Benign breast diseases include conditions like fibrocystic disease, fibroadenomas, and breast cysts. Fibrocystic disease involves fibrosis, cyst formation, and breast pain or lumps and is caused by aberrations in normal hormonal cycles. Fibroadenomas are benign solid tumors composed of epithelial and stromal elements that can be solitary or multiple. Breast cysts are fluid filled sacs formed from lobular involution and cyst formation, and can be simple or complex. Clinical exam, imaging like mammography and ultrasound, and biopsy are used in evaluation and diagnosis of benign breast conditions.

1. BENIGN BREAST DISEASES

2. • The human breast makes its appearance in the
6th week of foetal life as an ectodermal
thickening extending from the axilla to the
groin- MILK LINE
• Dista 2/3rd of this lines disappearby 9th week
• Only the pectoral portion thickens,
appearance of the lens shaped thickening
• From this 15 to 20 solid cords develop to for
the rudimentary mammary gland .

4. • These cords show bulbous dilatations at their
ends from which alveoli of the gland develop
• The solid cords develop in to the lactiferrous
duct by the end of the 20th week
• The skin from which the ducts develop show a
small depression which correspond to the
nipple .

5. ANATOMY
• Brest is a modified sweat gland, lies between
the subdermal layers of adipose tissue and the
superficial pectoral fascia
• Vertically extends from the second to sixth
ribs
• Horizontally at the level of 4th costal cartilage
extends from the side of the sternum to the
mid axillary line

6. • Axillary tail is a process or prolongation from
superolateral part of the gland which passes
into the axilla through an opening in the
axillary fascia
• Its under the deep fascia

7. • 2/3rd – pectoralis major and fascia covering it
• Lateral 1/3rd – serratus anterior
• Inner and lower most – aponeurosis of
externa oblique muscle
 RETROMAMMARY or SUBMAMMARY space

8. ARCHITECTURE
• The mature breast is composed of three
principal tissue types
i. Glandular epithelium
ii. Fibrous stroma
iii. Adipose tissue
• Ligaments of cooper

9. Nipple
• This a cylindrical or conical eminence from
near the centre of the breast surface
• It lies at the level of the 4th intercostal space, 4
inches from the midline
• It contains circular muscle and longitudinal
muscle

10. Areola
• Hyperpigmented encircled around the base of
the nipple
• The fibres of the areola are arranged in
concentric rings
• There is no fat immediately beneath the skin
of the areola and nipple

11. ARTERIAL SUPPLY
• Perforating branches of the internal mammary artery
• Lateral mammary branches of the lateral thoracic
artery
• Pectoral branch of the acromiothoracic artery
Others
• Superior thoracic artery
• Lateral perforating branches of the intercostal arteries
• Branches from the subscapular artery

12. VENOUS DRAINAGE
• Superficial veins
Majority in to the internal mmammary and
the axillary vein
Also in to the superficial veins of the neck

13. • Deep veins
Drain alon the routes of the corresponding
arterial supply
Majority in to the internal mammary veins
Next in to the axillary vein
In to the intercostal veins

14. NERVE SUPPLY
• Secretory- sympathetic nerves via 2nd to 6th
intercostal nerves
• Skin- anterior and lateral branches of the 4th
to 6th intercostal nerves

15. LYMPHATIC DRAINAGE
• OVERLYING SKIN
Not the skin of the areola and the nipple
They pass in a radial direction and end in the
surrounding nodes
Those from outer side go to the axillary nodes
Skin of upper part drain to supraclavicular nodes
Skin over the inner part goes to internal
mammary nodes

16. • PARENCHYMA OF THE BREAST
Subareolar plexus of sappey is a collection of
large lymph vessels situated under the areola
Axillary nodes receives 75% of the lymphatics
from the breast
Most to theanterior groups
Lymphatics from the deep surface of the
breast drain to axillar or internal mammary
nodes

17. LYMPH NODES
1. ANTERIOR SET
• Situated alon the lateral thoracic vein
• Lies mainly on the third rib
• Axillary tail of spence is in contact
2. POSTERIOR SET
• Relation to the subscapular vessels

18. 3. LATERAL SET
• along the upper part of the humerus in
relation to the subscapular vessels
4. CENTRAL SET
• Situated in the fat of the upper part of the
axilla
• Intercostobrachial nerve

