This document provides an outline and overview of benign breast disorders and diseases. It discusses the anatomy and investigations of the breast, including mammography, ultrasound, MRI, and biopsy techniques. It covers various anatomical anomalies, injuries, and infections that can occur in the breast. It also examines benign breast disease, cysts, nipple disorders, and benign neoplasms. Key points include classifications of benign breast disorders, their presentations, pathological features, and treatment approaches.

1. BENIGN BREAST
DISORDERS
DR. MINHAJUDDIN KHURRAM

2. OUTLINE
 Anatomy (in brief)
 Investigations
 Anamolies
 Injury to breast
 Infections
 Benign breast disease
 Benign Neoplasms
 Breast cysts
 Nipple

3. ANATOMY

4. ANATOMY

5. ANATOMY

6. ANATOMY

7. ANATOMY

8. INVESTIGATIONS
 Mammography
 Ultrasound
 MRI
 Needle biopsy/ cytology
 Large-needle with vacuum system
 Triple assessment

9. INVESTIGATIONS
 Mammography
 Direct radiograph
 Exposure to low-voltage, high amperage Xrays
 Exposure of 0.1 cGy (very low)
 Sensitivity increases with age
 Normal mammograph does not exclude carcinoma

10. INVESTIGATIONS
 Ultrasound:
 USG more useful in young women : as breast is more dense
 Mammographs are difficult to interpret
 Distinguish cysts from solid lesions
 Locate impalpable lumps
 Diagnosis of axillary pathology
 USG guided aspiration and biopsy

11. INVESTIGATIONS
 MRI
 Distinguish scar from recurrence for women with previous surgeries
 Becoming the standard when lobular ca is diagnosed
 To assess the multicentricity and multifocality
 Best imaging modality for women with implants
 Less useful in axilla pathology
 Biopsy possible but difficult than USG guided

12. INVESTIGATIONS
 Needle biopsy / cytology
 To obtain histology under local ansthesia
 Spring loaded core needle biosy using 21G or 23G 10 ml syringe
 Multiple passes with negative suction
 Fixed or dried to view under microscope
 Least invasive technique of obtaining a cell diagnosis
 Receptor staining is possible
 False negetives: cannot differentiate invasive carcinoma from in situ
 Large-needle biopsy
 Less sampling error
 Using 8G or 11G
 More helping in calcifications

13. INVESTIGATIONS
 Triple Assessment
 Clinical diagnosis
 Imaging
 Tissue diagnosis
 Accuracy of 99.99%

14. ANAMOLIES
 Amazia:
 Athelia
 Polymazia
 Polythelia
 Micro-mastia
 Diffuse Hypertrophy
 Gynacomastia

15. ANAMOLIES
 Amazia:
 Congenital absence of breast (unilateral/ bilateral)
 More common in males
 Poland’s syndrome*
 Athelia
 Congenital absence of nipple

16. ANAMOLIES
 Polymazia
 Accessory breast tissue
 Along the “MILK LINE”
 Axilla is the commonest site
 Other sites: groin, thigh and buttocks*
 They function during lactation
 Treatment is excision
 Polythelia
 Multiple nipples along the “MILK LINE”

17. ANAMOLIES
 Micromastia: due to hypo-functioning ovary (congenital defect); breasts
are smaller
 Diffuse Hypertrophy (Benign virginal hypertrophy)
 Occurs sporadically in otherwise normal female
 At puberty or first pregnancy
 Enormous size (may reach upto knees when sitting)
 Rarely unilateral
 Pathophysiology unknown
 Some response to anti-oestrogen drugs*
 Plastic surgical repair is the only definitive treatment

18. ANAMOLIES
 Gynacomastia
 Breast-like swelling in males*
 The breast is enlarged, not the nipple and areola
 Unilateral/ bilateral
 Mostly Physiological
 Oestradiol excess
 Testosterone deficiency

19. ANAMOLIES
 Gynacomastia
 Pathophysiology
 Oestrogen excess: may result from an increase of oestradiol from
 Testicular tumors
 Leydig cell / Sartoli cell tumour
 Choriocarcinoma
 Embryonal carcinoma
 Non testicular tumors
 Adrenal cortical neoplasm
 Lung carcinoma
 Hepatocellular carcinoma
 Endocrine disorders
 Hyperthyroidism
 Hypothyroidism
 Liver cirhosis

