Galactocoele, Fibroadenoma and Incision

A 29-year-old presented with a discrete 3-cm mass on her right breast.  She nursed a child 2 years prior.  The ultrasound showed solid well-circumscribed mass.  The primary preoperative diagnosis was a fibroadenoma.

The plan of the operation was an excision through a circumareaolar incision as the mass was freely movable and could be pushed to the areola area.

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During dissection of the mass, there was scanty whitish fluid coming from the mass.  A galactocoele was suspected.  The ultrasound report was reviewed which showed solid mass.  On excision, the mass turned out to be a galactocoele with a thick capsule and inspissated milk with pasty caseous materials within.

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ROJoson’s Insights:

  1. Galactocoele is a differential diagnosis in patients with history of lactation even up to 2 years prior.
  2. The ultrasound is not 100% correct all the time.  The mass is strictly speaking cystic or complex as it exudes fluid and contains pasty materials.  It is not solid as reported.  The inspissated milk makes it appear to be solid.
  3. If the mass is cystic on ultrasound and a macrocyst or a galactocoele is considered, a needle aspiration will be the treatment of choice.
  4. A discrete movable mass, with preoperative diagnosis of benign lesion, can be moved towards the areola area to allow a circumareolar incision, thereby producing an inconspicuous postoperative scar.

ROJ-TPOR@16feb9

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