Breast Lesions, Benign

• • Types of lesions include:

  • -Mammary dysplasia (fibrocystic disease)

    -Fibroadenoma of the breast

    -Intraductal papilloma

    -Fat necrosis and mastitis

    -Breast abscess

Epidemiology

• • Fibrocystic disease is most frequent lesion of the breast; common from 30 to 50 years of age but rare after menopause

  • Fibroadenoma occurs more frequently in blacks than whites

  • Only 50% of patients with fat necrosis report antecedent trauma

  • Subareolar abscess can develop spontaneously in young or middle-aged women who are not lactating

Symptoms and Signs

Fibrocystic Disease

• • Painful, multiple, bilateral masses

  • Rapid fluctuation in mass size

  • Symptoms increase during premenstrual phase of cycle

Fibroadenoma

• • Round, firm, discrete, mobile mass

Intraductal Papilloma

• • Unilateral bloody nipple discharge

Fat Necrosis

• • Mass with associated skin or nipple retraction; tenderness and ecchymosis occasionally seen

Mastitis/Breast Abscess

• • Area of erythema, tenderness, and induration

  • Localized mass

Imaging Findings

• • Mammography often unreliable due to dense breast parenchyma in this age group

  • US can distinguish solid from cyctic mass

• • Nursing can continue with mastitis but should be discontinued with breast abscess

  • Most common causative pathogen in mastitis and breast abscesses is Staphylococcus

Rule Out

• • Breast carcinoma

  • Inflammatory breast carcinoma (when signs of breast abscess in the nonlactating breast)

• • Complete history (including family and reproductive) and physical exam

  • Mammography or US

  • Biopsy if any possibility of cancer

Surgery

Indications

• • Persistent dominant mass; mass after cyst aspiration

  • Suspicious cytologic studies or biopsy results

  • Fibroadenoma (excisional biopsy)

  • Intraductal papilloma (total excision through circumareolar incision)

  • Fat necrosis

  • Subareolar abscess in the nonlactating breast

Medications

• • Danazol: Synthetic androgen; can reduce pain

  • Symptomatic relief with vitamin E and with discontinuation of caffeine

  • Antibiotics for mastitis/abscess

Treatment Monitoring

• • Self breast exams

  • Annual clinical breast exams

  • Annual bilateral mammogram

Prognosis

• • Excellent

References