Benign breast conditions encompass nonmalignant disorders of the breast. The pathogenesis of these conditions is poorly understood, and little research is being done because most efforts are appropriately being directed toward breast cancer. However, there are large numbers of women with benign breast conditions, and the treatment of mastalgia/mastodynia is currently difficult; therefore more research is required in this area. This chapter summarizes benign breast conditions and outlines their diagnosis and management.
Fibrocystic disease has been used as a generic term to describe symptoms and fails to encompass the extent of the histologic changes. The aberration of normal development and involution (ANDI)1 was published in 1987 to help define patients' problems in terms of pathogenesis, histology, and clinical implications.2
The concept of the ANDI is based on the fact that benign breast disease arises from normal physiology (Table 16-1). The horizontal headings show the spectrum of benign conditions—normal to mild abnormality ("disorder") to severe abnormality ("disease"). The vertical headings define the pathogenesis of the conditions.3
Table 16-1 ANDI Classification ||Download (.pdf)
Table 16-1 ANDI Classification
|Reproductive Period||Normal →||Disorder →||Disease →|
|Development||Ductal development||Nipple inversion||Mammary duct fistula|
|Lobular development||Single duct||Giant fibroadenoma|
|Cyclical change||Hormonal activity||Mastalgia|
|Pregnancy and lactation||Epithelial hyperplasia||Blood-stained nipple discharge|
|Lactation||Galactocele and inappropriate lactation|
|Involution||Lobular involution||Cysts and sclerosing adenosis||Periductal mastitis with suppuration|
|Ductal involution||Nipple retraction||Lobular hyperplasia with atypia|
|Fibrosis||Duct ectasia ||Ductal hyperplasia with atypia|
|Dilatation||Simple hyperplasia micropapillomatosis|
|Involutional epithelial hyperplasia|
At the onset of puberty, estrogen is a major influence in the development of the breast by stimulating ductal growth. During the menstrual cycle, the cyclical secretion of progesterone facilitates the lobuloalveolar growth marking the developmental period. Typically, these changes are noted through the menarchal period (15-25 years old). During this period, nipple inversion, juvenile hypertrophy, and fibroadenomas are seen.1
Nipple inversion can occur during the development of terminal ducts. This results in the lack of protrusion of the ducts and areola. Nipple inversion predisposes to terminal duct obstruction, which may lead to subareolar abscesses.
Juvenile hypertrophy is a rare condition. The spectrum can range from a small breast to massive gigantomastia in peripubertal females. The etiology of juvenile hypertrophy is unknown; however, there is a hormonal basis to the condition. Baker and associates described that tamoxifen may be a useful adjunct when combined with reduction mammoplasty for the ...