Advertisement

Breast Surgery in the Pregnant Patient

  • Meredith ReddenEmail author
  • Natalie Kessler
  • Amelia Donlan
Chapter

Abstract

The breast undergoes significant transformation during pregnancy, making surveillance and identification of changes challenging. A palpable breast mass persisting for greater than 2 weeks mandates further evaluation with clinical breast examination and ultrasonography. The common differential diagnosis includes gestational breast cancer, fibroadenoma, lactating adenoma, fibrocystic changes, or cyst. Breast ultrasound has demonstrated an excellent degree of accuracy in the evaluation of both benign and malignant pregnancy-associated breast masses. Ultrasound-guided incisional breast biopsy is safe during pregnancy and allows for pathologic evaluation of new or enlarging solid nodules. The treatment for gestational breast cancer follows the same NCCN guidelines established for nonpregnant breast cancer, with modifications to protect the developing fetus. The bilateral, rapid, enormous enlargement of the breasts raises suspicion for gestational gigantomastia, which can require surgical intervention, if life-threatening complications develop. Lactating adenomas, enlarging fibroadenomas and hamartomas, and breast infarcts are benign and can be treated with surveillance during the gestational period; elective surgical resection, if necessary, is delayed until the postpartum period.

Keywords

Pregnancy-associated breast cancer Gestational breast cancer Sentinel lymph node biopsy in the pregnant patient Breast-conserving surgery in the pregnant patient Gestational gigantomastia Lactating adenoma Breast infarcts Bloody nipple discharge Mammogram in pregnancy Ultrasound in pregnancy Ultrasound-guided incisional breast biopsy in pregnancy 