20. ANAMOLIES
 Gynacomastia
 Pathophysiology
 Androgen deficiency states
 Aging
 Kline-felter syndrome
 Congenital anorchia
 Heriditary defect in androgen biosynthesis
 ACTH deficiency
 Renal Failure
 Secondary Testicular fauilure
 Trauma
 Orchitis
 Crytochordism
 Irridiation
 Varicocoele

21. ANAMOLIES
 Gynacomastia
 Pathophysiology
 Drugs
 Oestrogen realted activity activity (Digitalis, Anabolic steroids)
 Anti-testosterone ( cemitidine, phenytoin, spironolactone, diazepam)
 Enhancing oestrogen activity (reserpine, theophylline, frusemide)
 Pathology
 Breast show fibro-fatty proliferation rather than acinar growth!!

22. ANAMOLIES
 Gynacomastia
 Clinical features
 No complaints other than enlargement of breast
 May be associated with slight pain
 Breast tissue can be moved over the underlying muscle
 Serious psychological consequences
 Can be associated with various pathologies

23. ANAMOLIES
 Gynacomastia
 Treatment
 Idiopathic gynacomastia resolves by itself so “wait and waitch”
 Androgen deficiency: administer testosterone
 Danazol, tamoxifene
 No cause elicited: surgical excision by sub-areolar mastectomy
 In case of suspected pathology: HPR should be sent for

24. INJURY TO BREAST
 Haematoma:
 Resolving haematoma gives impression of a lump
 In the absence of an overlying bruise, diagnosis is difficult unless biopsied
 Traumatic Fat Necrosis:
 May be acute or chronic
 Some sort of injury: Direct or Indirect
 Diagnosis is confused with ca.
 Prsents as a painless lump, firm and irregular
 Some skin tethering
 No retraction of nipple may be present)
 No axillary lymph nodes
 History of trauma*

25. INJURY TO BREAST
 Traumatic Fat Necrosis:
 Pathophysiology
 Trauma  Focal necrosis of fat Inflammatory reaction  subsequent scarring to give
rise to a focus of firmer consistency
 Chronic cases mimic new lumps
 Treatment:
 Whenever in doubt excisional biopsy should be done

26. INFECTIONS
 Acute Inflammatory Mastitis
 Chronic Inflammatory Mastitis
 Sub-areolar abscess
 Duct ectesia / periductal mastitis
 Mastitis of infants
 Retromammary abscess
 Tuberculosis
 Syphilis
 Mondor’s Disease

27. INFECTIONS
 Acute Inflammatory Mastitis
 Aetiology
 Acute bacterial mastitis is very common: associated with lactation
 Develepment of cracks and bruises in the nipple: ascending infection
 Staph aureus infection, penicillin resistant if nosocomial*
 Streptococcus cuases more toxic symptoms
 Blockage of one or more of the lactiferous ducts with epithelial debris*
 Retracted nipple*

28. INFECTIONS
 Acute Inflammatory Mastitis
 Clinical features
 Acute mastitis
 Redness, oedema, induration
 Cellulitis  Abscess
 Redness, oedema and induration are somewhat localized
 Fluctuation is very difficult to elicit

29. INFECTIONS
 Acute Inflammatory Mastitis
 Treatment:
 Cellulitis stage: breast support + local heat + analgesia + antibiotics
 Feeding from the affected site can be continued if patient can manage
 Absces stage: whenever pus has formed, it has to be let out
 Antibiotics at this stage will lead to the formation of Antibioma*
 Incision and drainage to be done*
 Latest view: Repeated aspirations have the same result
 Can be accomplished with USG guidance
 No scar and patient can breast feed

30. INFECTIONS
 Acute Inflammatory Mastitis
 Treatment:
 Incision and drainage: needed only if there is marked skin thinning
 Radial incision in the most prominent part
 Counter-incision if it is not the dependent part
 Break all loculi
 Pack loosely with gauze, drain may be kept
 Give firm support.

