Abordaje diagnóstico y terapéutico de la mastalgia. Un reto cotidiano en la consulta ginecológica.

La mastalgia es uno de los principales motivos de consulta diaria para el ginecólogo. Se estima que alrededor del 70% de las mujeres experimentará mastalgia en algún momento de su vida, además que es un síntoma que puede presentarse de manera reincidente. Es un cuadro que suele representar gran angustia en la paciente dada la posible asociación con algún proceso maligno, lo cual se ha demostrado que tan solo ocurre hasta en el 3% de los casos, por lo que se debe tranquilizarla durante la consulta de primer contacto. Se trata de un síntoma con múltiples etiologías, que en la mayoría de los casos se deben a patologías benignas de la glándula mamaria. La evaluación por estudios de imagen debe apegarse a las recomendaciones emitidas por las diferentes guías internacionales y no solicitar estudios innecesarios que lleven a un sobrediagnóstico y sobretratamiento. El abordaje en el tratamiento puede representar un gran reto para el ginecólogo, ya que existen diversas opciones que abarcan desde terapéuticas no farmacológicas, como son modificaciones en el estilo de vida y múltiples terapéuticas farmacológicas, sin embargo, existen pocos ensayos clínicos aleatorizados que permitan demostrar la superioridad de uno. En objetivo del presente es revisar las diversas recomendaciones en el abordaje diagnóstico y tratamiento que sustentan el manejo clínico de la mastalgia.

Mastalgia and associated breast diseases in a tertiary care center, Tamil Nadu: A cross-sectional study

Background: Mastalgia is the common breast condition among women. Mastalgia has highly variable prevalence which ranges 41–79%. It is more common in age group between 30 and 50 years. Mastalgia is approached according to its classification into three major categories, that is, cyclical pain, non-cyclical pain, and extra mammary pain. Breast pain ranges from mild to severe influencing the lifestyle of women affecting sexual relations, sleep pattern, and decreasing their daily life activities. Aim and Objectives: The aim of the study was to determine the incidence of benign and malignant breast disease in mastalgia. Materials and Methods: This cross-sectional study was conducted in Government Medical College, Sivagangai. Patients complaining of breast pain were examined. The data were compiled in an Excel worksheet, Epiinfo version 7.0 was used to analyze the data. Results: In our study, 100 patients complaining of breast pain were examined ranging from age 18 to 68 years. The mean age of the study population was 37.54 years and standard deviation of 9.077. Among 100 patients with mastalgia only 1 (1.64%) had malignancy which is insignificant and among rest 99 patients with mastalgia, 60.61% had benign breast diseases and 39.39% had no any breast lesions. Benign breast diseases are more commonly found in patients with mastalgia. Conclusion: Women having mastalgia can be reassured and some lifestyle modifications may aid the women. Hence, early detection of any breast disease in women having mastalgia and treating accordingly has considerable importance. Lifestyle modifications are needed in patients with mastalgia and they should come to facility to check and identify the issues and solve soon.

Mastalgia in medical students: a prospective and multicentric study

Introduction: Mastalgia or breast pain affects most women, especially those of reproductive age. Of organic or nonorganic cause and variable intensity, it is related to factors such as hormonal, dietary, metabolic, and emotional changes, making it difficult to understand its pathophysiology and the definition of care conduct. It can influence the quality of life. The aim of this study was to identify, classify, and know the treatments and their effectiveness for breast pain in university students, relating their interference in the quality of life. Methods: A total of 1,064 students from two medical schools in the interior of São Paulo were interviewed and evaluated using a standardized and specific questionnaire with the aim of characterizing breast pain. Results: Mastalgia was reported in 1,034 students (p=0.0003), body mass index >25 increased breast tenderness by 4.3 times (RR=4.3; p=0.001; 95%CI 2.5­6.73), and sedentary lifestyle increased by 10.82 times (p=0.02). It was more common in the premenstrual cycle (p=0.002), and the greater the intensity, the smaller the number of students who performed the self-examination (p=0.02). The greater the pain, the greater the chance of being absent from classes (RR=15.82; p=0.0003; 95%CI 13.23­17.3). Drug treatment was applied in 15.54% of the cases, with satisfactory results in 92.16% of them (p=0.000004). Conclusions: The study showed a high incidence of breast pain in medical students, impairing their academic activities, making it clear the importance of investigating any symptom related to the hormonal axis and showing significant efficiency of the pharmacological treatment.

