Benign breast diseases

Mastalgia

Classified as cyclical (with menstrual cycle) or acyclical. 7% of patients with Ca Breast have mastalgia as only symptom. Cyclical-Benign, avg age 34years , relieved by menopaus. Noncyclical-Affects older women(>43 ) from chest wall.

Gynecomastia

Growth of glandular tissue. Accounts for >65% of male breast abnormalities. Pseudogynaecomastia-Accumlation of abnormal excessive fat in male breast. Usually unilateral cases have No hormonal deficiency. Bilateral due to systemic causes. Classification:Grade1-Mild breast enlargement without skin redundency.GradeIIa-Moderate breast enlargement without skin redundancy. Grade IIb-Moderate breast enlargement with skin redundancy. Grade III-Marked breast enlargement with skin redundancy and Ptosis which simulates a female breast.

Fat necrosis

It is usually Traumatic due to direct Trauma, Surgery, Biopsy. Common with large fatty breast. There will be a Post surgery scar/ hematoma/ seroma. Clinically Bruising after trauma but the bruise settles eventually. Swelling persists like Ca breast.

Duct ectasia

Widening of ducts of breast usually in the age group 40 to 50 years. Presents with Tenderness and redness of the nipple and surrounding breast tissue. CLINICALLY presents with Solitary or multiple tender swelling in the subcutaneous or periareolar region and Nipple retraction, skin edema, axillary LN or a Hard diffuse mass/ Cord like swelling from areola/ Inspissated yellow cheesy material discharge from nipple. Sometimes acute cases present with inflammation and mimics breast abscess. Treatment is surgery.

Galactocele

Cystically dilated terminal ductules filled with milk. Presents with Painless lump for weeks-months post lactation. Caused by Obstruction to the duct and retained milk proximal to obstruction sometimes presenting with cheese like nipple discharge. Comlication-Infection. Treatment- Excision

Intraductal papilloma

Present Beneath areola. Complain of Bloody nipple discharge associated with pain. Treatment is Excision of duct as wedge resection.

Fibroadenoma

Represents hyperplastic or proliferative process in a single terminal ductal unit. It is a Benign tumour with a well circumscribed lesion. May involute in postmenopausal women or Coarse calcification may develop inside the lump. Sudden increase in growth mimics malignancy.In a 2 yr period-20% lumps increase in size, 10% decrease in size, 20% completely resolve, 50% remain static. For <35 yrs – triple assessment/ support/ observation. For >35yrs or patients wish-excision biopsy.

Phylloides

Most commonly occurring nonepithelial tumour of the breast. It has Sharply demarcated smooth structures. Avg size 5cm. Treatment- Wide local excision with rim of normal tissue.

Breast abscess

Etiopathology is complex and most are idiopathic. Lump and pain are common symptoms. Evaluation with Triple assessment method. Treatment depends on natural history of clinical problem. Treatment should be tailored to individual needs.

Breast cyst

Most common in 35 – 50years age. most are subclinical microcysts. Difficult to differentiate from solid masses by Clinical Breast Examination or mammography. Accurate diagnosis with USG and FNAC. Treatment- Observation. For Complex cyst-USG diagnosis. Treatment- Follow up.

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