31. INFECTIONS
 Chronic Inflammatory Mastitis
 Continuous antibiotic treatment
 Improper drainage of the abscess
 Too tight packing of the abscess cavity
 Has thick fibrous cavity
 May have sterile pus
 May mimic carcinoma
 Incision of the cavity wall and curettage of the walls

32. INFECTIONS
 Sub-areolar abscess
 Not a true mastitis
 Results from an infected sebaceous gland of Montogomery of areola
 Or follow a furuncle near the areola
 Incision and drainage of pus OR excision of the sebaceous cyst

33. INFECTIONS
 Sub-areolar abscess/ Periductal mastitis/ Duct ectesia/ Plasma cell mastitis
 More common in smokers
 Develops behind the nipple pointing towards the areola; avoiding the tough
fibromuscular tissue of the areola
 Dilatation of the larger peri-areolar ducts
 Usually 6-8 ducts are involved, rest are normal
 May be bilateral
 Condition may mimic carcinoma with an indurated mass beneath the areola

34. INFECTIONS
 Sub-areolar abscess/ Periductal mastitis/ Duct ectesia/ Plasma cell mastitis

35. INFECTIONS
 Sub-areolar abscess/ Periductal mastitis/ Duct ectesia/ Plasma cell mastitis
 Duct dilatation theories:
 Hormonally induced muscular relaxation of duct wall
 Inadequate absorption of secretions
 Obstruction of duct with squamous debris (but how bilateral?)
 Smoking  arteriopathy  periductal inflammation  damage to the duct wall 
duct dilatation  stasis  infection or healing by fibrosis*.
 Cessation of smoking prolongs the long term survival.

36. INFECTIONS
 Sub-areolar abscess/ Periductal mastitis/ Duct ectesia/ Plasma cell mastitis
 Clinical features
 Mostly seen after menopause
 Diffuse lump in the sub-areolar region
 Differentiate with ca.
 Nipple retraction (slit like)
 Nipple discharge
 Clasically it is thick and creamy / but may be greenish
 Bloody discharge at times
 Chronic milk fistula (on and off with abscess)
 No adenopathy

37. INFECTIONS
 Sub-areolar abscess/ Periductal mastitis/ Duct ectesia/ Plasma cell mastitis
 Treatment:
 Exclude malignancy by mammography
 If unsure: excision of the mass
 Antibiotics
 Fistula; fistulectomy with excision of the involved duct
 Recurrent plasma cell mastitis : Hadfield’s operation
 Remove all the terminal ducts*

38. INFECTIONS
 Mastitis of infants
 Drop of colourless fluid can be expressed on the third day of life
 Witch’s milk
 Seen only in full-term infants
 Cause: Stimulation by prolactin from the mother’s milk

39. INFECTIONS
 Retromammary abscess:
 This conditionis nothing to do with breasts
 Infection arises from
 Infected haematoma
 Tuberculosis of the ribs
 Osteomyletis of the ribs
 Incision and drainage by Guillard Thomas incision  breast lifted and chest wall
drained corrugated rubber drain kept dressing done.
 Appropriate antibiotics

40. INFECTIONS
 Tuberculosis of Breast
 Usually secondary to:
 Pulmonary tuberculosis
 Chest wall tuberculosis
 Cervical lymph node tuberculosis
 Mediastenal tuberculous lymphadenitis
 Blood borne
 Clinical features:
 Parous women mostly
 Primary focus somewhere else in the body
 Multiple chronic abscesses with bluish hue

41. INFECTIONS
 Tuberculosis of Breast
 Clinical features:
 Cold abscess: no or very little signs of inflammation
 Discharging sinuses, may be multiple
 Anti-tubercular therapy
 Mastectomy only with persistent residual infection

42. INFECTIONS
 Syphilis:
 All three stages can be seen in breast
 Primary: Primary chancre seen on the nipple
 Secondary: Mucous patches in the sub-mammary folds; with diffuse mastitis
 Diffuse Syphilitic Mastitis)
 Tertiary: Gumma (very rare)

43. INFECTIONS
 Mondor’s disease
 Superficial thrombophlebitis of the superficial veins
 No known cause
 Not encountered in arm
 Clinical feature:
 Thrombosed sub-cutaneous chord, usually attached to the skin
 May be painful and tender
 When arm is raised; a groove alongside the vein is seen
 Treatment: Rest to the arm and firm support to the breast*
 D/D: lymphatic permeation of occult malignancy to be ruled out

44. BENIGN BREAST DISEASE (ANDI)
 Concept:
 Breast in in dynamic change throughout reproductive life
 Super-imposed by menstrual cycles and pregnancies
 Concept of ANDI was first given by L.E. Hughes et.al of Cardiff University (1987)
 This concept recognizes conditions as being within a spectrum from normal to
mild abnormalities to disease process.