Mastitis granulomatosa: una simuladora de cáncer, un gran reto diagnóstico y terapéutico / Granulomatous mastitis: a cancer simulator, a great diagnostic and therapeutic challenge

Resumen ANTECEDENTES: La mastitis granulomatosa idiopática es un padecimiento benigno de la glándula mamaria sumamente raro, simulador de cáncer de mama. Las manifestaciones clínicas más significativas son: nódulo palpable, cambios en la coloración de la piel y mastalgia. Para integrar su diagnóstico se requiere el apoyo de estudios auxiliares de imagen, sin que por ello deje de ser imprescindible la toma de biopsia para establecer el diagnóstico definitivo. No existen pautas de tratamiento debidamente establecidas, pero sí de tratamiento farmacológico y quirúrgico, ésta última se reserva para casos de recidivas, que son frecuentes. CASO CLÍNICO: Paciente de 35 años, nuligesta; acudió a consulta debido a la aparición de un tumor palpable en la glándula mamaria derecha, de siete meses de evolución, con cambios en la coloración y retracción del pezón. La mastografía y ecografía catalogaron el tumor en BI-RADS 5. La biopsia con aguja de corte y citología integraron el diagnóstico de mastitis granulomatosa idiopática. Se indicó tratamiento farmacológico y el tumor desapareció espontáneamente. CONCLUSIONES: La mastitis granulomatosa es una enfermedad rara y de diagnóstico complejo. Para cada paciente habrá un protocolo diferente para evitar el sobretratamiento. Su pronóstico es bueno, a pesar de ser un simulador de cáncer de mama. El tratamiento aún es ambiguo, pero en primera instancia se recomiendan los corticosteroides o inmunosupresores y la cirugía se reserva para casos de recidivas.

Abstract BACKGROUND: Idiopathic granulomatous mastitis is an extremely rare benign entity of the mammary gland, simulating breast cancer. The most significant clinical manifestations are: palpable nodule, skin discoloration changes and mastalgia. The diagnosis requires the support of auxiliary imaging studies, although a biopsy is essential to establish the definitive diagnosis. There are no well-established treatment guidelines, but there are guidelines for pharmacological and surgical treatment, the latter is reserved for cases of recurrence, which are frequent. CLINICAL CASE: A 35-year-old nulligesta patient came for consultation due to the appearance of a palpable tumor in the right mammary gland, of 7 months of evolution, with changes in color and nipple retraction. The mastography and ultrasound catalogued the tumor in BI-RADS 5. The biopsy with cutting needle and cytology integrated the diagnosis of idiopathic granulomatous mastitis. Pharmacological treatment was indicated, and the tumor disappeared spontaneously. CONCLUSIONS: Granulomatous mastitis is a rare disease with a complex diagnosis. For each patient there will be a different protocol to avoid overtreatment. Its prognosis is good, despite being a breast cancer simulator. Treatment is still ambiguous but, in the first instance, corticosteroids or immunosuppressants are recommended and surgical treatment is reserved for cases of recurrence.

A Clinicopathological Study on Cyclical Mastalgia with Special Reference to Serum Oestrogen Level and Breast Volume.

