ABSTRACT
More than a quarter of general surgical outpatient referrals are of females with breast symptoms, but less than 10 per cent of general surgical operations are for breast disease. Most patients require no more than reassurance, but the rapid identification of those few with malignant disease remains a challenge. Breast development is occasionally seen in neonates as a consequence of maternal oestrogens crossing the placenta. Babies of both sexes may be affected and lactation can occur (‘witches’ milk’), sometimes complicated by abscess formation. The breasts increase in size in the second half of each menstrual cycle, following ovulation. Mild pain and tenderness are common during this phase. In pregnancy and lactation, the size and texture of the breasts change profoundly, making clinical assessment more difficult. The texture of the breast is enormously variable depending on age, parity, body mass and hormonal activity.
