CONGENITAL ANOMALIES OF BREAST Flashcards
Virginal mammary hypertrophy
Rare condition characterised by rapid, excessive and unyielding proliferation of one or both breasts in the adolescent years for at least 6 months.
Difference between virginal hypertrophy and prepubertal hypertrophy
Virginal hypertrophy occurs a few months after puberty, prepubertal hypertrophy is before puberty and usually bilateral
Symptoms of virginal mammary hypertrophy
- Large breasts (13 to 23 kg)
- Shoulder and neck pain
- Bra strap grooving
- Rashes
Examination findings in virginal mammary hypertrophy
- Breast hypertrophy
- Tender parenchyma with thin skin and dilated veins.
Etiology of virginal mammary hypertrophy
- Excess local estrogen production
- Estrogen end-organ sensitivity
Differential diagnoses of virginal mammary hypertrophy
- Fibroadenoma
- Phyllodes tumor
- Lymphedema
- Endocrine conditions
- Rheumatologic conditions
- Lymphoma
Management of virginal mammary hypertrophy
Medical management - Dydrogesterone, bromocriptine, medroxyprogesterone, tamoxifen
Surgical management - Reduction mammoplasty, mastectomy.
Important preoperative counselling points to be made in a case of virginal mammary hypertrophy
- Recurrence of breast tissue is sevenfold higher following reduction mammaplasty compared to mastectomy.
- Lactation and aesthetic outcome can be preserved with reduction mammaplasty with preservation of NAC on a vascularised pedicle.
- Defer reduction mammaplasty until later years of adolescence to reduce risk of recurrence and revision surgery.
- Rates of breast feeding after careful preservation of subareolar gland with or without reduction mammaplasty - 60%.
- Operated or non operated groups, 34-39% required supplementation of breast milk.
- Tamoxifen administration for 4 months - shown to be most effective in retarding breast growth. Use is limited by side effects (hot flashes, venous thrombosis, osteoporosis, endometrial hyperplasia) in pediatric population.
Clinical presentation of fibroadenomas
- Common in adolescents, 75-95% of breast lesions are fibroadenomas
- Well circumscribed, painless, rubbery, mobile masses of benign connective tissue and epithelial proliferation.
What is giant fibroadenoma?
Refers to when tumor is larger than 5 cm in diameter and/or weighs more than 500 g.
Features of giant fibroadenoma
- Large breast mass - well circumscribed, painless, rubbery and mobile
- Skin changes can occur - severe cases - skin ulceration of overlying tissue
- Venous dilation
Investigations required in giant fibroadenoma management
- Breast ultrasound - may reveal well circumscribed Avascular mass
- Fine needle aspiration cytology - confirmation of diagnosis
Treatment of fibroadenoma
- Surgical excision is the choice.
- Early treatment is necessary to prevent distortion of existing tissue.
- Remove lesion in the well demarcated plane.
- To fill in the cavity, tissue rearrangement techniques are required with consideration to the pedicle and nipple perfusion.
- If malignant phyllodes tumor is diagnosed pathologically, consult surgical oncology or pediatric surgery.
Incidence of polythelia
5.6% of male and female patients along the milk lines.
Important association of polythelia
Polythelia can be associated with nephrourologic abnormalities - so urinalysis and renal ultrasound is necessary.
Treatment of polythelia
Surgical excision via elliptical excision, performed typically performed before puberty.
Delay in treatment - wider incisional pattern as glandular tissue may become involved.
Prevalence of Polymastia
1-2% may occur along the embryonic mammary ridges, most commonly in axilla
Important association of polymastia
Renal abnormalities
What is the difference of polymastia and ectopic breast tissue?
Ectopic breast tissue lies outside the mammary ridges
Diagnosis of polymastia
Usually identified after puberty, pregnancy, or lactation and when hormonal influences enlarge the breast tissue.
Clinical features of polymastia
May present with discomfort during certain points of menstrual cycle.
Treatment of polymastia
Excision of accessory breast tissue and primary closure over a drain as needed.
Important consideration if polymastia is left untreated
If surgical excision is forgone, screen for malignancy as breast cancer can occur with the accessory tissue at an equal rate to the natural breast.
