Benign Breast Disease

Overview

Benign breast illness encompasses all nonmalignant breast disorders, such as benign tumors, trauma, mastalgia, mastitis, and nipple discharge. Through the careful utilization of existing diagnostic tests and multidisciplinary teamwork, benign breast alterations can be conclusively separated from malignant tumors.

What is Benign breast disease?

Nearly every woman will have non-cancerous (benign) breast illness at some point in her life. There are several benign conditions. Some may resemble cancer symptoms, but none are fatal. That is why it is important to understand the many forms, their symptoms, and how they are diagnosed and treated.

Epidemiology

Breast symptoms account for around 3% of all visits with general practitioners. Breast cancer is the most frequent type of cancer among women in Germany, with roughly 70 000 new cases diagnosed each year. It affects one out of every eight women at some point in their life. Breast cancer is more frequent in women of childbearing age, peaking between the ages of 30 and 50, whereas benign breast alterations are more likely in women of childbearing age.

While white women have a greater incidence of breast cancer than African American women after the age of 40, African American women have a higher incidence of early breast cancer (before the age of 40) and are more likely to die from breast cancer at all ages. African-American women have a higher risk of having a primary breast abscess, according to several reports.

Pathophysiology

The mammary glands grow from a caudal segment of ectodermal tissue known as the "milk lines," which run from the axilla to the groin on the developing fetus's front side. Pituitary and ovarian hormonal effects increase female breast development throughout puberty, mostly due to adipocyte accumulation.

Each breast has around 15-25 glandular units called breast lobules, which are separated by Cooper ligaments. A tubuloalveolar gland and adipose tissue make up each lobule. Each lobule drains into the lactiferous duct, which then discharges onto the nipple's surface. Multiple lactiferous ducts join to produce a single ampulla, which travels through the nipple and opens at the apex.

Lactiferous ducts generate extensive dilations beneath the nipple surface known as lactiferous sinuses, which serve as milk storage during lactation. When the lactiferous duct lining epidermalizes, keratin synthesis may induce duct clogging, leading in abscess development. This may explain the high recurrence incidence of breast abscesses (estimated 39 percent -50 percent) in patients treated with traditional incision and drainage, as this treatment does not address the core process through which breast abscesses are considered to form.

Postpartum mastitis is a kind of cellulitis caused by bacterial invasion of the breast through an inflamed or fissured nipple. It usually happens during the second postpartum week and is caused by milk stasis. A history of a cracked nipple, skin abrasion, or failure to clean nipples after breastfeeding is common. The posture in which you sleep may also influence the development of mastitis to breast abscess. Staphylococcus aureus is the most often isolated organism, however Staphylococcus epidermidis and streptococci have also been identified. Milk drainage from the afflicted section should be promoted, which is best accomplished by ongoing nursing or the use of a breast pump.

Nonlactating infections are classified as either central (periareolar) or peripheral breast lesions. Periareolar infections are caused by active inflammation around nondilated subareolar breast ducts, which is known as periductal mastitis. Peripheral nonlactating breast abscesses are less prevalent than periareolar abscesses and are frequently associated with an underlying illness such diabetes, rheumatoid arthritis, steroid therapy, granulomatous lobular mastitis, trauma, or smoking. Primary breast skin infections (cellulitis or abscess) most typically affect the skin of the bottom part of the breast and frequently reoccur in women who are overweight, have big breasts, or have poor personal hygiene.

Breast masses can involve any of the breast tissues, including the overlaying skin, ducts, lobules, and connective tissues. Fibrocystic disease, the most prevalent breast mass in women, is identified in 60-90 percent of autopsied breasts. The most frequent benign tumor, fibroadenoma, generally affects women aged 30 years or younger and accounts for 91% of all solid breast tumors in females less than 19 years.

The most prevalent type of malignant tumor is infiltrating ductal carcinoma; nevertheless, inflammatory carcinoma is the most aggressive and has the worst prognosis. Mammary Paget disease, also known as adenocarcinoma of the nipple epidermis, is very uncommon but might be misinterpreted as a benign dermatosis if certain precautions are not followed.

Common Benign Breast Conditions

There are other benign breast conditions, however the ones listed here are the most frequent. While none of these illnesses are directly connected to breast cancer, they may raise your risk. If you are diagnosed with any of these conditions, you should see your breast specialist very away.

