Ultrasound findings of the physiological changes and most common breast diseases during pregnancy and lactation

Because of the physiological changes that occur during pregnancy and lactation, diagnostic ultrasound of the breast during these periods is a challenge for physicians. Therefore, a comprehensive understanding of imaging, anatomy, and physiology of the breast is important to effectively diagnosing diseases that can arise in women who are pregnancy or lactating. The aim of this article was to review the physiological changes that occur in the breasts during pregnancy and lactation, as well as to describe the main features of the breast diseases that occur most frequently during these periods.

Keywords:
Pregnancy; Lactation; Breast; Ultrasonography

Authorship

Antônio Arildo Reginaldo de Holanda

MSc, Doctoral Student in the Graduate Program in Health Sciences at the Universidade Federal do Rio Grande do Norte (UFRN), Physician at the Maternidade Escola Januário Cicco, Natal, RN, BrazilUniversidade Federal do Rio Grande do NorteBrazilNatal, RN, BrazilMSc, Doctoral Student in the Graduate Program in Health Sciences at the Universidade Federal do Rio Grande do Norte (UFRN), Physician at the Maternidade Escola Januário Cicco, Natal, RN, Brazil

Ana Katherine da Silveira Gonçalves

PhD, Associate Professor in the Department of Obstetrics and Gynecology at the Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, BrazilUniversidade Federal do Rio Grande do NorteBrazilNatal, RN, BrazilPhD, Associate Professor in the Department of Obstetrics and Gynecology at the Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil

Robinson Dias de Medeiros

PhD, Adjunct Professor in the Department of Obstetrics and Gynecology at the Universidade Federal do Rio Grande do Norte (UFRN), Physician at the Maternidade Escola Januário Cicco, Natal, RN, BrazilUniversidade Federal do Rio Grande do NorteBrazilNatal, RN, BrazilPhD, Adjunct Professor in the Department of Obstetrics and Gynecology at the Universidade Federal do Rio Grande do Norte (UFRN), Physician at the Maternidade Escola Januário Cicco, Natal, RN, Brazil

António Manuel Gouveia de Oliveira

PhD, Visiting Professor at the Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, BrazilUniversidade Federal do Rio Grande do NorteBrazilNatal, RN, BrazilPhD, Visiting Professor at the Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil

Técia Maria de Oliveira Maranhão

PhD, Full Professor in the Department of Obstetrics and Gynecology at the Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, BrazilUniversidade Federal do Rio Grande do NorteBrazilNatal, RN, BrazilPhD, Full Professor in the Department of Obstetrics and Gynecology at the Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil

Mailing address: Dr. Antônio Arildo Reginaldo de Holanda, Rua Joaquim Câmara, 226, ap. 201, Tirol, Natal, RN, Brasil, 59015-270. E-mail: arildoholanda@ufrnet.br

SCIMAGO INSTITUTIONS RANKINGS

Figures

Figures (10)

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Figure 1
A: Breast in the first trimester of pregnancy: predominantly hypoechoic breast parenchyma, showing dilatation of the milk ducts. B: Breast in the second trimester of pregnancy: breast parenchyma showing greater echogenicity and more pronounced ductal dilatation than in the first trimester. C: Breast in the third trimester of pregnancy: breast parenchyma showing considerably greater echogenicity and extremely more pronounced ductal dilatation in comparison with the second trimester.

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Figure 2
Breast during lactation. Diffusely hyperechoic breast parenchyma, with ductal dilatation due to the accumulation of milk.

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Figure 3
Puerperal mastitis. Amorphous areas of variable echogenicity, predominantly hypoechoic and heterogeneous, diffusely distributed throughout the breast parenchyma, with poorly defined borders.

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Figure 4
Abscess. A: Amorphous, unilocular complex lesion, with ill-defined borders, parallel to the skin, heterogeneous, with variable echogenicity, that is predominantly hypoechoic, with discrete posterior acoustic enhancement, corresponding to an abscess with a fluctuant area. B: Ovoid lesion, with well-defined borders, parallel to the skin, hypoechoic, homogeneous, featuring discrete posterior acoustic enhancement, corresponding to abscess formation.