Cyclic mastalgia is defined as a breast pain that has a relationship to the menstrual cycle. As far as research studies are concerned the main etiological factors for cyclical mastalgia include dietary factors and hormonal imbalance. In this study, the clinicopathological aspect of cyclical mastalgia is studied with special reference to serum oestrogen and breast volume. This study provides valuable data on cyclical mastalgia with special reference to serum oestrogen level and breast volume.METHODSA total of 101 patients meeting inclusion criteria were selected for this prospective comparative observational study. Sample was selected from OPD patients from Surgery Department, Medical College Kolkata. A detailed history of the patients who was taken with special reference to the dietary habits and lifestyle. A thorough physical examination including breast size and volume were taken (by visual assessment method, size of the undergarments the patient wear and then breast circumference measurement) and the findings were noted. Patients underwent Tru-Cut biopsy for histopathological study and Oestrogen Receptor Status. All data was captured in a predesigned Case Data Sheet and analysis of all the data was done from the CDS using master chart or grand chart.RESULTS58.3% patients with cyclical mastalgia have h/o fatty diet. Patients with increased breast volumes had increased levels of serum oestradiol which signifies that mastalgia with medium and large size breast would respond to antioestrogens better than those patients with small sized breast volume. Majority of the patients with cyclical mastalgia in our study had medium breast volumes as per Bra-size, where the range of 32-36 has the highest frequency (42.8%). The mean measurement of bra size is 33.7 and the standard deviation is 3.737. In our study, we find positive correlation with breast volume and serum oestrogen level (Pearson correlation of breast volume as 1 and serum oestrogen level as 0.381 respectively) and negative correlation with breast volume and serum progesterone level (Pearson correlation of breast volume as 1 and serum progesterone level as -0.134 respectively).CONCLUSIONSThis study shows a significant positive correlation between breast volume, fatty diet and oestrogen level with cyclical mastalgia.

Role of ormeloxifene in regression of benign breast diseases

Background: Benign breast diseases are common pathological entities with which women in her early reproductive age present to OPD with fear of malignancy and significant morbidity. Except for surgery and use of non-selective estrogen receptor blockers, there are no other treatment options, and these have lot side effects. Ormeloxifene a newer drug has shown promising results with minimal side effects and used as the first line of treatment reducing the morbidity of surgery and subjecting the patient to less hormonal side effects.Methods: Diagnosis of benign breast diseases was made by baseline investigation which included measurement of size of fibroadenoma using Vernier caliper and USG, fibroadenosis,ie nodularity measured using  Lucknow-Cardiff scale and VAS score was used for pain assessment of mastalgia after which patients will be given the drug and  placebo and the response for the drug and its side effects are noted.Results: 61.9% (44) were diagnosed with fibroadenoma, 16.9% (12) with fibroadenosis and 21.1% (15) with mastalgia. Lucknow Cardiff score for fibroadenosis exhibited 50% had smooth breasts with no nodularity at the end of six months, in fibroadenoma group 52% showed decrease in size and 31% showed complete disappearance of the lump and in the mastalgia group 40% had no pain (VAS score of 0). 16(22.5%) of had menstrual abnormality as the major side effect.Conclusions: Ormeloxifene can be used as the first line of treatment in patients with fibroadenosis and mastalgia and used as an alternative to surgery for fibroadenoma.

Mastodynia / Mastalgia

Abstract Introduction: Mastalgia is a frequent clinical symptom in general and gynecological medicine consultation. The objectives of this bibliographical review are: to define the diagnostic concept, classification and treatment of mastalgia. Methods: literature search in Pubmed, Scielo, Cochrane and Google Scholar, using the MeSH terms: mastodynia, mastalgia, breast pain, chest pain. The search limits were: full texts in English and Spanish, in humans and published during the last 10 years. Results: the physiopathology of the mastodynia is not caused by a single mechanism, but by different causes with independent pathways. The main mechanisms are hormonal, mammary density, neuropathic and extra-mammary. Conclusion: It is important to know the pathophysiology and classification of mastodynia, due to its therapeutic implications and possible association with breast cancer.