Adenosis

The lobules (milk glands) grow and proliferate as a result of this disorder. It is frequently encountered in women with fibrosis or simple cysts. When the lobules are close enough together to form a lump, it is sometimes misdiagnosed as breast cancer.

Symptoms of adenosis may include:

A lump that can be felt through the nipple or skin
Small white calcium deposits (calcification)

No treatment is required for adenosis.

Duct Ectasia

This syndrome causes the lobules (milk glands) to grow and proliferate. It is frequently encountered in women who have fibrosis or simple cysts. When the lobules are close enough together to feel like a lump, it is sometimes misdiagnosed as breast cancer.

Symptoms of duct ectasia may include:

Nipple discharge
Pain, swelling, and/or tenderness
A lump behind the affected duct
An inverted nipple

Duct ectasia is generally a normal component of aging and may not necessitate further treatment. Antibiotics and over-the-counter pain medications may be prescribed by your doctor at times. Surgery may be necessary in rare circumstances.

Ductal or Lobular Hyperplasia

Breast hyperplasia is defined as the abnormal proliferation of benign cells in the breast. This disorder can manifest itself in the breast ducts (ductal hyperplasia) or the milk glands (lobular hyperplasia). It can be classified as "ordinary" (the cells appear normal) or "atypical" (the cells look distorted). Ductal or lobular hyperplasia is frequently asymptomatic. There is no need for therapy.

Fat Necrosis and Oil Cysts

Fat necrosis and oil cysts are both caused by fatty breast tissue injury. When the body replaces breast tissue with hard scar tissue, this is referred to as fat necrosis. Oil cysts form when cells die rather than forming scar tissue and releasing their contents.

Symptoms of fat necrosis and oil cysts may include:

A lump that can be felt through the nipple or skin
Redness, bruising, and/or swelling

No treatment is required for fat necrosis and oil cysts unless the lumpy area becomes irritating, in which case surgery may be done.

Fibroadenomas

Fibroadenomas are noncancerous breast tumors made up of both fibrous and glandular tissue. They are more prevalent in premenopausal women in their twenties and thirties. Fibroadenomas are often tiny, spherical, and hard or rubbery. They have the ability to grow, shrink, and disappear on their own. There are no further symptoms associated with fibroadenomas. There is no need for therapy.

Fibrocystic changes

Fibrocystic changes refer to a group of clinical and histological alterations in the female mammary gland, some of which should be recognized as a disturbance of physiological development, maturation, and involution rather than a disease. Both of these disorders are very frequent among women of childbearing age. Fibrosis might be stiff or rubbery, whereas cysts can be spherical and delicate. Either of these might be misinterpreted for malignant tumors.

Symptoms of fibrosis and simple cysts may include:

Pain, swelling, and/or tenderness
A lump that can be felt through the nipple or skin

Breast cysts

Breast cysts are fluid-filled enlargements of the terminal duct that are coated with a single layer of epithelium. They are detected as an accidental discovery during imaging or on histological examination of a breast biopsy specimen by probing of a lump (smooth, elastic, movable). Pathognomonic ultrasonography reveals cysts as well-circumscribed, oval to circular, anechoic or hypoechoic foci of varying size. Aspiration is only required for big lesions causing chronic symptoms.

The color and viscosity of cyst fluid vary greatly, from a clear, thin secretion to a white, opaque secretion to a dirty-green, blue, or gray secretion; the color has no diagnostic value. Cysts arise as a result of hormonal changes and usually disappear during menopause. Simple cysts must be differentiated on ultrasonography from so-called complicated cysts, which have a 23% to 31% risk of malignancy and must be histologically studied.

Intraductal Papillomas

These are noncancerous tumors that develop within the milk ducts. They are typically less than 1 centimeter in length, but can develop to be 5 or 6 centimeters in length. Fibrous tissue, gland tissue, and blood vessels make up their structure. They are most common in women between the ages of 30 and 50.

Symptoms of intraductal papillomas may include:

Nipple discharge (clear or bloody)
A lump that can be felt through the nipple or skin

Treatment will usually involve removing the papilloma with minor surgery.

