A Case Study – Unilateral Breast enlargement.

A Case Study -   Unilateral Breast enlargement.

20 year female presented with unilateral enlargement of breast for 2 years. She did not have any pain or discomfort but a cosmetic issue. In the past she had suffered from pulmonary Koch’s and had completed her Antioch’s treatment. On examination she had her right breast enlargement almost four times the left breast and a lump almost 20 x 15 cm, firm and mobile. History of cleft lip repaired in childhood with an unrepaired Cleft palate. Since she has an asthenic body built she was suggested to take some medicine for weight gain which did not make the gain weight but in 3-5 months made her right breast grow to present size.

  

 

 

 

A week later   post op                          2 weeks later.post op

On sonomammography it showed a benign lump with a differential diagnosis of fibroadenoma and lipoma.

X-ray chest showed signs of pneumatocele on the left side lung as post-tubercular sequaelaes. HR CT was done to decide the safety for the type of anaesthesia for the surgery. Because of her lung condition it was decided to give thoracic epidural anesthesia as patient was unfit for General anaesthesia..

A sub-mammary incision was made and skin was reflected superiorly and lump was explored and dissected off its surroundings. Eventually it was dissected off the breast tissue and excised completely. The mass showed multiple lobulations. After achieving complete haemostasis the wound was closed with a 10 number medinorm drain. Wound was closed with subcuticular stitches. Specimen was 20 x 13 cm. in size

 

Post operative recovery was smooth, Histopathology showed: Fibroadenoma

Postoperative phase showed gradual reduction in breast size.

Differential diagnosis is giant fibroadenoma , giant lipoma , malignant Phyllodes tumour (malignant cystosarcoma phyllodes) ,hamartoma . Final diagnosis depends on Histopathology.

What to do in a breast lump in young girls

Complete history and examination,

Sonomammography7 SOS Mammography

FNAC then excision Biopsy.

When does a patient need a check up: If she ever had

  1. 1.      Pain,
  2. 2.      Swelling or lump in your breast  during or before your periods
  3. 3.      Breast feeding
  4. 4.      Nipple discharge
  5. 5.      For a routine check up at least twice a year
  6. 9.      Pulling or pain  in the nipple area
  7. 10.  Any change in the size or shape of  the breast
  1. Thickening or swelling of part of breast
  2. Irritation or dimpling of breast skin
  3. Redness or flaky skin in the nipple area or the breast

 

Dr. Ashima Acharya (M.S.)(General surgery )                                   

Cumballa Hill Hospital and Heart Institute Mon –Fri    : 10-12 noon (By appointment), Noor Hospital –Tues: 10-11am , Saboo Siddiqui Hospital Tues :11.30 to 12.30 pm Thursday 9-10 am St Elizabeth  : Mon : 10-11am.For appointment: 02223803336 , 9322260116

On line enquiries : www.ladydoctor.in

Email : dr_ashima@hotmail.com