Resumen Introducción: la mastalgia es un síntoma clínico frecuente en la consulta medicina general y ginecológica. Los objetivos de esta revisión bibliográfica son: definir el concepto diagnóstico, clasificación y tratamiento de la mastalgia. Métodos: búsqueda bibliográfica en Pubmed, Scielo, Cochrane y Google Académico, utilizando los términos MeSH: mastodynia, mastalgia, breast pain, chest pain. Los límites de búsqueda fueron: textos completos en idioma inglés y español, en humanos y publicados durante los últimos 10 años. Resultados: la fisiopatología de la mastodinia no es causada por un solo mecanismo, sino por diferentes causas con vías independientes. Los mecanismos principales son de tipo hormonal, densidad mamaria, neuropático y extra-mamaria. Conclusion: es importante conocer la fisiopatología y clasificación de mastodinia, debido a sus implicaciones terapéuticas y posible asociación con cáncer de seno.

A Descriptive Study of Various Causes and Treatment Modalities of Mastalgia in Females of all Age Groups in Guru Nanak Dev Hospital, Amritsar

Mastalgia or Breast pain, is a common symptom which women may experience at different time in their lives. Many women worry that pain in their breasts is caused by breast cancer. Breast cancer rarely causes breast pain, however a thorough history and clinical examination by clinician appreciates it. Methods: A descriptive study was carried out in department of general surgery, Govt. Medical College in Guru Nanak Dev Hospital, Amritsar. there is 500 cases of mastalgia collected in Guru Nanak Dev Hospital and diagnosis was made on basis of clinical history and local examination of both breasts. All the quadrants of the breast were examined. Treatment of each patient was done as per the diagnosis. Results: Among 500 Patients 449 patients had cyclical mastalgia were as 51 patients has non cyclical mastalgia. Conclusion: In our study 89.8% of the patients experienced cyclical mastalgia and 10.2% non cyclical mastalgia.

Evidencias en indicaciones de la progesterona / Evidence in progesterone prescription

Resumen ANTECEDENTES: la progesterona es una hormona esteroide con participación en la ovulación, implantación, embarazo y regulación de la función uterina durante el ciclo menstrual y de otros órganos, como la glándula mamaria. Por su mecanismo de acción, la progesterona está indicada en distintos padecimientos ginecológicos y obstétricos: síndrome premenstrual, amenaza de aborto, parto pretérmino, hemorragia uterina disfuncional y mastalgia relacionada con el ciclo menstrual. OBJETIVO: evaluar la seguridad y eficacia de la progesterona en pacientes con: síndrome premenstrual, amenaza de aborto y de parto pretérmino, hemorragia uterina disfuncional, mastalgia y terapia hormonal en la menopausia. METODOLOGÍA: revisión sistemática de la evidencia científica acerca de las distintas indicaciones de la progesterona. RESULTADOS: se encontraron 92 artículos de los que se seleccionaron 41 para revisión. CONCLUSIONES: la evidencia clínica evaluada acerca de las indicaciones de la progesterona demuestra ventajas en eficacia y seguridad en los diferentes esquemas.

Abstract BACKGROUND: Progesterone is a steroid hormone involved in ovulation, implantation, pregnancy and regulation of uterine function during the menstrual cycle and other organs such as the mammary gland. Because of its mechanism of action, progesterone is indicated in different gynecological and obstetric conditions: premenstrual syndrome, threatened abortion, preterm birth, dysfunctional uterine bleeding and mastalgia related to the menstrual cycle. OBJECTIVE: To evaluate the safety and efficacy of progesterone in patients with: premenstrual syndrome, threatened abortion, preterm birth, dysfunctional uterine bleeding, mastalgia and hormone therapy in menopause. MATERIAL AND METHODS: Systematic review of scientific evidence about different indications of progesterone. RESULTS: We found 92 articles from wich 41 were selected for review. CONCLUSIONS: The clinical evidence evaluated on different indications of progesterone demonstrates advantages in efficacy and safety in different regimens.

