Benign Breast Disease

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Benign Breast Disease

• July 12, 2007
• Maggie Gordon, R2

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Benign Breast Disease

• Breast Anatomy

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• A ducts
• B lobules
• C lactiferous sinus
• D nipple
• E fat
• F pectoralis major
• G ribs and intercostal muscles
• A duct cells
• B basement membrane
• C duct lumen

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Benign Breast Disease

• By Diagnosis

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Risk Factors

• Estrogen replacement
• Genetic changes
• Acquired
• Congenital, including BRCA1, BRCA2
• Protective
• Anti-estrogens, e.g. Tamoxifen

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Fibrocystic Change

• Normal variant
• 60 of pre-menopausal women
• ? cysts or fibrous tissue in otherwise normal
  breast
• Types
• Hyperplasia 20s
• Adenosis 30s
• Cystic disease 30s-40s

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Fibrocystic Disease

• Fibrocystic change w/
• severe pain
• nipple discharge
• excessive lumpiness ? suspicion of cancer
• Cause blockage / dilation of ducts

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Duct Ectasia

• Distension of ducts
• Contain crystalline material
• Can develop localized infection
• May leave nodule after resolution

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Solitary Papillomas

• Arise from cyst
• Present with sanguinous / sero-sanguinous
  discharge

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Fibroadenoma

• Benign solid tumours
• Present as well-defined, mobile masses
• ? with estrogen, pregnancy
• 2-23 prevalence in adolescents to mid-20s

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Others

• Superficial thrombophlebitis of the
  thoracoepigastric vein (Mondor's disease)
• Mastitis, breast abscess, granuloma
• Galactocele
• Fat necrosis (panniculitis)
• Hamartoma
• Lipoma
• Neurofibroma
• Squamous, apocrine metaplasia
• Tubular adenoma
• Sarcoidosis
• Diabetic mastopathy

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Benign Breast Disease

• By Symptoms

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Breast Pain

• Normal cyclic breast pain
• Fibrocystic change
• Fibrocystic disease, when severe
• Mastitis
• Large, pendulous breasts
• Coopers ligaments stretching
• Occasionally
• Masses, including malignancy
• Duct ectasia
• Hidradenitis suppurativa

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Nipple Discharge

• Spontaneous, bloody, unilateral malignancy
• Provoked, non-bloody, bilateral benign
• Milky
• Post-partum
• ? thyroid
• Pituitary tumour ? prolactin
• Meds
• OCP
• TCAs

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Nipple Discharge

• Sticky
• Cystic changes
• Duct ectasia

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Breast Mass

• Mostly fibroadenoma
• 90 palpable breast masses 20s to early 50s
  are benign

Must exclude malignancy
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Benign Breast Disease

• Investigation

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History
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Physical Exam
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Palpation of Mass

• Classic findings in malignancy
• Single lesion
• Hard
• Immovable
• Irregular border
• Skin dimpling over lesion
• Size 2cm

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Imaging

• Mammography
• 35y.o.
• Ultrasound
• lt35y.o.
• Dense breasts

May be omitted in women who have lactational
nipple discharge or cyclic breast pain as long as
there is no breast mass
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Biopsy

• Essentially any solid mass

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Benign Breast Disease

• Treatment

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Fibrocystic Change

• Reassurance
• Support with appropriate bra
• Acetaminophen, NSAIDs
• Cysts can be aspirated
• May help
• ? fat, caffeine, nicotine
• Vit E, evening primrose oil
• Tamoxifen, danazol
• ? medical estrogen

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Simple Fibroadenoma

• Several options
• Follow with US
• Core bx, then nothing further
• Surgical excision not recommended
• Up-and-coming US-guided cryoablation

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Cyst

• Aspiration
• Bloody fluid ? cytology
• Non-bloody fluid ? garbage
• Follow-up US
• No recurrence ? no further intervention
• Recurrence ? surgical consult