultrasound (< 30 years old) or mammogram (> 30 years old) oil cysts or (later) calcified oil cysts if imaging suspicious or inconclusive fine needle aspiration oily fluid biopsy lipid-filled macrophages ("foamy macrophages"), fibrosis and inflammatory cells conservative treatment (observation and reassurance) excision only if symptomatic or disfiguring Mondor's Disease Clinical definition thrombophlebitis of the superficial veins of the anterior chest wall which be seen in complications after breast cancer surgery and breast augmentation malignancy Epidemiology incidence ~1% in patients after receiving breast cancer surgery and breast augmentation demographics mostly between 30-60 years of age more common in females than males (3:1) prognosis typically benign and a self-limiting disease Presentation physican exam cord-like thrombosed vein that can be tender or non-tender Treatment symptomatic management Male Gynecomastia Clinical definition a benign condition that results in glandular proliferation in the male breast caused by increased relative estrogen to androgen activity Etiology physiologic gynecomastia pseudogynecomastia due to obesity there is no glandular proliferation medications spironolactone ketoconazole cimetidine gonadotropin-releasing hormone (GnRH) agonists 5α-reductase inhibitors estrogens drugs of abuse alcohol marijuana heroin and methadone amphetamine idiopathic cirrhosis testicular malignancy