45. BENIGN BREAST DISEASE (ANDI)

46. BENIGN BREAST DISEASE (ANDI)
 Pathology:
 The disease consists centrally of four features:
 Cyst formation
 Fibrosis
 Hyperplasia
 Papillomatosis

47. BENIGN BREAST DISEASE (ANDI)
 Pathology:
 Cyst formation: Two types of cysts are found
 Simple cysts: Formed due to passive diffusion of plasma through simple membrane to
cause cyst
 Aspirate from simple cysts are similar to plasma in Na:K ratio
 These are single and do not recur with no risk of malignancy
 Complex cysts: Lined by apocrine epithelium cahractereised by large columnar cells
like those in sweat glands
 These cysts arise from a single lobule.*
 The solitary draining duct is blocked and cysts become very large
 Multiple cysts: but all may not be palpable

48. BENIGN BREAST DISEASE (ANDI)
 Pathology:
 Complex cysts:
 Complex cysts tend to recur
 May be associated with malignancy
 Classic diffuse cystic disease :Schimmelbusch’s Disease
 One large cyst becomes tense and blue domed: “Blue-domed cyst of Bloodgood”
 Cysts usually contain greyish green desquamated cells
 Cysts may contain blood due to haemorrhage

49. BENIGN BREAST DISEASE (ANDI)
 Pathology:
 Fibrosis: Fat and elastic tissue is replaced by white fibrous tissue
 Interstitium is infiltrated with chronic inflammatore cells
 This fibrous tissue compresses the ducts and distorts the acinar patterns.
 Hyperplasia: Hyperplasia of epithelium of ducts and acini
 Hyperplasia of both glandular and connective tissue
 Ductal lumen may get full of cells
 Can be a pre-malignant condition if epitheliosis is more
 Papillomatosis: Hyperplasia may be extensive enough to cause papillomatous
growth within the ducts

50. BENIGN BREAST DISEASE (ANDI)
 Clinical feature:
 A benign discrete lump in the breast is commonly a cyst or fibroadenoma
 Lumpiness : described by patient as heaviness in the upper outer quadrant
 Mastalgia:
 Cyclical mastalgia with nodularity (fibrocystic disease)
 Non-cyclical mastalgia

51. BENIGN BREAST DISEASE (ANDI)
 Fibrocystic disease / Cyclical mastalgia with nodularity /Fibroadenosis
 Aetiology: It is an Aberration in normal involution (ANI) of breast
 Hyper-oestrogenism
 Increased estrogen OR
 Decreased progesterone
 Exessive caffeine
 Inadequate essential fatty acids
 Pathology:
 Cyst formation
 Fibrosis
 Hyperplasia
 Papillomatosis

52. BENIGN BREAST DISEASE (ANDI)
 Fibrocystic disease / Cyclical mastalgia with nodularity /Fibroadenosis
 Clinical feature:
 Cyclical mastalgia: breast pain has a definitive relation to the menstrual cycle
 40% of the patients present with cyclical mastalgia in breast clinic
 Discomfort lasts for a varying period of time (for months) then disappears, to relapse again
after years
 Pain is mostly located in the upper-outer quadrant
 May radiate to axilla, chest wall or side of the arms
 No mammographic findings

53. BENIGN BREAST DISEASE (ANDI)
 Fibrocystic disease / Cyclical mastalgia with nodularity /Fibroadenosis
 Clinical feature:
 Lumps or lumpiness: The next mode of presentation
 Upper-outer quadrant
 Just before menstruation both lump and pain increase with tenderness
 On examination:
 Nodular lesion with lumps, lumps are inseparable
 Best palpated between thumb and fingers
 Easily movable lumps, not adherent
 No axillary lymph nodes enlarged
 No retraction of nipple

