This document discusses benign breast disorders occurring in different reproductive periods in females. It describes conditions like fibroadenoma and fibrocytstadenosis. Fibroadenoma is a benign encapsulated tumor occurring commonly in females under 30 years of age. It is an aberration in normal lobule development. Fibrocystadenosis is now called cyclic mastalgia with nodularity, which is an estrogen dependent condition causing painful, cystic swelling of the breast tissue. The document provides details on the clinical features, investigations, classifications, and treatment options for these common benign breast conditions like fibroadenoma and fibrocytstadenosis.

1. ANDI
REDDY SEKHAR
3 rd YEAR MBBS

2. INTRODUCTION
It is ABERRATION of NORMAL DEVELOPMENT and
INVULTION (ANDI) of BREAST
• It is benign breast disorder occurring in different
reproductive period in female-
EARLY,MATURE,INVULTION phases of reproductive
age group
• All conditions in ANDI should be carefully examined
and mammography ,FNAC /BIOPSY to rule out
malignancy
• It include different diseases and aberrations

3. cont..
IN EARLY REPRODUCTIVE AGE GROUP(15-25 YRS)
Normal lobular formation may cause aberration-
FIBRADENOMA
If it is >5cm it is GIANT FIBRADENOMA
Normal stroma may develop juvenile hypertrophy as aberration
and multiple fibradenoma as disease
IN MATURE REPRODUCTIVE AGE GROUP(25-40 YRS)
Normal cyclic hormonaleffects on glands and stroma get
exaggerated by aberration causing generalized enlargement
Its disease state is cyclic mastalgia with nodularity-
FIBROCYSTADENOSIS

4. FIBROADENOMA
• It is benign encapsulated tumour occurring commonly in15-
25 yrs age group (old definition)
• Presently,it is HYPERPLASIA of single LOBULE of breast
• More common in female below 30 years of age group
• It is aberration in normal development of lobue
• It shows similar hormonal activity like normal breast like
lactation
• INCIDENCE :15% of palpable breast lumps
• Common in blacks,negros
• In 20% cases bilateral

5. Cont…
• JUVENILE FIBROADENOMA:
• Occurs in adolescents and it is rare
• It shows rapid growth with stromal and epithelial hyperplasia
• It may clinically mimics phyllodes tumour .but not turn into tumour
• COMPLEX FIBROADENOMA:
• IT HAS FIBRO CYSTIC changes like apocrine metaplasia,cyst
formation, sclerosing adenosis mainly in old age
• Occasionally turn into malignancy
• 30% fibroadenoma disappear or reduce in size in 2-4 yrs
• Usually fibro adenoma not turn into malignancy

6. TYPES
GROSS:
1. SOFT-common after 30yrs ,more cellular;bilateral
2. HARD-common below 30 yrs,more fibrous
3. GIANT-COMMON IN AFRICA
MICROSCOPY:
1. INTRA CANALICULAR: large and soft-mainly cellular.stroma
with distorted duct
2. PERICANALICULAR: small and hard mainly fibrous.stroma
with normal duct

7. Clinical features
It appear as pain less swelling in one of the quadrent .it is smooth firm
nontender ,well localized move freely with breast tissue
Axillary lymph nodes not enlarged
Investigations:
• popcorn calcification on mammography
• FNAC/CORE BIOPSY and MRI if needed
Treatment:
Excision through a circum areolar incision(websters )
Or submmammary incision (gaillard thoms incision) under GA
FIBROADENOMA which is small can be left alone with follow up

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9. FIBROCYSTADENOSIS
It is presently called CYCLIC MASTALGIA with NODULRITY
• It is estrogen dependent condition
• One of the cyst may get enlarged to become clinically
palpable ,well localized swelling
• It is fluctuant ,transillumutant,nontender,cystic swelling with
bluish capsule
• Surgical excision is done if persists even after 2 aspirations;if
blood stained;if residual lump after aspiration
• When diffuse small,multiple cysts are main component it is
SCHIMMELBUSCH DISEASE(MOST COMMON)
• IT IS COMMON IN UPPER AND OUTER QUADRANT

10. CLASSIFICATION
NONPROLIFERATIVE:MODERATE HYPERPLASIA of ductal
luminal cells-no life time risk of cancer
proliferative without atypia-severe hyperplasia
Proliferative with atypia- risk factor for breastcancer(often
mimics insitu carcinoma)
STAGES:
1-stromal proliferationor hyperplasia
2-ADENOSIS
3-CYST FORMATION

11. CLINICAL FEATURES
• PRESENTATION is during menstrual age group as bilateral,painful
diffuse ,granular,tender,swelling,which is better with palpating
finger
• Common in upper outer quadrant
• Pain and tenderness more just prior to menstruation
• It subsides with pregnancy ,lactation,after menopause
• Discharge from nipple when present will be serous or occasionally
greenish
• Occasionally shotty enlargement of axillary lymph nodes can occur
• Not fixed to skin ,muscle or chest wall

12. INVESTIGATIONS
• FNAC(epitheliosis,when florid is undoubtedly premalignant)
• Ultrasound
• Mammography
TREATMENT:
• CONSERVATIVE-1)reassurance,avoid caffeine,chocolate,salt
2)medical(drugs)
goal:tostop progression,to relieve pain
to reverse changes,to soften breast tissue
DRUGS ARE –OIL OF EVENING PRIMROSE (DOC)
IT CONTAINS GAMOLENIC ACID THAT FORM UNSATURATED FATTY
ACIDS FROM SATURATED ONE

13. CON…
GAMOLENIC ACID-120 mg/ day
Danazol- interferes with fsh and LH ;MOST EFFECTIVE DRUG
BUT 2nd drug of choice 200mg/day
Bromocriptine lowers prolactin 2.5mg/day for 3 months
Tamoxifen 10 mg BD
Ormiloxifen 30 mg,twice weekly for 6 months
NSAIDS
Diruetics
SURGERY
Subcutaneous mastectomy with prosthetic placement
Excision of cyst or localized excision

14. Reference
SRB Manual Of Surgery

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