स्तनरोग/ Diseases of the Breasts

By:- Dr. Priyanka Gupta

Introduction

Breasts are the seat of all types of sothas , vranas
granthis and arbudas; etiopathogenesis, clinical
features and treatment of all these conditions is similar
as described for these diseases of any other body-part.
Though breast-abscesses are also similar to external
abscesses, yet, there is slight difference in the line of
treatment; probably due to this reason, in Suśruta
Samhitā, MādhavaNidāna and Bhawaprakāsa a disease
with the name of ‘Stanaroga’ is described.

Classification of breast disorders

यावत्यो गतयो यैश्च कारणैैः सम्भवन्तत हि । तावततैः
स्तनरोगाैः स्ययैः स्रीणाांतैरेव िेतयभभैः । । १५ । ।

पञ्चानामपप तेषाततयहित्वा शोणणतपवद्रधिम्। । २७ । ।
( स०य सां० नन० १० / १५ एवां २७ )

बाह्यपवद्रधिलक्षणैः । । २२ । । ( अ० सां० नन० ११ / २२ )

Classification of breast disorders

Sushruta	Vaghbhat
1. Vataja	1. Vataja
2. Pittaja	2. Pittaja
3. Kaphaja	3. Kaphaja
4. Sannipataja	4. Sannipataja
5. Abhighataja	5. Abhighataja
6.	6. Shonita

Etiopathogenesis

सक्षीरौ वाप्यदग्यि वा प्राप्य दोषैः स्तनौ न्स्रयाैः । रक्तांमाांसश्च सतदष्ूय स्तनरोगाय कल्पते। । । पञ्चानामपपतेषाततयहित्वा शोणणतपवद्रधिम्। लक्षणानन समानाननबाह्यपवद्रधिलक्षणैैः । । । (स०यसां०नन०१० / २६ , २७ ) ।

सिानपानेन यदा िारी वज्रांसमश्नयते। पच्यमानेन पाके नह्यनतनत्वातन पच्यते। । अपच्यमानांपवन्क्लतनांवाययनासमयदीररतम्। रसेन सि सांपक्ृ तांयानत स्ततयविाैः भसराैः । । सववस्रोताांभसहि स्रीणाांपववतृानन पवशेषतैः ।तत्पयोिरमासाद्य क्षक्षप्रांपवकयरुतेन्स्रयाैः । । (का○सां○सू○19/29)

Kashyapa says that when a wet nurse swallows the
vajra (piece of grass, straw, chaff of grains, bristle,
fly etc.) Then this vajra which is neither digested
nor metabolized, gets propelled by vayu along with
rasa, reaches to milk carrying channels. This
produces abnormality immediately.

General clinical feature of
stanakilaka

Clinical features of woman having ingested vajra are
Indigestion, Uneasiness, Languor, Anorexia, Severe
pain in joints, Body ache, headache, burning
sensation in eyes and retention of urine.
In breasts stiffness, discharges, inflammation, severe
pain and burning sensation are present, a net of
vessels present all around highly tenderness.

Specific clinical features of all
types of breast of abscesses

Specific clinical features of all types of breast of abscesses

Vataja stana vidradhi	Pittaja stana vidradhi	Kaphaja stana vidradhi
1. Krushna	1. Shyav vrana	1. Earthen plate
2. Aruna	2. Jwara include with daha	2. Yellowish white discharge
3. Parusa	3. Yellowish discharge	3. Cold in touch
5. unusual shape	5.	5. Has itching
7. Suppuration	7.	7.
8. After bursting thin discharge comes out	8.	8.

Principles of treatment of
stanaroga

(i) In case of stanaroga the treatment of vrana should be done
(ii) Even in the beginning of suppuration, poultice or sedation
not to be used(Yogarataskaro has advised use of poultice).
Suppuration should be enhanced by oral use appropriate drugs
or diet, because the poultice produces very quick putrefaction of
whole of breast tissue as these are composed of very soft
mamsa due to this putrefaction the abscess bursts
spontaneously.
(iii) Once suppuration of this abscess is established, the
instrumentation should be done protecting dugdhaharinadis
(calciferous ducts), areola and nipples.

Treatment of stanakilaka

(i) First of all ghrta should be given orally, with this unction,
the srotasas get softened, thus, vajra slips out or is expelled
(ii) Careful and methodical milking, massaging and
moistening should be done.
(iii) Cold irrigations and anointments should be used.
(iv) Purgation and congenial diet should be given.
(v) Giving due consideration to the status and strength of
doshas and body, drainage before suppuration and incision
after suppuration should be done.

Treatment of inflammation

(1) Prescribed anointment, massage, specially in
sequential order i.e. ist anointment then massage
should be softened by gentle rubbing. During stage
of inflammainn constant cold treat- ment (diet,
anointment and irrigation ete.) should be given. As
fire subsides by water, similarly and pain also
disappears heat of doshas subsides immediately by
use of anointments or cold treatment and pain also
disappears.

(ii) In inflammation, specially acute or hard,
discoloured and associated wih pain or with mild
pain and inflammation of ulcer specially caused due
to poisons, the venesection or application of leeches
should be done. Due to bloodletting of vitiated
blood, the inflammation, redness and pain subside
immediately, because blood is the cause of pain,
besides, suppuration also does not occur.

Diseases of the breasts

1. Mastitis
2. Breast abscess
3. Galactocele

Mastitis

• A painful infection of the breast tissue.
• Possible causes are a blocked milk duct or bacteria
entering the breast. It usually occurs within the first
three months of breast-feeding.

Management

For simple mastitis without an abscess, oral
antibiotics are prescribed. Cephalexin (Keflex) and
dicloxacillin (Dycill) are two chosen
Surgery for an abscess if needed

Galactocele

A galactocele (also called lacteal cyst or milk cyst) is a
retention cyst containing milk or a milky substance
that is usually located in the mammary glands. They
can occur in women during or shortly after lactation

• They present as a firm mass, often subareolar, and
are caused by the obstruction of a calciferous duct.
Clinically, they appear similar to a cyst on
examination. The duct becomes more distended
over time by epithelial cells and milk. It may rarely
be complicated by a secondary infection and result
in abscess formation. These cysts may rupture
leading to formation of inflammatory reaction and
may mimic malignancy.

Management

• Once lactation has ended the cyst should resolve
on its own without intervention. A galactocele is
not normally infected as the milk within is sterile
and has no outlet through which to become
contaminated. Treatment is by aspiration of the
contents or by excision of the cyst. Antibiotics are
given to prevent infection.