Breast Conditions

Benign breast disorders

These are benign conditions as part of the ANDI spectrum (Aberrations of Normal Development and Involution), relating to the normal processes of breast development and changes during reproductive life.

Fibroadenoma

This is the most common breast presentation. Fibroadenoma are benign breast lumps that are predominant in the 15-25 age group. It often grows to 1-2 cm then usually maintains a stable size. ~30% will decrease in size or disappear and <10% will enlarge.

Fibroadenoma are commonly present as a single lesion but up to 15% patients can develop multiple fibroadenoma. There is no increase risk of breast cancer. Multiple fibroadenoma can be associated with some rare cancer syndromes including Cowden, Maffuci and Carney and should be removed in these circumstances.

Fibroadenoma can enlarge rapidly during pregnancy or when there’s increase of hormone influence. A biopsy to prove the benign nature of the lump is required, then observation is the common pathway. Giant fibroadenoma is fibroadenoma larger than 5 cm.  An operation would only be indicated if the lump is >4cm, enlarging rapidly or has a suspicious biopsy result.

Phylloides

Larger than fibroadenomas but similar clinically. Operation would always be indicated. There is a small risk of malignancy.

Cyst

Common in pre-menopausal women. ~ 30 % of women age between 20-50 have cysts in their breasts. Only 7% present with a palpable lump in the breast. These can be painful and can be aspirated for symptomatic relief. A simple cyst will need no intervention however if the cysts have an atypical appearance on ultrasound, a biopsy or excision will often be recommended.

Mastalgia (Breast pain)

Experienced by ~70% of women. Less than 5% women with breast cancer actually present with breast pain. There are several theories of mastalgia causes, such as too much oestrogen, not enough progesterone, too much prolactin, abnormal fatty acids/increased receptor sensitivity.

Nipple discharge

A common clinical presentation. The cause is benign in most cases.

Breast Abscess/ Mastitis

Mastitis is the inflammation of the breast tissue with or without bacterial infection. Presenting symptoms include breast pain, swelling, redness and possible flu-like symptoms such as fever, lethargy, nausea, and muscle pain. It is a common sequelae of breast feeding. Other causes include trauma, unresolved blocked duct, overall poor health and nutrition.

Breast abscess is a collection of pus in the breast which can be a complication of mastitis. It is important to differentiate mastitis with inflammatory breast cancer, a rare but aggressive form of breast cancer that can mimic signs and symptoms of mastitis. Therefore, you must seek medical attention as soon as possible to initiate investigation and appropriate treatment.

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