19. 5. APICAL SET
• Also infraclavicular nodes
• Along the axillary nerves

20. LEVEL’S OF AXILLARY NODES
Level 1 – anterior , lateral, posterior
Level 2 – central, interpectoral
Level 3 - apical

21. INVESTIGATIONS
1. MAMMOGRAPHY
• X ray examination of the breast
• Views are taken of each breast from the
superior and medial aspects, with the inferior
and lateral surfaces of the breast respectively
against the cassette

22. BENIGN MALIGNANT
Mass lesion Well circumscribed Spiculated
Density low High
Asymmetry Asymmetric involution,
trauma
Intraductal CA
calcification Duct ectasia- needle like
Arterial – parallel line
Fibroadenoma – popcorn
Microcystic disease- tea
cup
Fat necrosis- oil cyst
calcification
Fine
Numerous

23. 2. BI-RADS
Categories are:
0: incomplete- needs additional imaging
1: negative
2: benign
3: probably benign
4: suspicious abnormality
5: highly suggestive of malignancy
6: known biopsy proven malignancy

24. 3.BREAST SONOGRAPHY
• If mammography is uncertain
• To differentiatesolid from cystic lesion
• Evaluating after surgical augmentation

25. STAVROS CRITERIA
• Spiculation 87-90%
• Thick Hyperechoic Halo 74%
• Hypoechoic nodule 70%
• Irregular margins 70%
• Posterior shadowing 50%
• Depth >width
• Shape: Microlobulation 1-2mm
• Branching pattern
• Punctate calcification

26. 4. FINE NEEDLE ASPIRATION CYTOLOGY
• 21 gauge needle
• Multiple passes through lump without
releasing negative pressure
• Differentiate solid and cystic lesions

27. 5. Core needle biopsy
• If FNAC is inconclusive
• Significant core of tissueobtained
• Cn distinguish invasive from intraductal
carcinoma
• Grading of tumour
• To know ER/PR and Her 2 status

28. • If this is nconclusive
1. Incision biopsy
2. Excision biopsy
• Most accurate and best diagnostic procedure
for a suspecious breast lesion
• Complete excision with rim of normal tissue
• Plan the incision in a way that subsequent
radical surgery can easily include the scar

29. 6. MRI
• TO DISTINGUISH sacr from recurrence
• Gold std for the imaging breast with implants
• Dense breast
• If axillary node positive and breast normal
after mammography and sonography

30. 7. MAMMOTOME
• Used for taking stereotactic biopsy from
mammographically detected breast lesions
that are not clinically palpable

31. 8. DUCTOSCOPE
• A fiber optic scope less than a millimeter thick
is inserted into the milk duct at the nipple
and threaded deep in to the breast through
duct
• Samples of theepithelial cellscan be collected

32. Indications
• Pts with pathologic nipple discharge
• Pts who are at high risk for developingcancer
but have normal breast on examination and
imaging studies

33. 9. DUCTOGRAPHY
• It’s a mammographic procedure that is
performed to help identify the breast duct
that may be the source of discharge

34. 10. THERMAL IMAGING
• Metabolic activity and vascular circulation
always higher in precancerous tissue
• Neo-angiogenesis
• Suggests pre cancerous state

35. GRADING
• TH1: Normal uniform non vascular
• TH2: Normal uniform, vascular
• TH3: Equivocal
• TH4: Abnormal
• TH5: Severely abnormal

36. • Use of FDG PET
• Breast scintimammography
• Computerized thermal imaging
• Computerized tomographic laser
mammography
• Digital tomosynthesis
• Elastography
• Digital subtraction mammography

37. CLASSIFICATION
• Congenital
• ANDI
• Traumatic
• Inflammatory
• Infectious
• Neoplastic

38. CONGENITAL
• Amazia
• Athelia
• Polymazia
• Polythelia
• Nipple inversion
• Symmastia – tevitale sign

39. NIPPLE INVERSION
• Congenital abnormality
• 20% of women
• Bilateral
• Creates problem during breast feeding
• Cosmetic surgery does not yield normal
protuberant nipple.

