Fibroadenosis

Or cystic hyperplasia, cyclical mastitis, cyclical mastalgia

• Settles after menopause
• Probably abnormal response of breast to hormonal changes
• exageration of fibrotic element
• hyperplasia of epithelial element
• tendency to cyst formation
• may be extremely painful

History

• patient 35-45
• Cyclical breast pain worse before period
• intermittent breast masses
• areas of thickening with no discrete mass
• discrete mass. i.e. cysts
• nipple discharge
  • clear
  • white
  • green

Examination

• Nodular breasts
• Multiple thickened areas,
  • usually upper and outer quadrant
  • tender
• Lesions change in size and number during menstrual cycle

Investigations

• Mammography - exclude cancer
• FNAC
• Aspiration of cysts

Treatment

• Firm supporting bra
• Mild diuretic premenstrually - esp. if associated with premenstrual tension
• Evening primrose oil - may need to be taken for several months before an effect can be seen
• Sector mastectomy may be appropriate
• Subcutaneous mastectomy with implants in severe cases (patients have been known to become suicidal because of symptoms)
• May respond to hypnotherapy and acupuncture
• Dominant masses, suggesting cyst should be aspirated
• ?Danazol

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