Benign Ductal Disease

Question 1

Define Benign Ductal Disease (BDD)?

Answer 1

Breast Tissue Changes ranging from normal to abnormal, either in development, cyclical change or involution phases

Question 2

What is involution?

Answer 2

Shrinking down of an organ in old age

Question 3

What are some of the changes that occur in BDD?

Answer 3

Fibrocystic change
Breast cysts 
Fibroadenomas 
Sclerosing Adenosis 
Intraductal Papillomas 
Duct Ectasia 
Periductal Mastitis 
Fat Necrosis

Question 4

What do fibroadenomas results from?

Answer 4

Hypertrophy of abreast lobule

Question 5

What is sclerosing adenosis?

Answer 5

Aberration of normal involution

Question 6

What is Intraductal Papillomas?

Answer 6

A small benign tumour that forms in a milk duct

Question 7

What is Duct Ectasia?

Answer 7

When central ducts become dilated with ductal secretions

These secretions may leak into periductal tissues and cause an inflammatory reaction (periductal masititis)

Question 8

What are the causes of BDD?

Answer 8

Related to changes in hormone levels

Fat necrosis occurs secondary to Trauma

Question 9

What are the risk factors of BDD?

Answer 9

May be less common in patients on the OCP

Smoking is a risk factor for periductal mastitis

Question 10

What is the epidemiology of BDD?

Answer 10

Very Common
Diffuse fibrocystic Changes are very common (60% of women)
Fibroadenomas are more common in 15-35 yrs

Question 11

What are the presenting symptoms of BDD?

Answer 11

History of breast discomfort or pain (may be cyclical)
Swelling or Lump
Nipple Discharge

Question 12

What do you suspect if the nipple discharge is bloody?

Answer 12

Malignancy

Question 13

What do we ask the patient to found out about their risk factors for breast cancer?

Answer 13

Family History

Exposure to oestrogen

Question 14

What sort of things would increase a pt’s exposure to oestrogen?

Answer 14

Age of Menarche 
Menopause 
Number of Kids
Breastfeeding 
Use of OCP/HRT

Question 15

What are the signs of BDD on physical examination?

Answer 15

Focal or diffuse nodularity of breast
Fibroadenoma
Duct Ectasia

Question 16

What is a Fibroadenoma?

Answer 16

Smooth, well circumscribed and mobile lumps (known as a ‘breast mouse)

Question 17

What is discharge colour in Duct Ectasia?

Answer 17

Yellow/Green

Question 18

What are the features of malignancy absent in BDD?

Answer 18

Dimpling
Peau D’Orange
Enlarged Axillary Lymph Nodes

Question 19

What investgatiions for BDD?

Answer 19

Triple Assessment:
Clincal Examination
Imaging
Cytology/Histology

Question 20

What imaging would you do for BDD?

Answer 20

Mammography (two-view)
Benign Lumps are less likely to be calcified
Ultrasound - in younger ptss (<35 yrs)

Question 21

What Cytology would you do for BDD?

Answer 21

FIne Needle Aspiration - sent for cytological analysis

Excision Biopsy - sent for histological analysis

Question 22

What is the conservative plan for BDD?

Answer 22

Symptomatic Treatment (e.g. analgesia for mastalgia)
Fibroadenomas may be treated conservatively

Question 23

What is the surgical management plan for BDD?

Answer 23

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

Question 24

What is Microdochetomy and what’s that used in?

Answer 24

Surgical removal of a lactiferous duct

Performed in intraductal papillomas

Question 25

What is Hadfield’s Procedure?

Answer 25

Surgical removal of ALL lactiferious ducts under the nipple

Used for duct ectasia

Question 26

What are some complications of BDD?

Answer 26

Pain

Recurrence