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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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