Correlation of clinical and sonological features in cases of mastalgia without a palpable lump

Background: Mastalgia is defined as pain, dull ache or heaviness in the breast. The most common cause of mastalgia is Aberration of Normal Development and Involution (ANDI) of breast tissue [1]. It can occur during adolescence, pregnancy and perimenopause. Materials and methods: Patients with complaints of breast pain in the age group 15-64 years with clinically no palpable mass attending to the surgical OPD in a tertiary care hospital between August2013- August 2015 (two years) were included in the study. Out of 700 patients who presented with pain in one or both breast, 482 (68%) had fibroadenoma, 78 (11%) were fibroadenosis with nodularity in breast followed by 50 (7%) cases had abscess and 40 (5.7%) had mastalgia without any palpable lesion which are included in this study. Detail history with particular reference to age, duration of symptoms, side of preponderance, menstruation, marital status, parity, lactation, nipple discharge and tenderness are recorded. Pain is recorded by subjective numerical pain intensity scale of 0-10. Clinical findings with particular reference to tenderness, quadrants involved are recorded. Ultrasound of the breast was done for all cases and findings recorded to correlate with clinical features. Results: Regarding age distribution, 18 (45%) patients belong to age group 26-35 years followed by 11 (27.5%) in age group of 36-45 years. 8 (20%) of patients were in the age group of 15-25 years. Remaining 3 (7.5%) were above 46 years. 20 (50%) had symptoms of < 1 month duration, 10 (25%) had duration of 1 - 6 months, 3 (7.5%) had symptoms for more than 6 months.13 (32.5%) had pain on right side, 16 (40%) had pain on left side, 11 (27.5%) had pain both sides. Severity of pain varied from 1 – 10 with an average of 5.4. 36 (90%) are married, 4 (10%) are unmarried. 35 (87.5%) had children, 5 (12.5%) were nulliparous. 32 (80%) women are having regular menstrual cycles and 8 Keerthi Sunil Kumar, Manga Muralidhar. Correlation of clinical and sonological features in cases of mastalgia without a palpable lump. IAIM, 2016; 3(8): 93-96. Page 94 (20%) were not menstruating due to either following hysterectomy or attained menopause apart from 3 (7.5%) patients were lactating mothers. Conclusion: The sonological findings of altered echogenisity and cystic changes can be the baseline while starting the treatment in patients with mastalgia without palpable lesion. These findings will also guide in assessing the response and follow-up of these patients.

Cyclical mastalgia: Prevalence and associated determinants in Hamadan City, Iran

Objective: To assess prevalence of cyclical mastalgia and its main determinants in women who attended in health centers of Hamadan City, Iran. Methods: This case-control study was conducted on 400 women (case: cyclical mastalgia, n = 240; control: without cyclical mastalgia, n = 160) who attended family planning clinic for routine follow-up in health centers. The cluster sampling was used. Information was collected by interviewing and using a standardized validated questionnaire. Severity of mastalgia was assessed through using visual analog scaling. Data processing and statistical analysis were performed by using SPSS 19.0. Results: The results revealed that majority of women (60.0%) experienced cyclical mastalgia. Out of these, 22.5% and 37.5% were mild and moderate-to-severe mastalgia, respectively. No association was revealed in experience of depression and anxiety in mastalgia group. In a multivariable logistic regression model, the increasing age, age of marriage, history of abortion and history of premenstrual syndrome were main determinants of mastalgia, while use of oral contraceptive and regular exercise was associated with lower incidence of mastalgia. Conclusions: Most of women with breast discomfort suffered cyclical mastalgia which severity can be determined by advanced age, age of marriage, history of abortion and history of premenstrual syndrome, but inversely by oral contraceptive use and exercise activity.

Can mastalgia be another somatic symptom in fibromyalgia syndrome?