40. ANDI
• Aberrations of normal development and
involution
• First propoded in 1987
• Accepted in 1992

41. ETIOLOGY
• Endocrine
1. Hypothalamo pituitary axis
2. Prolactin level
• Non endocrine
1. Methylxanthines
2. Stress
3. Iodine deficiency

42. The principles of classifications are
1. Benign disorders are related to the normalprocesses
of reproductive life
2. The spectrum ranges from normal to aberration to
diseases
3. The distinction between normal and abnormalis
pragmatic
4. Unifying concept of symptoms, signs, histology and
physiology
5. Not includes infetion, trauma , male breast pahology

44. NON PROLIFERATIVE
LESIONS ( risk:1.0)
PROLIFERATIVE WITH OUT
ATYPIA (risk:1.3-1.9)
ATYPICAL PROLIFERATIVE
(risk:3.7-4.2)
Cysts Sclerosing adenosis Atypical lobular
hyperplasia
Apocrine metaplasia Radial and complexing
sclerosing lesions
Atypical ductal hyperplasia
Duct ectasia Intraductal papilloma
Mild ductal epithelial
hyperplasia
Moderate and florid ductal
epithelial hyperplasia
Calcifications
Fibroadenoma

45. FIBROCYSTIC DISEASE
SYNONMS
• Cystic mastopathy
• Chronic cystic disaese
• Mazoplasia
• Cooper”s disease
• Fibroadenomatosis
• Reclus”s disease
• Schimmelbusch”s disease

46. • Age group: 30-50 years
• Aberration in normal cyclical hormonal effects
• Cyclcial mastalgia with nodularity
• Blue-domed cyst of Bloodgood : Large cysts
often contain brown fluid, which gives a blue
color to the intact cyst, the blue-domed cyst of
Bloodgood

47. PATHOMORPHOLOGY
• Fibrosis
• Cyst formation
• Adenosis
• Epitheliosis
• Papillomatosis
• Apocrine metaplasia

48. CLINICAL FEATURES
• Discrete breast lump
• Lumpy breast
• Nipple discharge
• Breast pain(cyclical,noncyclical)
• Mastalgiaaffects upto70% of women at some
point in their life.
• •Two‐third of patients affected have cyclical
mastalgia& one‐third have non‐cyclical mastalgia.

49. INVESTIGATIONS
• FNAC
• Biopsy
• Mammography
• ultrasound

50. • Reassurance itself may suffice for those with lumpy
breasts.
• CYCLICAL MASTALGIA : due to hyperestrogenism.
abnormal prolactin secretion
• Initial treatment: assurance.
evening primrose oil
• Treatment of choice:Danazol
Bromocriptine
Tamoxifen

51. • NON‐CYCLICAL MASTALGIA: difficult to treat.
• Search should be made for musculoskeletal
cause of pain.
• Excising a painful trigger spot in breast causes
occasional relief.

52. SURGERY
• Indications intractable pain
• florid epitheliosis on FNAC
• Blood good cyst
Excisional biopsy
Circumareolar incision
Submammary incision of gaillard thomas
Radical / curved incission along the langer’s
line

53. FIBROADENOMA:
• “Benign solid tumors composed of stromal and
epithelial elements “
• Represent a hyperplastic or proliferative process
in a single lobule
• Etiology is unknown, thought to be due to
hormonal influence Occurs in developmental
stage of breast, due to oestrogen sensitivity
• Risk of malignant transformation is rare
• Resulting carcinoma : 50% LCIS , 35% IDC, 15%
DCIS FIBROADENOMA

54. TYPES
• Simple/solitary/small (<1 cm )
• Multiple (>5)
• Juvenile -in young women between the ages of 10 – 18
• Large ( 1-3 cm)
• Giant (> 5cm)-rapidly growing
• Complex -contain other histological changes such as
sclerosing adenosis , duct epithelial Hyperplasia,
epithelial calcification

55. • Gross examination: tumor is,
‐2 to 3cm in size.
‐sharp boundaries
‐cut surface is glistening white.
Microscopically,there are two types:
• Intracanalicular type: stroma compresses the
ducts into slit‐like structures.
• Pericanalicular type: stroma just surrounds the
ducts without compressing them.

56. CLINICAL FEATURES
• Common in 2nd& 3rddecade.
• Firm.
• Extremely mobile –” breast mouse”.
• Lobulatedtumor
• 2 to 3cm in size.
• Painless.
• 10% cases –multiple.
• Increasing age –less mobile –due to involution.

