Benign breast disease

• Risk factors:

  • Early pubarche and late menarche
  • Dense breast with a high proportion of breast tissue
  • History of breast pathology
  • Previous irradiation to the area
  • Obesity
  • Hormonal treatment
  • Nullparity or first pregnancy after 30
  • Never breast feeding
  • Alcohol
  • Smoking
• Triple assessment algorithm:

  • Clinical exam - inspection and palpation (size, shape, consistency, symmetry, fluctuance and overlying skin changes)
  • Radiological analysis - US if under 35, mammography if over 35
  • Histological/cytological analysis - US guided fine needle aspiration or core biopsy
• Fibroadenoma (breast mice):

  • Most common cause of benign breast lumps
  • Usually present in patients younger than 30
  • Firm, smooth and mobile under the skin lumps
  • Painless and tend to occur in multiples
  • Observation and reassurance - if unsure refer for US
  • Uniform hypoechogenicity on US
• Breast cysts:

  • Common in patients over 35, especially if perimenopausal
  • Fluid-filled, round and mobile under the skin
  • Usually painful and produce cyclical symptoms related to menstruation
  • Diagnosis confirmed by aspiration
• Infective mastitis/breast abscesses:

  • Infection of the mammary ducts causes mastitis, which if left untreated leads to breast abscess formation
  • This is often associated with lactation, the most common causative organism being Staphylococcus aureus.
  • Painful, immobile subcutaneous lumps
  • Erythema and warmth of the involved area of skin
  • Tenderness on palpation
  • Patient may develop a fever
  • Antibiotics are the mainstay of treatment
• Duct ectasia:

  • Typically develops around menopause
  • Common in smokers
  • Mammary ducts become blocked by stagnant secretions
  • Present with greenish nipple discharge, may be brown or bloody
  • Other signs include nipple retraction and a lump below or at the areola
  • US of the lump would confirm diagnosis
  • Usually no treatment needed apart from smoking cessation
• Fat necrosis:

  • Occurs after a traumatic injury to breast tissue
  • The trauma leads to fibrosis and calcification
  • Immobile firm lumps at the area of injury
  • May be associated bruising around the area
  • No treatment required once diagnosis confirmed
• Non-lactational breast abscess:

  • Common in diabetics and heavy smokers
  • peri and retro-areola area
  • Associated peri-ductal mastitis
  • Can develop recurrent abscesses - may result in fistulae formation
  • If recurrent inflammatory breast abscess consider the possibility of cancer