54. BENIGN BREAST DISEASE (ANDI)
 Fibrocystic disease / Cyclical mastalgia with nodularity /Fibroadenosis
 Management of cyclical mastalgia
 Breast pain monthly diary
 Re-assurance
 Breast support
 Evening primrose oil
 Danazol
 Bromocriptine
 Tamoxifene
 MedroxyProgesterone
 Oral contraceptives
 Avoid conception for three months when using bromocriptine and danazol

55. BENIGN BREAST DISEASE (ANDI)
 Fibrocystic disease / Cyclical mastalgia with nodularity /Fibroadenosis
 Management of lumpy breast
 In case of no discrete lump (supported by mammography)
 Reassurance
 Ask the patient to come in different phase of cycle*
 In case of lumps
 Mammography and USG to exclude other conditions
 Biopsy from a single or multiple lumps

56. BENIGN BREAST DISEASE (ANDI)
 Fibrocystic disease / Cyclical mastalgia with nodularity /Fibroadenosis
 Management of lumpy breast
 Surgical management:
 Indications:
 Intolerable pain
 Lump inspite of best conservative management
 Presence of concomitant malignancy cannot be excluded
 Older patients causing anxiety
 Excision biopsy by circumareolar incision
 If not possible then sub-mammary of Gaillard Thomas
 In case of failure then radial or curved incision over Langer’s line

57. BENIGN BREAST DISEASE (ANDI)
 Sclerosing adenosis:
 It is an AND of normal breast
 Characterised by terminal duct and myo-epithelial proliferation
 Distorted glandular proliferation: loss of normal lobular architecture
 May be multifocal
 May calcify: mimics carcinoma
 Causes mastalgia :perineural invasion causing “trigger spot zones”
 Causes mastalgia rather than lump
 Lump: smooth relative mobile mass
 Treatment: Reassurance and management of mastalgia

58. NON-CYCLICAL MASTALGIA
 Cyclical nodularity:
 Mass rather than pain, being the chief complaint
 Teenagers mostly affected /premenopausal women may sometimes be affected
 A large and uncomfortable swelling develops in the upper outer quadrant
 Vague discomfort may be associated
 Examination: Diffuse nodular swelling with tenderness
 Management:
 Reassurance: may resolve by next cycle
 Mammography
 Aspiration cytology in older women

59. NON-CYCLICAL MASTALGIA
 No co-relation with the menstrual history
 More commonly seen in peri-menopausal women
 Less understood
 Mostly felt in the medial quadrant of breasts
 Described as “burning” or “dragging”
 Sometimes well localized at “trigger spot zones”
 May be associated with Periductal mastitis
 50% doesn’t arise from breast.

60. NON-CYCLICAL MASTALGIA
 Management:
 Exclude extra mammary causes like chest pain*
 Non- steroidal analgesics
 Injection with local ansthetics in the trigger spots
 Surgical excision of trigger spot zone (NOT WIDELY ACCEPTED)

61. BENIGN NEOPLASMS
 Fibroadenoma
 Phyllodes tumour
 Duct papilloma
 Papillary cystadenoma

62. BENIGN NEOPLASMS
 Fibroadenoma
 The most common tumour female breast
 It is composed of both glandular and fibrous tissue
 Aetiology: It is AND
 May be seen along with Fibroadenosis (ANI)
 Pathology
 Increased sensitivity to oestrogen
 More common in blacks
 Mostly spherical; may be multinodular
 They typically stop growing after 2 to 3 cm size
 May harbor lobular carcinoma in situ

63. BENIGN NEOPLASMS
 Fibroadenoma
 Types:
 The Pericanalicular (hard fibroadenoma): it is firmer, smaller and moves well within the
breast tissue “BREAST MOUSE”
 The Intracanalicular (Soft fibroadenoma): is relatively less firm, grows larger with profuse
connective tissue “INTRADUCTAL MYXOMA”
 Both variants can co-exist

