HEGAZY SURGERY

1. Breast Lump and Nipple
Discharge
Professor Reda Abd Eltawab
January 2010

2. Case:1
• 18 years young female
presented to the breast
clinic with a firm rubbery 1
cm mass of the right breast.
• The mass moves freely
inside the breast.
• What is your diagnosis?
• Confirm diagnosis?
• Surgical removal only at the
option of the patient.
• FNA
• US

3. Case:2
• 35 years old female presenting with
pain and tenderness of both
breasts of 10 years duration,
related to the menstrual cycle, with
multiple nodular masses that come
and go in relation to menses.
• Now she has a rounded,firm (tense
cystic) 2 cm mass in her right breast
of 6 weeks duration.
• Diagnosis: Fibrocystic disease +
• Probably a cyst but it could be
carcinoma!!
• What should we do?
• Mammography
• Ultrasonography
• Aspiration
• If still suspicious we
do formal biopsy

4. Case:3
• 52 years old female
presented with the picture
of blood discharge from
the right nipple, that
comes out spontaneously
from a single orifice for
several months, not
responding to any type of
treatment.
• On examination no
palpable mass inside the
breast.
• Diagnosis:
• But it could be carcinoma.
• Investigations:
• Surgical exploration

5. Case:4
• A 26 years lactating mother
had cracks in the nipple,
presenting with a fluctuating
red hot tender mass in her left
breast with leucocytosis and
hectic fever.
• Diagnosis:
• No mammography!!
• Ruling out carcinoma : After
doing incision and drainage you
have to take tissue biopsy from
the wall of the abscess for
pathological examination.
• Rule: Only lactating
females are entitled to get
an intramammary abscess.
In nonlactating ladies think
in infected carcinoma.

6. Case:5
• A 69 years old female has
an ill-defined firm mass
under the left nipple,
movable on chest wall
but not movable inside
the breast, with
retraction of the nipple 3
months ago.
• Diagnosis: Cancer
• Management:

7. Case:6
• A 60 years old lady doing routine
screening mammogram.
• The radiologist reported an
irregular area of increased density
with fine microcalcifications. It
wasn’t there two years ago.
• On examination NAD(no mass felt)
We need tissue diagnosis.
• How to obtain biopsy from
something that we don’t feel!!
• What we don’t The Radiologist
does.
• Radiological guided core biopsy.
• Wire localization.
• Mammotome.

8. Thank you & Good Luck