OBJECTIVE: The purposes of this study were to determine the coexistence of mastalgia and fibromyalgia, to investigate the effects of this combination on pain patterns, and to discuss the status of breast pain in the diagnostic algorithm of fibromyalgia syndrome. METHODS: Sixty-one female patients reporting breast pain during the last three months and 53 female patients diagnosed with fibromyalgia syndrome were enrolled in this study. The Breast Pain Questionnaire was administered to all participants in the mastalgia group and to those in the fibromyalgia syndrome group who had experienced mastalgia during the past three months. The patients in the fibromyalgia syndrome group were evaluated using the 2010 preliminary American College of Rheumatology classification criteria. All of the patients in the mastalgia group were evaluated for the diagnosis of fibromyalgia syndrome by a single physiatrist. The coexistence and pain patterns of mastalgia and fibromyalgia were assessed statistically. RESULTS: Approximately half of the patients with fibromyalgia syndrome (47.2%) reported having mastalgia at the time of admission and 37.7% of the patients with mastalgia met the diagnostic criteria for fibromyalgia syndrome. The patients with mastalgia in the fibromyalgia syndrome group had significantly higher total breast pain scores compared with the women in the mastalgia group. In addition, the patients with fibromyalgia syndrome in the mastalgia group had significantly higher Widespread Pain Index and Symptom Severity Scale scores than the patients with fibromyalgia syndrome. CONCLUSIONS: We suggest that mastalgia can be an aspect of the central sensitivity syndrome and can be added to the somatic symptoms of fibromyalgia.

Alterações funcionais benignas da mama / Benign functional alteration of the breast

A alteração funcional benigna da mama está intimamente relacionada à ansiedade e ao medo do câncer de mama. Acomete cerca de 70% das mulheres, 54% de mamas normais à autópsia, 34% de biópsias mamária e 40% de todos os cânceres de mama. Tem sido observada maior incidência nas pacientes de alto poder econômico. O diagnóstico é basicamente clínico e está relacionado à história de dor mamária pré-menstrual de caráter progressivo, ocupando todo o ciclo, além da presença de vários "nódulos". Ocorre na idade reprodutiva com pico entre mulheres de 30 a 40 anos. O quadro clínico passa obrigatoriamente por dor e nodularidade. O diagnóstico radiológico se restringe à mamografia e ao ultrassom sem alterações patológicas. A confirmação diagnóstica é dada pelo estudo anatomopatológico, através de punção aspirativa por agulha fina, trocarte e biópsia cirúrgica. A principal conduta terapêutica é afastar a causa oncológica como responsável pela mastalgia, portanto o exame físico das mamas, adicionado aos exames subsidiários, é obrigatório. Com a exclusão de processo neoplásico, 60% a 80% das pacientes têm remissão espontânea da dor. A presença de nodularidade deve ser tratada de acordo com o resultado anatomopatológico. A indicação de retirada da área somente ocorre na vigência de diagnóstico duvidoso ou suspeito e, até mesmo, nos casos de refratariedade ao tratamento clínico. O tratamento medicamentoso se baseia no emprego de várias drogas, tais como progesterona, antiprolactinas, agentes antigonadotropinas, medicamentos competidores com os receptores hormonais para estrogênio, uso de análogo de GnRH (goserelina), ácido gamalinoleico, restrição de metilxantinas, vitaminas E e A, complexo B, diuréticos e anti-inflamatórios...

Clinical analysis of 1,393 females with mastalgia

To determine the clinical profile of benign and malignant mastalgia in terms of age distribution, geographic location, laterality, pain severity and pattern.METHOD: This is a 3-year (April 1,2001 until March 31, 2004) retrospective chart review of female patients presenting with mastalgia in a hospital-based government breast center at Vicente Sotto Memorial Medical Center, Cebu City. Malignant mastalgia was diagnosed based on histopathologic findings. Pain severity assessment was based on a numeric scale of 0 to 10. Exclusion criteria include patients without mastalgia as chief complaint, no histopathologic confirmation of malignancy and males. All statistical computations were done using Chi square test with a = 0.05.RESULTS: A total of 1237 patients (89 percent) had benign mastalgia with an average age of 29.72 +/- 10.96 years and 156 (11 percent) had malignant mastalgia with an average of 48.92 +/- 11.96 years. Patients less than 60 years of age had a statistically significant probability that their mastalgia is due to benign pathology (p CONCLUSION: Age above 60 years, right-sidedness and non-cyclical pain pattern are the only significant factors for differentiating whether the mastalgia is due to a benign or malignant etiology.

