Chapter 48: Breast Disorders

Three primary clinical presentations structure the discussion: mastalgia, which accounts for approximately ninety percent of benign complaints yet generates significant patient anxiety and requires age-appropriate imaging strategies; palpable masses, distinguished by their physical characteristics such as mobility and margin definition to differentiate benign from potentially malignant lesions; and nipple discharge, with specific concern for spontaneous, unilateral, or sanguinous presentations that warrant further investigation. Inflammatory breast disorders are examined through the lens of mastitis, subdivided into puerperal or lactational forms occurring in the early postpartum period, nonpuerperal variants, and periductal mastitis associated with duct dilation and tobacco use. Management emphasizes continued milk removal through breastfeeding or expression combined with empirical antibiotic therapy and supportive measures. The chapter provides comprehensive coverage of breast cancer as the second most common malignancy in women, detailing established risk factors including genetic mutations in tumor suppressor genes, reproductive history, and lifestyle factors. Pathophysiological classification distinguishes preinvasive lesions from infiltrating carcinomas, with emphasis on the systemic nature of disease at diagnosis due to potential occult metastatic spread. Current screening recommendations from major organizations are presented alongside diagnostic methodologies using biopsy confirmation and TNM staging systems. Treatment approaches are individualized based on tumor characteristics including hormone receptor status and growth factor expression, with options spanning surgical techniques, radiation, and systemic therapies including chemotherapy, endocrine manipulation, and targeted biological agents. The discussion of benign conditions such as fibrocystic changes, fibroadenomas, and intraductal papillomas provides differential diagnostic context. Advanced practice nurses are positioned as key providers in screening facilitation, early detection promotion, patient education regarding lifestyle modifications and breastfeeding support, and long-term survivorship care including management of treatment-related complications.