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  • • Types of lesions include:

    • -Mammary dysplasia (fibrocystic disease)

      -Fibroadenoma of the breast

      -Intraductal papilloma

      -Fat necrosis and mastitis

      -Breast abscess

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Epidemiology

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  • • Fibrocystic disease is most frequent lesion of the breast; common from 30 to 50 years of age but rare after menopause

    • Fibroadenoma occurs more frequently in blacks than whites

    • Only 50% of patients with fat necrosis report antecedent trauma

    • Subareolar abscess can develop spontaneously in young or middle-aged women who are not lactating

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Symptoms and Signs

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Fibrocystic Disease

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  • • Painful, multiple, bilateral masses

    • Rapid fluctuation in mass size

    • Symptoms increase during premenstrual phase of cycle

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Fibroadenoma

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  • • Round, firm, discrete, mobile mass

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Intraductal Papilloma

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  • • Unilateral bloody nipple discharge

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Fat Necrosis

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  • • Mass with associated skin or nipple retraction; tenderness and ecchymosis occasionally seen

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Mastitis/Breast Abscess

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  • • Area of erythema, tenderness, and induration

    • Localized mass

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Imaging Findings

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  • • Mammography often unreliable due to dense breast parenchyma in this age group

    • US can distinguish solid from cyctic mass

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  • • Nursing can continue with mastitis but should be discontinued with breast abscess

    • Most common causative pathogen in mastitis and breast abscesses is Staphylococcus

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Rule Out

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  • • Breast carcinoma

    • Inflammatory breast carcinoma (when signs of breast abscess in the nonlactating breast)

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  • • Complete history (including family and reproductive) and physical exam

    • Mammography or US

    • Biopsy if any possibility of cancer

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Surgery

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Indications

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  • • Persistent dominant mass; mass after cyst aspiration

    • Suspicious cytologic studies or biopsy results

    • Fibroadenoma (excisional biopsy)

    • Intraductal papilloma (total excision through circumareolar incision)

    • Fat necrosis

    • Subareolar abscess in the nonlactating breast

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Medications

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  • Danazol: Synthetic androgen; can reduce pain

    • Symptomatic relief with vitamin E and with discontinuation of caffeine

    • Antibiotics for mastitis/abscess

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Treatment Monitoring

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  • • Self breast exams

    • Annual clinical breast exams

    • Annual bilateral mammogram

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Prognosis

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  • • Excellent

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References

Guray M et al: Benign breast diseases: classification, diagnosis, and management. Oncologist 2006;11:435.  [PubMed: 16720843]
Mannello F et al: Human gross cyst breast disease and cystic fluid: bio-molecular, morphological, and clinical studies. Breast Cancer Res Treat 2006;97:115.  [PubMed: 16331347]
Qureshi S et al: Topical nonsteroidal anti-inflammatory drugs versus oil of evening primrose in the treatment of mastalgia. Surgeon 2005;3:7.  [PubMed: 15789786]
Rosolowich V et al. Mastalgia. J Obstet Gynaecol Can 2006;28:49.  [PubMed: 16533457]

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