Mastalgias cíclicas: quando tratar medicamentosamente / Cyclical mastalgias: when to treat pharmacologically

Nosso objetivo foi discutir a oportunidade do tratamento medicamentoso nas mastalgias cíclicas. Uma amostra de 128 pacientes com mastalgia cíclica de diferentes graus de intensidade foi submetida a tratamento não-medicamentoso (orientação verbal). Para avaliar a intensidade da dor, foi usada uma escala analógica visual da dor, antes e após tratamento. Usou-se também o Cardiff Breast Score (CBS) para avaliar a resposta clínica. Às pacientes que não melhoraram com a orientação verbal, foi oferecida à opção de tratamento medicamentoso, após considerações sobre custos, efeitos colaterais e resultado esperado. A análise dos dados foi feita com o teste do X2 (Epi-Info 6.04). Verificou-se índice de sucesso com a orientação verbal de 59,4%, considerando critérios preestabelecidos no estudo. Ao grupo restante, de 52 mulheres (40,6%), ao qual foi oferecida a opção medicamentosa, apenas 14 (26,9%) resolveu fazê-Ia. Constatou-se, portanto, uma rejeição ao uso de drogas de 73,1 %. Apenas o grupo que apresentava mastalgia intensa (grau III) aceitou a opção medicamentos a sem ressalvas e nesse aspecto houve diferença estatisticamente significativa (p = 0,002) quando comparados com os outros grupos de diferentes graus de mastalgia. O tratamento medicamentoso das mastalgias cíclicas deve ser feito, única e exclusivamente, após o insucesso da orientação verbal e após discussão criteriosa sobre custos, efeitos colaterais e efeito esperado das drogas e, particularmente, se a paciente manifestar o desejo de fazê-lo.

Our purpose was to discuss the opportunity of pharmacologic treatment in cyclic mastalgias. A total of 128 patients with cyclic mastalgia with different degrees of intensity were submitted to a nonpharmacologic treatment (reassurance). A visual linear analogical scale of the pain was used before and after the treatment in order to assess its severity. We also used a modified Cardiff Breast Score (CBS) to assess the c1inical response. It was offered the option of pharmacologic treatment to the patients that were not benefited with reassurance, after considerations about costs, side effects and expected results. The data analysis was performed using the X2 test (Epi-Info 6.04). We verified a success rate of 59,4% with reassurance considering preestablished criterions. To the remaining group of 52 women (40,6%) which was offered the pharmacological option, only 14 patients (26,9%) decided to do it. It was verified, therefore, a rejection to the pharmacologic treatment of 73,1 %. Only the group with severe mastalgia (grade III) accepted the pharmacologic option without restrictions and in this aspect there was significant statistical difference (p = 0.002) when compared with the others groups with different degrees of mastalgia. The pharmacologic treatment of cyc1ic mastalgias should be done only and exc1usively after the failure of reassurance and after a judicious discussion about costs, side effects and expected result of the drugs and, particularly, if the patient wishes.

Clinical application of ductoscopy: A report of 3 000 cases / 中国微创外科杂志

Objective To discuss the clinical value of f iberoptic ductoscopy in the diagnosis and treatment of breast diseases. Methods A total of 3 000 patients with mastalgia, breast mass or ni pple discharge received examinations by fiberoptic ductoscopy. Cytological exami nations were carried out in part of the patients after ductoscopy. Resu lts Of the 3 000 cases, there were 608 cases of intraductal space-occup ying lesions, 1 709 cases of obstructive galactophoritis, 350 cases of galactost asia, 24 cases of acute galactophoritis, 282 cases of simple mammarv duct ectasi a, and 27 cases of normal mammary ducts. Of 1 167 patients with nipple discharge , intraductal space-occupying lesions were clarified by ductoscopy in 585 cases (50%). Surgery was performed in 643 cases while intraductal interventional thera py was adopted in 2 365 cases. Conclusions Fiberoptic ductosco py may be used for the diagnosis and treatment of various breast diseases, not c onfined to nipple discharge.

