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Case:

Case:. Two ladies aged 20 and 48 years, respectively, consulted because of bilateral breast tenderness . Breast tenderness. Pain ( mastalgia or mastodynia ) is the most common clinical presentation of breast disease More common in premenopausal women Rarely a symptom of Cancer

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Case:

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  1. Case: • Two ladies aged 20 and 48 years, respectively, consulted because of bilateral breast tenderness.

  2. Breast tenderness • Pain (mastalgia or mastodynia) is the most common clinical presentation of breast disease • More common in premenopausal women • Rarely a symptom of Cancer • Although 10% of breast cancers present with pain

  3. (1)In the 20-year old, what is your foremost consideration? (2)In the 40-year old, what is your foremost consideration?

  4. (3) How do you differentiate the diagnosis in #1 from that of #2?

  5. Reference: Schwartz’s Manual of Surgery 8th Edition

  6. (4) How will you manage the 20 year old?

  7. Evaluation and Management of Breast Pain Breast pain History and PE normal Patient age < 35 years Patient age > = 35 years mammogram Reassurance Normal Persisting pain Pain relievers DANAZOL

  8. Evaluation and Management of Breast Pain Breast pain Breast Mass

  9. Treatment of Fibroadenomas: • Removal of all fibroadenomas has been advocated irrespecitve of age or other considerations • Solitary fibroadenomas in young women are frequently removed to alleviate patient concern • Yet most fibroadenomas are self-limiting and may go undiagnosed, so a conservative approach is reasonable • Careful US examination with core-needle biopsy will provide for an accurate diagnosis • Consequently, the patient is counseled concerning the biopsy results, and excision of the fibroadenoma may be avoided Reference: Schwartz’s Manual of Surgery 8th Edition

  10. (4)The 48-year old undergoes surgery showing the gross finding below, What is your treatment?

  11. Treatment of Fibrocystic Change: • Reassurance • Pain management • 3 Treatments shown by RCT to be effective: 1. Caffeine free diet 2. Smoking cessation 3. Danazol

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