64. BENIGN NEOPLASMS
 Fibroadenoma
 Clinical features
 The pericanalicular occurs in younger females (15 to 30 yrs)
 The intracanalicular affects older age group (30 to 50 yrs)
 Painless, slow growing solitary lump (pain when associated fibroadenosis)
 Mostly seen in the lower part of the breast
 Multiple may be present; 10% cases
 Intracanalicular can grow large causing pain due to stretching skin
 No discharge per nipple

65. BENIGN NEOPLASMS

66. BENIGN NEOPLASMS
 Fibroadenoma
 On examination:
 No visible swelling ( large intracanaliclar may be visible)
 Freely mobile; more in young girls*
 Firm consistency
 No axillary lymph nodes
 Treatment:
 Present trend: women under 25 yrs of age, routine excision is avoided
 The fibroadenoma grows upto 3 cm in 5 yrs
 Thereafter gradually become smaller

67. BENIGN NEOPLASMS
 Fibroadenoma
 Treatment:
 In case of suspected pathology: excision biopsy is the treatment of choice
 Enucleation of the pericanacular variety
 Excision of the intracanalicular variety
 Peri-areolar or Sub mammary incision (Gaillard Thomas’s incision)
 If not possible then radial or curved incision over Langer’s lines

68. BENIGN NEOPLASMS
 Giant fibro-adenoma
 Grows more than 5 cm in size
 Bimodal age of presentation (at puberty and peri-menopause)
 More common in blacks
 Epithelial hyperplasia and atypia
 Characterised by rapid growth
 Differentiate from phyllodes tumour, Benign virginal hypertrophy
 On examination:
 Enlarged breast
 Displaced nipples
 Stretched and shiny skin
 Dilated veins
 Skin necrosis may occur
 Treatment: Enucleation

69. BENIGN NEOPLASMS
 Phyllodes Tumour
 Also called Cystosarcoma Phyllodes, Serocystic Disease Of Brodie or Benign
Cystosarcoma
 Mostly seen in premenopausal women (40yrs age)
 Show a wide range of histology
 From an almost benign condition resembling fibroadenoma
 To the ones with high mitotic index
 Tumour has irregular projections: cause for recurrences
 Clinical features:
 Presents as massive tumour
 Unevenly bosselated surface

70. BENIGN NEOPLASMS
 Phyllodes Tumour
 Clinical features:
 Pressure necrosis of overlying skin
 Or warm, red, shiny skin with dilated veins
 Normal nipple
 Firm consistency
 Smooth margins
 Not fixed: the stretched skin can be picked up
 No axillary lymph node involvement
 Known for local recurrence

71. BENIGN NEOPLASMS

72. BENIGN NEOPLASMS
 Phyllodes Tumour
 Treatment:
 Younger women (Benign end of spectrum): Simple enucleation
 Older patients (Malignant end of the spectrum) :Wide excision with 1 cm margin or
more
 Recurrences: mastectomy with recostruction

73. BENIGN NEOPLASMS
 Duct Papilloma
 Benign tumour, usually small
 Arising from ther lining epithelium of lactiferous duct
 It may too small for clinical palpation, but may obstruct a duct for cyst formation
 Not a pre-cancerous condition*
 Usually single and unilateral
 Papillonama has a stalk
 Papilloma vs papillomatosis (epithelial hyperplasia without a stalk)

74. BENIGN NEOPLASMS
 Duct Papilloma
 Clinical features
 Age 30 to 50 yrs
 Bloody discharge: commonest presentation
 Small and soft lump palpable beneath the areola or nipple; often difficult
 Discharge from the affected duct on pressing the lump
 May present with a cystic swelling; due to impalpable lump blocking the duct
 No lymph nodes are affected

75. BENIGN NEOPLASMS
 Duct Papilloma
 Treatment:
 Complete excision of the affected duct Microdochectomy
 Wedge resecteion
 If not palpable then gently probe the affected duct
 Carry on the resection with 1mm distance from the probe
 Papilloma is mostly situated 4-5 cm away from the nipple

76. BENIGN NEOPLASMS
 Papillary cystadenoma:
 Swellings or lumps are composed of cysts
 Into these cysts papillomatous processes extend
 Cysts are almost filled with these papillomatous processes
 Swelling feels soft: not cystic
 Management
 Excision and biopsy
 Benign condition