Reduction Surgery for Giant Breast / 한국유방암학회지

PURPOSE: Women with large breasts suffer from both physical embarrassment and physical discomfort. Recently, partially due to socioeconomic development, growing numbers of woman with large breasts have sought reduction surgery, which previously had not been popular in Korea. At this time, a proper evaluation of the operation is required in order to promote the procedure. METHODS: Case files of 60 reduction operations using the inferior pedicle flap method for the reduction of large breasts were clinically reviewed. RESULTS: The patients were aged 19~65 (mean 34.5) years. The primary reasons for surgery were self-consciousness, shoulder/neck/back pain, wet skinfold/eczema and intractable mastalgia. Breast parenchymal pattern analysis by mammography revealed relatively a high frequency of dysplastic change (DY) among women with intractable breast pain, which was nearly entirely relieved by reduction surgery. The nipple-areolar complex were saved with inferior dermal pedicle flaps without any occurrence of necrosis. An average of 350 (range 50~800) grams of tissue from each breast was removed. There were no blood transfusions and significant postoperative complications were rare, although some patients complained of hypertrophic scars. CONCLUSION: Postoperative results were sufficiently satifactory to consider reduction surgery for inappropriately large breasts as a rehabilitative method.

Reduction Surgery for Giant Breast / 한국유방암학회지

PURPOSE: Women with large breasts suffer from both physical embarrassment and physical discomfort. Recently, partially due to socioeconomic development, growing numbers of woman with large breasts have sought reduction surgery, which previously had not been popular in Korea. At this time, a proper evaluation of the operation is required in order to promote the procedure. METHODS: Case files of 60 reduction operations using the inferior pedicle flap method for the reduction of large breasts were clinically reviewed. RESULTS: The patients were aged 19~65 (mean 34.5) years. The primary reasons for surgery were self-consciousness, shoulder/neck/back pain, wet skinfold/eczema and intractable mastalgia. Breast parenchymal pattern analysis by mammography revealed relatively a high frequency of dysplastic change (DY) among women with intractable breast pain, which was nearly entirely relieved by reduction surgery. The nipple-areolar complex were saved with inferior dermal pedicle flaps without any occurrence of necrosis. An average of 350 (range 50~800) grams of tissue from each breast was removed. There were no blood transfusions and significant postoperative complications were rare, although some patients complained of hypertrophic scars. CONCLUSION: Postoperative results were sufficiently satifactory to consider reduction surgery for inappropriately large breasts as a rehabilitative method.

Reduction Surgery for Giant Breast

PURPOSE: Women with large breasts suffer from both physical embarrassment and physical discomfort. Recently, partially due to socioeconomic development, growing numbers of woman with large breasts have sought reduction surgery, which previously had not been popular in Korea. At this time, a proper evaluation of the operation is required in order to promote the procedure. METHODS: Case files of 60 reduction operations using the inferior pedicle flap method for the reduction of large breasts were clinically reviewed. RESULTS: The patients were aged 19~65 (mean 34.5) years. The primary reasons for surgery were self-consciousness, shoulder/neck/back pain, wet skinfold/eczema and intractable mastalgia. Breast parenchymal pattern analysis by mammography revealed relatively a high frequency of dysplastic change (DY) among women with intractable breast pain, which was nearly entirely relieved by reduction surgery. The nipple-areolar complex were saved with inferior dermal pedicle flaps without any occurrence of necrosis. An average of 350 (range 50~800) grams of tissue from each breast was removed. There were no blood transfusions and significant postoperative complications were rare, although some patients complained of hypertrophic scars. CONCLUSION: Postoperative results were sufficiently satifactory to consider reduction surgery for inappropriately large breasts as a rehabilitative method.