Benign Breast Disease

Fibroadenoma

Commonly affects those in their early 20s, and presents as a firm, mobile, painless lump, that's smooth and rounded.

Investigations - Triple assessment to rule out cancerous changes

Management:

• Surgical excision

• Most regress after menopause

N.B. Phyllodes tumour presents very similarly to this, but it typically grows quickly over weeks to months. Also, more typical in 40-50 year olds.

Fibrocystic changes (Cyclical mystalgia)

Caused by the cumulative effect of cyclical hormones, leading to chronic changes in the breast including multiple small cysts and proliferative changes. It commonly affects those in the 20-50 years age group.

It presents with:

• Bilateral painful, “lumpy” breasts – most commonly in upper outer quadrant

• Symptoms worsen with the menstrual cycle – normally peak 1 wk before menstruation

Cyclical mystalgia presents very similarly to this. Here, patients will only have breast tenderness related to their menstrual cycle, without the presence of lumps.

Investigations:

• Thorough history and examination

• Breast pain diary (aim is to confirm cyclical presentation)

Management:

• Supportive with:

  • Soft, well-fitting bra

  • Simple analgesia

  • Avoid caffeine

  • Apply heat to the area

• Most regress after menopause

Other benign conditions

• Intraductal papilloma - Benign tumour of the breast ducts. Presents with bloody nipple discharge without a palpable mass.

• Radial scar - Benign, sclerosing breast lesion. It's usually found incidentally on a mammogram as a star-shaped/stellate pattern of central scarring surrounded by proliferating glandular tissue.

• Fat necrosis - Painless breast mass and skin thickening as a response to adipose tissue damage/trauma.

• Mammary breast ectasia - Inflammation and dilatation of the large breast ducts. It presents with a palpable peri-areolar breast mass and thick, green nipple discharge.