57. HARD FIBROADENOMA:
• Younger age.
• No malignant potential
SOFT FIBROADENOMA:
• Older age
• Has malignant potential.

58. • Clinical examination
• Ultrasound scan –circumscribed lobulated
mass
• FNAC/Core needle biopsy

59. • Conservative : Reassurance
• Surgery :
1. Very large/increasing in size
2. Suspicious cytology
3. Surgery is desirable
4. Extracapsular excision with a 1cm rim of normal
tissue
5. Newer techniques -laser ablation & cryo -
ablation (<2cm)

60. PHYLLOIDES TUMOUR
• Previously termed as cystosarcomaphyllodes.
• PATHOLOGY:The tumor is
1. Circumscribed
2. Irregular surface with projections(leaf‐like)
hence called as phyllodes.
3. Soft in consistency
4. Cut surface –brown color,with areas of
hemorrhage,necrosis,cystic change.
5. Histologically: epithelial & fibrous elements
present.

61. 3 GRADINGS:
• BENIGN
• INTERMEDIATE
• MALIGNANT
-Malignant lesions have evidence of sarcoma
which is usually liposarcoma or
rhabdomyosarcoma.

62. CLINICAL
• very fast growing between the ages of 40 and 50 prior
to menopause 60-70% of examined tumors are benign
• Gelatinous, cystic and solid areas
• Molecular biology : monoclonar ( derived from a single
progenitor cell )
• Tumor –grows‐large size –usually mobile.
• Skin –not infiltrated but stretched out,reddenedwith
ulceration due to pressure necrosis.

63. • Small/Benign :Wide local excision
• Suspicious/Borderline - Wide local excision ( 1
cm margin ) +Follow up
• Large/Malignant -SIMPLE MASTECTOMY
• chemotherapy and radiation therapy are not
effective
• ALND : not recommended
• Local recurrence‐upto25% ‐wide local excision.

65. BREAST CYST
• Formed due to cystic lobular involution with
formation of lobular microcystswhich coalesce
to form macrocyst.
• Predisposing factor –obstruction to lobular
outflow.
• It is a type of ANDI and associated with
hyperestrogenism.

66. 2 TYPES
SIMPLE CYST:
• simple cuboidalepithelium
• Single
• Do not recur
• No association with cancer
APOCRINE CYST:
• apocrineepithelium
• Tendency to recur
• Association with cancer.

67. CLINICAL FEATURES:
• Age group of 40‐50 yrs
• Pain –occasionally present
• Solitary & large at time of presentation
DIAGNOSIS:
• Aspirationof cyst fluid‐pale yellow to black color.
• Mammography & ultrasound to exclude malignancy.
• Pneumocystogram : In complex cysts, inject air into the
cyst and then mammogram

69. TREATMENT:
• Aspiration of cyst till it is impalpable
• Residual mass after aspiration is an indication
for FNAC or biopsy
• Blood stained : cytological analySIS

70. • CYCLICAL
• NON CYCLICAL
MASTALGIA

71. • Menstruating age group
• Hormone related- pain
around the time of
ovulation
• Dull diffuse bilateral
• Upper outer quadrant
CYCLICAL MASTALGIA

72. 1. Relative hyperoestrogenism
2. Hyper prolactinaemia
3. Psychological
4. Caffeine
5. Abnormal lipid metabolism
ETIOLOGY

73. RECENT THEORY
LOW EFA
LOW PGE1
( PROSTAGLANDIN )
UNOPPOSED
ACTION OF
PROLACTIN

74. 1.Pain diary
2.Reassurance
3.Exclude caffeine
4.Low fat diet
5.Stop OCPs/HRT
6.stop smoking
7.drugs
MANAGEMENT

75. PRIM ROSE OIL
BROMOCRIPTINE
(blocks prolactin)
GOOD RESPONSE
DANAZOL
TREAT 6 MONTHS
NO RESPONSE IN 4
MONTHS
TAMOXIFENE
GOSERELIN

76. • CAUSES
1.musculoskeletal pain
2.teitz syndrome
3.malignancy
NON CYCLICAL MASTALGIA

77. • Unilateral
• Chronic
• burning or dragging
• Pre and post menopausal
MANAGEMENT
• Treat the cause
FEATURES

78. • EXCLUDE MALIGNANCY
• TREAT THE CAUSE
MANAGEMENT

79. NIPPLE DISCHARGE

80. • Surface
Eczema
Psoriasis
Chancre
• Dischage from a single duct
Blood stained Serous
intraduct papilloma fibrocystic disease
duct ectasia duct ectasia
Causes