Lobular Carcinoma in Situ (LCIS)

LCIS occurs when cells that mimic cancer cells begin to proliferate inside the breast milk glands. LCIS, unlike cancer, stays inside the milk glands rather than infiltrating adjacent healthy tissue. While this disease is not dangerous, it does increase your chances of developing breast cancer.

There are no further symptoms associated with LCIS. However, because it is linked to an increased risk of getting breast cancer, you should visit your doctor.

Mastitis

Mastitis is an infection-induced inflammation of the breast. Breastfeeding mothers are more likely to be affected. It is most usually caused by blocked milk ducts or a failure to adequately drain the milk from the breast. Infection can also occur as a result of injured skin on the nipple.

Symptoms of mastitis may include:

Pain, swelling, redness, and/or tenderness
Warmth and hardening of infected area
Nipple discharge
Fever and headache

Treatment will usually involve an antibiotics course. If an abscess develops, your doctor may drain the pus using a needle or surgery.

Benign breast disease symptoms

Pain can be caused by several benign breast diseases. Some will go undetected unless you feel a lump or your doctor notices it during a regular mammography.

Here are common symptoms of each condition:

Breast fibrocystic changes: Your breasts will feel lumpy. These lumps are composed of fibrous, rubbery, thick tissue or a fluid-filled cyst.
Cysts are fluid-filled lumps in your breasts that can be painful to touch. You may notice that they emerge and then disappear when you get your period.
Fibroadenomas feel like little, spherical, moving marbles in your breast.
Mastitis can cause a lump to form. The lump might be red and heated. Mastitis is frequently accompanied by a fever.
Fat necrosis is characterized by a circular, firm lump. It occurs when fatty tissue hardens. It is frequent among highly overweight women. These lumps might sometimes be the consequence of a breast injury. It might be made of fluid fat.
Calcification: These small, hard areas may or may not be felt. They are caused by hardened calcium deposits in your breast. It is not caused by consuming an excessive amount of calcium. The vast majority are harmless. Some calcification, however, can be a symptom of malignancy.
Nipple discharge: The fluid emitted by your nipple may be of various hues. A clear or milky color indicates a hormonal imbalance. If the discharge is green-black, it might be due to a clogged milk duct. If the discharge is bloody, it may be the result of an accident, infection, or benign tumor. It has also been linked to breast cancer.
Male gynecomastia: When a guy is diagnosed with this illness, his breasts may become enlarged and sensitive. They may, however, be asymptomatic.

Mastalgia

Mastalgia (also known as mastodynia) is the term used to describe discomfort in the mammary gland that occurs either spontaneously or in reaction to contact. Mastalgia is divided into two types: cyclic and noncyclic. Extramammary chest discomfort, such as intercostal neuralgia, and pain from cardiac or vertebrogenic sources should be ruled out as differential diagnosis.

More than half of all women feel considerable breast discomfort, which in 30% to 40% of instances interferes with their daily and sexual lives (e5). In two-thirds of instances, the pain is cyclic and worst a week before and after menstruation. Cyclic mastalgia appears around the age of 30; noncyclic mastalgia appears much later, at the age of 41 on average. It is unknown what causes mastalgia.

The fact that cyclic mastalgia improves in conjunction with hormonal changes, such as menopause, pregnancy, and breastfeeding, suggests a hormonal basis. In a woman suffering with noncyclic mastalgia, inflammatory, neoplastic, and vascular breast illness must be ruled out. Following breast cancer therapy, 30% of women experience persistent noncyclic mastalgia, particularly those who are premenopausal, have a high BMI, or have a concurrent psychiatric disorder.

Diagnosis

You may become aware of an issue with your breast. Occasionally, your doctor will notice a problem during a routine exam or screening. When you see your doctor, he or she will ask you questions regarding your symptoms. Your doctor will inquire about your family history of breast cancer and non-breast cancer, as well as do a physical examination of your breasts.

Additional tests may be required to rule out cancer. These examinations may include a mammography or an ultrasound. Your doctor can check inside your breasts using ultrasound technology by gliding a tiny wand-like instrument around the exterior of them. Your doctor may also advise you to have the lump removed surgically, or to have a tiny needle biopsy or aspiration.