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Figure 5
Benign reactive lymph node. Ovoid nodule, parallel to the skin, with well-defined, hypoechoic borders, and a hyperechoic halo, corresponding to a benign lymph node.

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Figure 6
Granulomatous mastitis. Amorphous formation, not parallel to the skin, with ill-defined, hypoechoic borders.

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Figure 7
Galactocele. A: Lesion, parallel to the skin, with well-defined borders, showing anechoic (cystic) and echogenic (solid) components, with discrete posterior acoustic enhancement and well-defined borders. B: Predominantly hypoechoic lesion, parallel to the skin, with welldefined borders, peripheral areas of hyperechogenicity, and posterior acoustic enhancement.

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Figure 8
Lactating adenoma. Ovoid nodule, parallel to the skin, with a heterogeneous, hypoechoic pattern and well-defined borders.

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Figure 9
Fibroadenoma. Ovoid nodule, parallel to the skin, with a homogeneous, hypoechoic pattern, well-defined borders, and discrete posterior acoustic enhancement.

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Figure 10
Pregnancy-associated breast cancer. A: Amorphous formation, parallel to the skin, with variable echogenicity (predominantly hypoechoic), a heterogeneous texture, discrete acoustic enhancement and poorly defined borders. B: Irregular, hypoechoic, heterogeneous nodule, parallel to the skin, featuring discrete acoustic shadowing and poorly defined borders.

Figure 1 A: Breast in the first trimester of pregnancy: predominantly hypoechoic breast parenchyma, showing dilatation of the milk ducts. B: Breast in the second trimester of pregnancy: breast parenchyma showing greater echogenicity and more pronounced ductal dilatation than in the first trimester. C: Breast in the third trimester of pregnancy: breast parenchyma showing considerably greater echogenicity and extremely more pronounced ductal dilatation in comparison with the second trimester.

Figure 2 Breast during lactation. Diffusely hyperechoic breast parenchyma, with ductal dilatation due to the accumulation of milk.

Figure 3 Puerperal mastitis. Amorphous areas of variable echogenicity, predominantly hypoechoic and heterogeneous, diffusely distributed throughout the breast parenchyma, with poorly defined borders.

Figure 4 Abscess. A: Amorphous, unilocular complex lesion, with ill-defined borders, parallel to the skin, heterogeneous, with variable echogenicity, that is predominantly hypoechoic, with discrete posterior acoustic enhancement, corresponding to an abscess with a fluctuant area. B: Ovoid lesion, with well-defined borders, parallel to the skin, hypoechoic, homogeneous, featuring discrete posterior acoustic enhancement, corresponding to abscess formation.

Figure 5 Benign reactive lymph node. Ovoid nodule, parallel to the skin, with well-defined, hypoechoic borders, and a hyperechoic halo, corresponding to a benign lymph node.

Figure 6 Granulomatous mastitis. Amorphous formation, not parallel to the skin, with ill-defined, hypoechoic borders.

Figure 7 Galactocele. A: Lesion, parallel to the skin, with well-defined borders, showing anechoic (cystic) and echogenic (solid) components, with discrete posterior acoustic enhancement and well-defined borders. B: Predominantly hypoechoic lesion, parallel to the skin, with welldefined borders, peripheral areas of hyperechogenicity, and posterior acoustic enhancement.

Figure 8 Lactating adenoma. Ovoid nodule, parallel to the skin, with a heterogeneous, hypoechoic pattern and well-defined borders.

Figure 9 Fibroadenoma. Ovoid nodule, parallel to the skin, with a homogeneous, hypoechoic pattern, well-defined borders, and discrete posterior acoustic enhancement.

Figure 10 Pregnancy-associated breast cancer. A: Amorphous formation, parallel to the skin, with variable echogenicity (predominantly hypoechoic), a heterogeneous texture, discrete acoustic enhancement and poorly defined borders. B: Irregular, hypoechoic, heterogeneous nodule, parallel to the skin, featuring discrete acoustic shadowing and poorly defined borders.

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