Ms. Marazas is a 58-year-old female with a personal history of left breast mastectomy in 2013 for DCIS papillary type and right silicone breast implant. She has no current breast-related complaints. Upon physical exam at the mammographic area of concern, no discrete mass is appreciated. Targeted ultrasound of the right inner breast demonstrates five masses correlating to the mammographic findings, four of which have benign morphologic features consistent with benign cysts, but the other of which is solid with internal flow and calcifications. The solid mass measures 5 x 4 x 3 mm (images time stamped 9:50:08 through 9:50:57, labeled right breast 3:00 4 cm from the nipple), with internal calcifications and vascularity. The additional benign appearing lesions are as follows: Right breast 3:00 5 cm from the nipple: simple cyst measuring 4 x 4 x 3 mm. Right breast 3:00 4 cm from the nipple: simple cyst measuring 4 x 3 x 2 mm.Right breast 2:00 2 cm from the nipple: simple cyst measuring 6 x 5 x 6 mm. Right breast 1:00 2 cm from the nipple: septated cyst without vascularity or internal solid component measuring 5 x 5 x 5 mm.
Several new masses in the right medial breast, one with indeterminate features as described above, for which ultrasound guided core biopsy with clip placement is recommended. The other lesions are consistent with simple benign cysts. These findings and recommendation were discussed with the patient at the time of the examination. The patient does not take blood thinning medications. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.