Benign Ductal Disease Flashcards
Define Benign Ductal Disease (BDD)?
Breast Tissue Changes ranging from normal to abnormal, either in development, cyclical change or involution phases
What is involution?
Shrinking down of an organ in old age
What are some of the changes that occur in BDD?
Fibrocystic change Breast cysts Fibroadenomas Sclerosing Adenosis Intraductal Papillomas Duct Ectasia Periductal Mastitis Fat Necrosis
What do fibroadenomas results from?
Hypertrophy of abreast lobule
What is sclerosing adenosis?
Aberration of normal involution
What is Intraductal Papillomas?
A small benign tumour that forms in a milk duct
What is Duct Ectasia?
When central ducts become dilated with ductal secretions
These secretions may leak into periductal tissues and cause an inflammatory reaction (periductal masititis)
What are the causes of BDD?
Related to changes in hormone levels
Fat necrosis occurs secondary to Trauma
What are the risk factors of BDD?
May be less common in patients on the OCP
Smoking is a risk factor for periductal mastitis
What is the epidemiology of BDD?
Very Common
Diffuse fibrocystic Changes are very common (60% of women)
Fibroadenomas are more common in 15-35 yrs
What are the presenting symptoms of BDD?
History of breast discomfort or pain (may be cyclical)
Swelling or Lump
Nipple Discharge
What do you suspect if the nipple discharge is bloody?
Malignancy
What do we ask the patient to found out about their risk factors for breast cancer?
Family History
Exposure to oestrogen
What sort of things would increase a pt’s exposure to oestrogen?
Age of Menarche Menopause Number of Kids Breastfeeding Use of OCP/HRT
What are the signs of BDD on physical examination?
Focal or diffuse nodularity of breast
Fibroadenoma
Duct Ectasia
What is a Fibroadenoma?
Smooth, well circumscribed and mobile lumps (known as a ‘breast mouse)
What is discharge colour in Duct Ectasia?
Yellow/Green
What are the features of malignancy absent in BDD?
Dimpling
Peau D’Orange
Enlarged Axillary Lymph Nodes
What investgatiions for BDD?
Triple Assessment:
Clincal Examination
Imaging
Cytology/Histology
What imaging would you do for BDD?
Mammography (two-view)
Benign Lumps are less likely to be calcified
Ultrasound - in younger ptss (<35 yrs)
What Cytology would you do for BDD?
FIne Needle Aspiration - sent for cytological analysis
Excision Biopsy - sent for histological analysis
What is the conservative plan for BDD?
Symptomatic Treatment (e.g. analgesia for mastalgia) Fibroadenomas may be treated conservatively
What is the surgical management plan for BDD?
Removal or excision biopsy of a breast lump
Wide local incision if there is any suspicion of the lump not being benignn
Microdochetomhy
Hadfield’s Procedure
What is Microdochetomy and what’s that used in?
Surgical removal of a lactiferous duct
Performed in intraductal papillomas
What is Hadfield’s Procedure?
Surgical removal of ALL lactiferious ducts under the nipple
Used for duct ectasia
What are some complications of BDD?
Pain
Recurrence
