FOREIGN BODIES IN THE MALE BREAST

FOREIGN BODIES IN THE MALE BREAST

Ketan R Vagholkar
Lecturer, Dept. of Surgery, Padmashree Dr. DY Patil Medical College and Rajawadi Municipal General Hospital, Ghatkopar, Mumbai - 77.
Foreign bodies in the male breast are unheard of. A unique case of two metallic foreign bodies being recovered from the male breast is reported. Presence of such foreign bodies without any obvious precipitating mechanisms on history and clinical examination is an indicator of psychiatric illness or in rare instances due to treatment taken from quacks. Surgical removal along with psychotherapy remains the treatment for such a rare condition.
INTRODUCTION

Surgical conditions of the male breast which warrant active surgical intervention are scarcely encountered. To think of a metallic foreign body in the male breast requires a wide range of imagination. It is impossible for a foreign body to enter the breast tissue without any obvious inciting cause, such as trauma or any sort of intervention. In the rare event of such a foreign body being diagnosed, besides surgical intervention for removal, detailed psychiatric evaluation is essential in order to prevent another such episode from taking place.

CASE REPORT

A 42 year male patient presented with history of bilateral enlargement of the breasts since 6 months. There was no history of any trauma to the chest region. Clinical examination revealed firm swellings in both breasts (Fig. 1). The swelling of the right breast was fluctuant in some areas. The swelling of the left breast was firm in consistency and was hard in one of the regions. An X-ray of the chest revealed two foreign bodies resembling nails in the region of the left breast (Fig. 2). The patient underwent surgery for drainage of the abscess of the right breast and excision of the swelling of the left breast. The two long metallic foreign bodies resembling nails were recovered from the left breast (Fig. 3). The foreign bodies were encased in dense fibrous tissue. Postoperative recovery was uneventful. A psychiatric evaluation of the patient during the stay of the patient in hospital revealed depressive psychosis. There was no element of perversion. During the course of repeated psychotherapy sessions the patient admitted to have introduced these foreign bodies himself into the breast for relief of pain.

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DISCUSSION

Metallic foreign bodies in the male breast are unheard of. There is no reference till date in the literature of foreign bodies in the male breast over the past 30 years. Hence this case is unique and peculiar in its own way. Such a rare entity poses a dilemma for diagnosis especially in a mentally ill patient.

Inappropriate and incoherent details furnished by the patient which do not march with the clinical findings should raise the suspicion of such a strange condition. The host response to the foreign body depends upon the nature of the foreign body. In case of metallic foreign bodies the reaction will be significant only if there is superimposed infection. Depending upon the morphology of the foreign body i.e. whether it has sharp or blunt surface, the foreign body may cause significant damage to the underlying tissues or may even enter the body cavities. Besides psychiatric cases presenting with such obnoxious presentations another important group comprises patients treated by quacks. In India significant number of patients especially villagers and slum dwellers still prefer to get treated by quacks not knowing the lethal consequences of such a decision. These quacks use any sort of devices or chemicals to treat a wide range of surgical disorders. Therefore in the context of the Indian setting all such patients may not be psychiatric cases. Hence such cases are a challenge to the basic clinical skills of the attending surgeon.

The treatment of foreign bodies is surgical removal taking utmost care to avoid any damage to the underlying structures or body cavities. An adequate antibiotic cover is essential since all such cases are usually infected. Reassurance and psychotherapy should follow surgical care.

ACKNOWLEDGEMENT

I thank Dr. (Mrs.) SN Bhatia superintendent of Rajawadi Municipal General Hospital, Ghatkopar, Mumbai - 77 for allowing me to report this case and Dr. (Mrs.) Suvarna K Vagholkar for her help in preparing the manuscript of this report.

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