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Breast Disorders

Breast cancer is twice as common as all gynecologic pelvic malignancies combined. When a persistent, palpable, dominant breast mass is identified, breast cancer should be excluded. All women should begin breast self-examination and have annual clinical breast examinations by age 20 years.

The breasts are composed mostly of adipose tissue with interwoven fibrous bands (Cooper's ligaments). The glandular tissue and ducts are organized into separate, anatomically distinct lobes.

Common benign breast disorders include the following:

• Adenolipoma (hamartoma)

• Cysts

• Ductal hyperplasia

• Fat necrosis

• Fibroadenoma

• Fibrocystic changes

• Galactocele

• Intraductal papilloma

• Lipoma

• Lobular hyperplasia

• Mammary duct ectasia (periductal mastitis)

• Mastitis

• Mondor disease (superficial venous thrombosis)

BREAST MASSES

A persistent, palpable, dominant breast mass must be diagnosed definitively. This can be accomplished in the ambulatory environment by using the diagnostic triad of clinical breast examination, mammography, and fine-needle aspiration. A specific pathologic diagnosis can be obtained by fine-needle.

MASTALGIA

In obtaining a pertinent history for the assessment of breast pain, it is important to ascertain 1) if the pain is cyclic (premenstrual) or noncyclic (constant or intermittent) and 2) if it is localized or diffuse. Most premenopausal women will experience some degree of physiologic diffuse cyclic mastalgia. A basic breast-oriented history should be obtained.