81. • Discharge from more than one duct
blood stained : duct ectasia
black/green : duct ectasia
purulent : infection
Serous : fibrocystic disease
duct ectasia
Milk : lactation
hypothyroidism
pituitary tumours
drugs

82. CLINICAL EXAMINATION
• Nature of discharge
• Mass present or not
• Unilateral or bilateral
• Single or multiple duct
• Spontaneous/expressed
• Relation to menstruation
• Pre/post menopausal
• Taking ocp/estrogen
Approach to a patient

83. • discharge analysis for
malignant cells and
occult blood
• Fnac
• Mammographyv
Investigations

84. • Reassurance
• Hadfields operation
• Microdochetomy
Treatment

85. • INTRAMAMMARY MASTITIS
• lactating females
• Development of cracks and bruises in the
nipple
• Retracted nipple
C/F- redness, oedema , tenderness, brawny
induration
BACTERIAL MASTITIS

86. • Antibiotics : metronidazole + dicloacillin
• Support of the breast , local heat,& analgesics
• Incision & drainage
• Now recommended : is repeated aspiration under
antibiotics coverage
• close follow up
• Antibioma if I&D not done

87. • Antibiotics : metronidazole + dicloacillin
• Support of the breast , local heat,& analgesics
• Incision & drainage
• Now recommended : is repeated aspiration under
antibiotics coverage
• close follow up
• Antibioma if I&D not done
• DD-inflammatory carcinoma of breast
TREATMENT

88. SUBAREOLAR MASTITIS
• Not a true mastitis
• Results rom the infected sebaceous gland of
montgmory
• This may follow furuncle
• Treatment is incision and drainage

89. RETROMAMMARY ABSCESS
• INFECTION ARISE from the deep to the breast
tissue
Causes- infectd hematoma, empyema, tb of the
rib or spine, osteomyelitis of the rib
• Treatment is I and d

90.  Tuberculosis of breast
 Syphilis of the breast
 Actinomycosis
OTHER INFECTIOUS CONDITIONS

91. • Breast tuberculosis is a rare form of
tuberculosis
• often overlooked and misdiagnosed as
carcinoma or pyogenic abscess
• Breast tissue is remarkably resistant to
tuberculosis
• considered invariably
• secondary to a lesion elsewhere in the
body
• Peau d’ orange is often seen
• Multiple c/c abscess & sinuses
• Bluish attenuated appearance of surrounding skin
• Diagnosis: FNAC an important diagnostic
tool
TUBERCULOSIS OF BREAST

92. • AFB on FNAC is not mandatory
• AFB negative breast abscess that fail to heal
despite adequate drainage and antibiotic therapy,
and those with persistent discharging sinuses
should raise suspicion of underlying tuberculosis
• Biopsy of the abscess wall
• Rx: Small lesions are eminently treatable by an
excision biopsy followed by a full course of ATT
• extensive disease : Simple mastectomy

93. • Primary
chancre of
nipple
• Secondary
lesions –
diffuse mastitis
SYPHILIS OF THE BREAST

94. MYCOTIC INFECTION
• Rare
• Usually blsatomycosis orsporotrichosis
• Intraoral fungi that are inoculated into breast
tissue by the suckling infant initiates
• Pus mixed with blood may be expressed from
sinus tracts
TREATMENT – systemic antifungal
I & d
topical nystatin

95. • Dilatation of the breast
ducts associated with
chronic inflammatory
response in the
periductal tissue
• Type of ANDI occurs
due to ductal involution
• Perimenopausal age
group
DUCT ECTASIA

96. PATHOLOGY:
• Ducts filled with periductalinfiltration of thick
green or creamy secretion with
periductalinfiltration of chronic inflammatory
cells
• Discharge: bilateral‐multifocal‐thick –varying
colors
• Intraductal ulceration‐bloody, unifocal discharge
from nipple
• Periductal ulceration‐mass below nipple

97. The exact mechanism of ductaldilatation is not
known but possibly due to:
• Primary periareolarinflammation leading to
ductal dilation
• Obstruction of the ducts with dilation

98. Pathogenesis
Duct
dilatati
on
Discharge to
periductal
tissues Periductal
mastitis
fistula
fibrosis
abcess

99. Microscopy

100. • Older age group
• Smokers
• Nipple discharge: bilateral
multifocal,thick,opalascent,variable colour
• nipple retraction/inversion
• pain
Clinical features