References

  1. 1.
    Woo JC, Yu T, Hurd TC. Breast cancer in pregnancy: a literature review. Breast cancer in pregnancy: a literature review. Arch Surg. 2003;138:91–8.CrossRefGoogle Scholar
  2. 2.
    Ahn BY, Kim HH, Moon WK, Pisano ED, Kim HS, Cha ES, et al. Pregnancy-and lactation-associated breast cancer: mammographic and sonographic findings. J Ultrasound Med. 2003;22:491–7.CrossRefGoogle Scholar
  3. 3.
    Robbins J, Jefferies D, Roubidoux M, Helvie M. Accuracy of diagnostic mammography and breast ultrasound during pregnancy and lactation. AJR. 2011;196:716–22.CrossRefGoogle Scholar
  4. 4.
    Liberman L, Giess CS, Dershaw DD, Deutch BM, Petrek JA. Imaging of pregnancy-associated breast cancer. Radiology. 1994;191:245–8.CrossRefGoogle Scholar
  5. 5.
    Yang WT, Dryden MJ, Gwyn K, Whitman GJ, Theriault R. Imaging of breast cancer diagnosed and treated with chemotherapy during pregnancy. Radiology. 2006;239:52–60.CrossRefGoogle Scholar
  6. 6.
    Vashi R, Hooley R, Bulter R, Geisel J, Philpotts L. Breast imaging of the pregnant and lactating patient: imaging modalities and pregnancy-associated breast cancer. AJR. 2013;200:321–8.CrossRefGoogle Scholar
  7. 7.
    Anderson JM. Mammary cancers and pregnancy. Br Med J. 1979;1:1124–7.CrossRefGoogle Scholar
  8. 8.
    Stensheim H, Moller B, van Dikj T, Fossa SD. Cause-specific survival for women diagnosed with cancer during pregnancy or lactation: a registry-based cohort study. J Clin Oncol. 2009;27:45.CrossRefGoogle Scholar
  9. 9.
    Ventura SJ. First births to older mothers, 1970-86. 1989 йил. Am J Public Health. 1989;79:1675.CrossRefGoogle Scholar
  10. 10.
    Nugent P, O'Connell TX. Breast cancer and pregnancy. Arch Surg. 1985;120:1221.CrossRefGoogle Scholar
  11. 11.
    Byrd BF Jr, Bayer DS, Robertson JC, Stephenson SE Jr. Treatment of breast tumors associated with pregnancy and lactation. Ann Surg. 1962;155:940.CrossRefGoogle Scholar
  12. 12.
    Mazze RI, Kallen B. Reproductive outcome after anesthesia and operation during pregnancy: a registry study of 5405 cases. Am J Obstet Gynecol. 1989;161:1178.CrossRefGoogle Scholar
  13. 13.
    Gianopoulos JG. Establishing the criteria for anesthesia and other precautions for surgery during pregnancy. Surg Clin North Am. 1995;75:33.CrossRefGoogle Scholar
  14. 14.
    Duncan PG, Pope WD, Cohen MM, Greer N. Fetal risk of anesthesia and surgery during pregnancy. Anesthesiology. 1986;64:790.CrossRefGoogle Scholar
  15. 15.
    Barron WM. The pregnant surgical patient: medical evaluation and management. Ann Intern Med. 1984;101:683.CrossRefGoogle Scholar
  16. 16.
    Petrek JA, Dukoff R, Rogatko A. Prognosis of pregnancy-associated breast cancer. Cancer. 1991;67:869–72.CrossRefGoogle Scholar
  17. 17.
    Berry DL, Theriault RL, Holmes FA, Parisi VM, Booser DJ, Singletary SE, et al. Management of breast cancer during pregnancy using a standardized protocol. J Clin Oncol. 1999;17:855–561.CrossRefGoogle Scholar
  18. 18.
    Meisel JL, Economy KE, Calvillo KZ, Schapira L, Tung NM, Gelber S, et al. Contemporary multidisciplinary treatment of pregnancy-associated breast cancer. Springerplus. 2013;2:297.CrossRefGoogle Scholar
  19. 19.
    Mondi MM, Cuenca RE, Ollila DW, Stewart JH 4th, Levine EA. Sentinel lymph node biopsy during pregnancy: initial clinical experience. Ann Surg Oncol. 2007;14:218.CrossRefGoogle Scholar
  20. 20.
    Khera SY, Kiluk JV, Hasson DM, Meade TL, Meyers MP, Dupont EL, et al. Pregnancy-associated breast cancer patients can safely undergo lymphatic mapping. Breast J. 2008;14:250.CrossRefGoogle Scholar
  21. 21.
    Gropper AB, Calvillo KZ, Dominici L, Troyan S, Rhei E, Economy KE, et al. Sentinel lymph node biopsy in pregnant women with breast cancer. Ann Surg Oncol. 2014;21(8):2506–11.CrossRefGoogle Scholar
  22. 22.
    Gentilini O, Cremonesi M, Toesca A, Colombo N, Peccatori F, Sironi R, et al. Sentinel lymph node biopsy in pregnant patients with breast cancer. Eur J Nucl Med Mol Imaging. 2010;37:78–83.CrossRefGoogle Scholar
  23. 23.
    Keleher A, Wendt R 3rd, Delpassand E, Stachowiak AM, Kuerer HM. The safety of lymphatic mapping in pregnant breast cancer patients using Tc-99m sulfur colloid. Breast J. 2004;10:492–5.CrossRefGoogle Scholar
  24. 24.
    Cullins SL, Pridjian G, Sutherland CM. Goldenhar’s syndrome associated with tamoxifen given to the mother during gestation. JAMA. 1994;271:1905–6.CrossRefGoogle Scholar
  25. 25.
    Agrawal N, Kriplani A, Gupta A, Bhatla N. Management of gigantomastia complicating pregnancy. A case report. J Reprod Med. 2002;47:871–4.Google Scholar
  26. 26.
    Rezai S, Nakagawa JT, Tedesco J, Chadee A, Gottimukkala S, Mercado R, et al. Gestational gigantomastia complicating pregnancy: a case report and review of the literature. Case Rep Obstet Gynecol. 2015;2015:892369.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Sumkin JH, Perrone AM, Harris KM, Nath ME, Amortegui AJ, Weinstein BJ. Lactating adenoma: US features and literature review. Radiology. 1998;206:271–4.CrossRefGoogle Scholar
  28. 28.
    Behrndt VS, Barbakoff D, Askin FB, Brem RF. Infarcted lactating adenoma presenting as a rapidly enlarging breast mass. Am J Roentgenol. 1999;173:933–5.CrossRefGoogle Scholar
  29. 29.
    Lafreniere R. Bloody nipple discharge during pregnancy: a rationale for conservative treatment. J Surg Oncol. 1990;43(4):226–30.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Meredith Redden
    • 1
    Email author
  • Natalie Kessler
    • 2
  • Amelia Donlan
    • 3
  1. 1.Northside HospitalAtlantaUSA
  2. 2.Sandy SpringsUSA
  3. 3.AthensUSA

Personalised recommendations