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Abstract: The patient unintentionally discovered a mass in the right breast 2 weeks ago and now came to the clinic for definitive diagnosis and treatment. After examination, the patient was considered to have a right-sided mammary hyperplasia with breast nodule and was advised to undergo surgery, to which the patient agreed. The suspected malignant breast nodule was successfully removed during surgery, and the patient’s nervousness and anxiety were relieved with postoperative medication.
Basic information】Female, 42 years old
Disease Type】Right-sided mammary hyperplasia with breast nodule
Hospital】The First Hospital of Harbin Medical University
Date of Consultation】January 2022
Treatment plan] Surgery (right mastectomy) + medication (tamoxifen citrate tablets)
Treatment Period】Hospitalization for 3 days, re-examination after 2 months
Results】The suspected malignant breast nodule was successfully removed, the patient’s nervousness and anxiety were relieved, and the nipple overflow disappeared.
I. Initial consultation
The patient unintentionally found a lump in the right breast 2 weeks ago and came to the clinic for a definitive diagnosis. A “peanut rice” sized lump was palpated in the patient’s left breast, and dark brown nipple discharge was observed. Mammography showed that a widened ductal echogenicity was seen in the right breast, with a width of 0.57 cm and poor acoustic transmission. Mammography showed a round-like, slightly dense mass of approximately 20 mm × 16 mm in size with partially indistinct borders behind the right nipple, and hyperplasia with calcification in the right breast gland. Combined with the patient’s medical history and relevant examinations, right-sided breast hyperplasia with breast nodules was considered.
II. Treatment history
In view of the patient’s breast hyperplasia with breast nodules with malignant tendency, surgery was considered. The patient had symptoms of nipple overflow, which was also one of the problems to be solved in this surgery. After the patient was hospitalized and the necessary preoperative examinations were completed, she underwent excision of the right breast mass, which showed malignant signs on ultrasound and mammography, and intraoperative rapid pathology showed glandular hyperplasia, which was benign and ruled out the possibility of malignant breast tumor, and the patient was discharged after 3 days of hospitalization. Since the breast incision is prone to fluid accumulation, the patient needed to apply a lap band to fix the breast incision for 2 weeks after surgery to avoid fluid accumulation in the incision. The suspected malignant breast nodules were surgically removed, but the breast hyperplasia still existed, so the patient was given tamoxifen citrate tablets orally to treat the breast hyperplasia.
III. Treatment results
The suspected malignant breast nodule was successfully removed surgically, and the pathological examination clarified that the lump was glandular hyperplasia, ruling out the possibility of malignant breast tumor, and relieving the patient’s nervousness and anxiety. In addition, the patient had nipple overflow before surgery, which was also resolved through this surgery. The patient was reviewed in the outpatient clinic 2 months after the operation, and the incision healed well and the nipple overflow disappeared.
IV. Notes
We are glad that the patient’s condition has improved after treatment, but we still need to remind the patient to pay attention to the following matters in daily life.
1. Patients should have regular postoperative review to observe the changes in lump size.
2. Breast incisions are usually closed with absorbable sutures, and no stitch removal is required after surgery. However, the breast is more fatty and easily liquefied. Therefore, if patients find that there is liquid leakage from the incision after discharge, they can promptly seek medical attention for incision dressing change.
3. Patients should have their first review 2 months after surgery, mainly to review the mammography ultrasound, to clarify whether there are new breast nodules and the drug control of mastopexy, and to adjust the dosage and type of drugs as prescribed by the doctor.
4. Since the patient has just undergone surgery, she should pay attention to moderate exercise for 2 weeks after discharge to avoid incisional dehiscence, and continue to wear a lap band on her chest for 2 weeks after surgery to avoid fluid accumulation in the incision, which will affect her recovery.
V. Personal insight
Mammary gland hyperplasia is a common disease in women, which requires standardized treatment in a regular hospital, and patients should be reviewed in the hospital every 3-6 months. Although breast hyperplasia can also be manifested as lumps and nodules, patients and doctors should never ignore the possibility that breast cancer and this disease exist at the same time, and surgical excision of breast lumps is needed for pathological diagnosis.