77. BREAST CYSTS
 Type I Classification
 A FROM THE DUCTS:
 Fibroadenosis
 Blue domed cyst of Bloodgood
 Galactocoele
 Serocystic disease of Brodie
 Papillary cystadenoma
 Intradeuctal papillary carcinoma

78. BREAST CYSTS
 Type I Classification
 B FROM THE STROMA
 Blood Cyst (encapsulation of haematoma)
 Lymphatic cyst
 Hydatid cyst
 Colloid Degeneration of carcinoma

79. BREAST CYSTS
 Type II Classification
 A FROM MAMMARY DYSPLASIA
 Fibroadenosis
 Cyclical nodularity
 Bluedomed cyst of Bloodgood
 Sclerosing adenosis
 B RETENTION CYSTS
 Galactocoele

80. BREAST CYSTS
 Type II Classification
 C FROM TUMOURS
 Benign
 Papillary cystadenoma
 Serocystic disease of Brodie
 Malignant
 Intracystic papillary carcinoma
 Colloid or mucinous carcinoma
 Medullary carcinoma
 D MISC
 Lymphatic cyst
 Hydatid cyst
 Blood cyst

81. BREAST CYSTS
 Clinical presentation
 Mostly seen in the last decade of reproductive life*
 Usually single in presentation, or just single cyst is palpable
 Relation to menstruation
 Sudden appearance (subclinical state)
 Mammography
 Aspiration of cyst (for confirmation of diagnosis)
 Treatment:
 Aspirate when in doubt
 Blood, mass after aspiration or recurrence: malignancy
 No blood; no mass after aspiration : Benign nature (Mostly Fibroadenosis)
 Follow up after 2 months

82. BREAST CYSTS
 Treatment:
 Diagnosis in Doubt / multiple cyst: excision and biopsy
 Theoritically: Patients with breast cysts are at increased risk of malignancy

83. BREAST CYSTS
 Galactocoele:
 Accumulation of milk and amorphous epithelial debris
 Blockage of main duct
 Presents as sub-areolar cyst
 Presents in patients who have just cased breast feeding
 Management:
 Excision of the affected duct

84. NIPPLE
 Nipple retraction
 Discharge per nipple
 Cracked nipple

85. NIPPLE
 Nipple retraction
 Causes:
 Benign horizontal inversion
 Duct ectesia
 Carcinoma
 Post surgical
 Types:
 Slit-like: Duct ectesia
 Circumferential: Carcinoma /Post surgical
 May cause retention of secretions

86. NIPPLE
 Nipple retraction
 Treatment:
 Spontaneous resolution during pregnancy or lactation
 Mechanical suction device
 Simple cosmetic surgery
 Ducts will have to be divided

87. NIPPLE
 Discahrge per Nipple:
 A. Discharge from the surface
 Paget’s disease
 Skin diseases (eczema, psoriasis)
 Rare cuases (chancre)
 B. Discharge from a single duct
 Blood stained
 Intraduct papilloma
 Intraduct carcinoma
 Duct ectesia
 Serous (any-colour)
 Fibrocystic disease
 Duct ectesia
 Carcinoma

88. NIPPLE
 Discahrge per Nipple:
 C. Discharge from more than one duct
 Blood- satined
 Carcinoma
 Ectesia
 Fibrocystic disease
 Black or green
 Duct ectesia
 Purulent
 Infection
 Serous
 Fibrocystic disease
 Duct ectesia

89. NIPPLE
 Discahrge per Nipple:
 Management: Mammography in those more than 35 yrs of age
 Microdochectomy: Probe and remove a single duct upto 5cm
 Hadfield operation: Cone excision of the major ducts*
 Patient will not be able to breastfeed
 Underlying pathology to be dealt with

90. NIPPLE
 Other conditions:
 Cracked nipple: fore-runner of acute mastitis
 Breast feeding should be rested for 48 hrs
 Milk to be evacuated with a breast pump
 Resume feeding as soon as possible
 Papilloma of nipple:
 Same features as cutaneous papilloma
 Excision with tiny disc of skin
 Eczema:
 Usually associated with eczema elsewhere in the body
 0.5% hydrocortisone

91. THANK YOU