101. • Breast abcess
Tender subareolar mass
• Mammary duct fistula
• slit like retraction of nipple
Complications

102. • If mass or nipple retraction is present rule out
malignancy
Mammography
Cytology,
histopathology
• Cytology of discharge: foam cells
• Ductography: ectatic ducts
Investigations

103. • Antibiotic
flucloxacillin and metronidazole
• Hadfield’s operation
Treatment

104. Surgery

105. • Proliferative breast disease
without atypia
• polyps of epithelium lined duct
• Differentiate from
pappilomatosis: epithelial
hyperplasia in association
with fibroicystic changes.
Not true polyp
INTRA DUCTAL PAPILLOMA

106. • Size: usually less than 0.5 cm, may be as large
as 5cm
• Site:
– central type :near the nipple. solitary and nearing
menopause.
– peripheral type: multiple papillomas arising at the
peripheral breasts, in younger women. higher risk of
malignancy
• Gross: Pinkish tan friable ,attached to the wall
by a stalk
Pathology

107. Microscopy

108. • Nipple discharge
:unilateral,blood
stained,from a single duct
• Palpable mass/density lesion
in mammography
Clinical features

109. • Ductography :filing defect
Investigations

110. Surgery
• less than 30 yrs:microdochectomy
• more than 45 yrs:major duct excision(Hadfield)
treatment

111. • Thromboplebitis of superficial
veins of the breast & chest wall
• Aetiology not known
• C/F – thrombosed subcutaneous
cord
• DD – breast cancer
In axilla, this condition is
known as axillary web
syndrome.
MONDOR’S DISEASE

112. • Treatment – anti-inflamatory
medication
warm compresses & support
restriction of movement
symptoms persist - excision
• It is named after Henri
Mondor (1885-1962),
a surgeon in Paris, France who
first described the disease in 1939

113. • essentially a retention cyst resulting
from lactiferous duct occlusion
• C/F: painless breast lump
• Diagnosis- needle aspiration
• Mammograms in the MLO obtained
with the patient erect may show the
characteristic finding of nodules
containing fat fluid levels.

114. • Clinical features - Pain & lump
in the breast
• Lump is hard - extensive fibrosis
caused by tissue reaction
• it can gradually change into scar
tissue or may collect as liquid
within an oil cyst.
• D.D : Carcinoma breast
• Mammography findings -
density lesion; can have
calcifications; may mimic
carcinoma breast
• Treatment - excision
TRAUMATIC FAT NECROSIS

115. • Contains only ducts
• No alveoli
Male breast

116. • Gynaecomastia
• Fibroadenoma
• Phyllodes tumour
• Epidermal inclusion cysts
• Sub cutaneous leiomyoma
• Sub areolar abscess
• Intra mammary lymph node
BENIGN BREAST LUMPS IN MALES

117. • “ benign
enlargement of
breast tissue in
males”
• Physiological:
– Neonate
– Adolescence
(U/L)
– Senescense
(B/L)
GYNAECOMASTIA

118. • Estrogen excess states :
– Gonadal Stromal Neoplasms: Leydig /Sertoli
– Germ cell tumors: Choriocarcinoma / Seminoma/ Embryonal
– Non Gonadal tumors: Adrenal/Lung/HCC
– Endo ( hyper and hypothyroidism)
– Hepatic (non alc or alc cirrhosis)
– Protein and Fat deprivation
• Androgen deficiency states
– Sensesccense
– Hypogonadism
• Primary testicular failure :Klienfelters/Kallmann/ACTH defi
• Secondary testicular failure: trauma/ orchitis
– Renal failure
• Refeeding gynecomastia: Resumption of pituitary gonadotropin secretion after
pituitary shutdown.
• Drug related : Reserpine/Theophylline/Verapamil
• Systemic diseases
PATHOPHYSIOLOGY

119. • Grade I: Minor enlargement, no skin excess
• Grade II: Moderate enlargement, no skin
excess
• Grade III: Moderate enlargement, skin excess
• Grade IV: Marked enlargement, skin excess ,
Ptosis simulates a female breast
CLINICAL CLASSIFICATION

120. MANAGEMENT
• If androgen defi : Testosterone administration
• If progressive and does not respond :
– Surgery
• subcutaneous mastectomy,
• liposuction-assisted mastectomy,
• laser-assisted liposuction,
• laser-lipolysis without liposuction
• Danazol : Androgenic side effects