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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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slide1
Case:
  • Two ladies aged 20 and 48 years, respectively, consulted because of bilateral breast tenderness.
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
    • Although 10% of breast cancers present with pain
slide3

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

evaluation and management of breast pain
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

treatment of fibroadenomas
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

4 the 48 year old undergoes surgery showing the gross finding below what is your treatment

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

treatment of fibrocystic change
Treatment of Fibrocystic Change:
  • Reassurance
  • Pain management
  • 3 Treatments shown by RCT to be effective:

1. Caffeine free diet

2. Smoking cessation

3. Danazol