This is a process in which a tiny needle attached to a syringe is placed into the lump to extract a sample of tissue or fluid from it. A hospital is where surgery and biopsies are performed. Your biopsy will be submitted to a lab for analysis. Your doctor will be notified of all test findings. He or she will contact you to inform you of the results.

The American Academy of Family Physicians (AAFP) recommends the following:

A routine mammography every other year for women between the ages of 50 and 74.
The use of ultrasound instead of a mammogram in young women with dense breast tissue and a lump.
Mammograms in women older than 40 if a fine needle biopsy shows a lump is solid. If a cyst can be drained successfully with a fine needle biopsy, no further evaluation of that cyst is needed.

If the findings of the physical exam and fine needle biopsy show that the breast disease is benign, a follow-up physical exam should take place in 4 to 6 weeks.

Complications

Potential complications are as follows:

Mastitis - Breast abscess development occurs in fewer than 10% of patients.

Breast abscess - Repeated infection, scarring, loss of breast size, and visible breast asymmetry

Chronic breast abscess - Mammary duct fistulization, nipple-areolar complex excision

Prognosis

Breast mass: Patients with fibroadenoma have a great prognosis, but those with inflammatory breast cancer have a bad prognosis. Tumor size, histology, nodal involvement, distant metastases, and concomitant diseases are all considerations to consider.

Breast abscess: Unfortunately, even treated with normal incision and drainage, the recurrence rate of breast abscess is substantial (39 percent -50 percent), and studies have indicated even greater recurrence rates in women receiving fine-needle aspiration. Nonpuerperal abscesses recur more frequently, especially when associated with non-staphylococcal species (recurrence rate more than 50%). Fistulectomy patients have a decreased recurrence rate,

Mastitis: The majority of individuals see improvement within 2 to 3 weeks. All individuals whose symptoms have not improved after 5 weeks should be checked for resistant infection or cancer.

Benign breast condition treatments

If you have fibrocystic breast changes, your doctor may advise you to use birth control tablets to minimize fluid buildup.
Fibroadenomas: Because this is frequently associated with the use of birth control pills, your doctor may recommend an alternative method of birth control. If the problem is uncomfortable, your doctor may recommend surgical removal of the mass. If it is not painful or growing, your doctor may advise you to leave it alone.
Cysts: Your doctor may use a tiny needle aspiration to remove part of the fluid that is causing the cyst to hurt. If the cyst is a chronic condition, your doctor may recommend surgical removal.
Mastitis: Because this is an infection, your doctor will prescribe medications, offer an over-the-counter fever reducer, and advise you to put a warm cloth to the lump to ease soreness.
Fat necrosis: Fat necrosis usually does not require additional treatment. If it includes fluid (called an oil cyst), your doctor will most likely use a tiny needle aspiration to empty the fluid from the cyst.
Calcification: These small, white spots on your mammogram may be examined by your doctor. If the spots do not appear to be cancerous, he or she will most likely do nothing else. If your doctor suspects cancer, he or she may perform (or recommend) a surgical or tiny needle biopsy.
Treatment for nipple discharge will be determined by the underlying reason of your nipple discharge (lump, infection, or cancer).

Can benign breast conditions be prevented or avoided?

Benign breast problems cannot be avoided or prevented. Your ancestors' genes have the most influence on your breast health. You can, however, reduce your chances of developing certain illnesses. Consider decreasing weight if your benign breast problem is caused by being overweight. If you think it's because you're using hormones or birth control pills, talk to your doctor about different medication choices. In rare situations, your doctor may advise you to use birth control tablets to treat a benign breast issue.

Conclusion

Most women have benign breast problems, which are quite frequent. In truth, the majority of breast alterations are harmless. Unlike breast cancer, benign breast disorders do not pose a threat to one's life. However, some have been linked to an increased risk of developing breast cancer later in life. Pain, a palpable lump, and nipple discharge are common presenting symptoms that can be caused by a wide range of benign differential diagnoses and necessitate focused diagnostic imaging in addition to a thorough history and clinical examination.

The treatment of benign breast alterations comprises clinical, radiographic, and, if necessary, histological diagnostic examinations to rule out malignancy; symptom relief; and counseling and monitoring of people at high risk of breast cancer.