Benign Breast Diseases
About these conditions
- Benign breast conditions are very common and most women have them.
- It is important to understand that 80% of breast lumps – biopsied – are benign.
- That means they cannot spread and are not life-threatening.
- But very few are linked with a higher risk of getting breast cancer.
Treatment of Fibroadenoma
- Fibroadenomas are most common benign breast tumors in young women.
- Commonly seen between 15-30 years of age group.
- Classic presentation is painless, firm, freely mobile lump (Known as breast mouse)
- Fibroadenomas have no additional risk for malignancy.
- There are no medications that will make them disappear.
- Some fibroadenomas stop growing or shrink over time.
How are fibroadenomas diagnosed?
- Fibroadenoma is usually felt during self breast examination.
- Diagnosis is made on ultrasound of breast, If women is over 35years, mammography is advised.
- A core needle biopsy or FNAC is done to confirm the diagnosis and rule out a malignancy.
Treatment for fibroadenoma
- All breast fibroadenomas do not require surgery.
- If fibroadenomas are large or are causing the patient concern, they may require surgical removal with Hidden scar lumpectomy or VABB (Vaccum Assisted Excision) – A scarless fibroadenoma surgery.
- Surgery for fibroadenoma is a day care procedure.
- A cosmetic incision is made around the nipple or inframammary crease to remove the fibroadenoma.
Treatment of Breast Cyst
- Cysts are fluid filled round or oval sacs within the breasts.
- They can be single/multiple, Unilateral/ Bilateral.
- They are most often found in women in their 40’s, but they can occur in women of any age.
- Monthly hormone changes can cause cysts to get bigger and become painful and sometimes more noticeable just before the menstrual period.
Treatment of Breast cysts:
- Breast cysts don’t require treatment unless a cyst is large and painful or uncomfortable. In that case, aspiration of the cyst is done to dryness.
- After aspiration, we examine the patient for residual mass. If there is residual mass, we do FNAC from that.
- 30% of cysts will recur and will require reaspiration.
- Review patient 4 to 6 weeks after aspiration to check for refilling.
- Complex breast cysts may need surgical excision.
Treatment of Breast Pain
- Breast pain, also called as Mastalgia, is a common condition among women.
- The pain is either cyclical or noncyclical.
- Cyclical pain is associated with your menstrual cycle and subside after your periods.
- Noncyclical pain can have many causes, including injury to the breast.
- Sometimes noncyclical pain can come from surrounding muscles or tissues rather than the breast itself.
Is breast pain linked to breast cancer?
Breast pain is not usually linked to breast cancer. However donot ignore, as 7% of breast cancer have mastalgia as only symptom. Treatment for cyclical pain will vary depending on whether your breast pain is cyclical or noncyclical which may include:
- wearing a supportive bra 24 hours a day
- taking calcium supplements
- taking oral contraceptives, which may help to make your hormone levels more even
- taking estrogen blockers, such as tamoxifen
- taking medications to relieve pain, including NSAIDs such as ibuprofen or acetaminophen
- Vitamin E or Evening Primrose Oil might help
Diet: Avoid caffeine, decrease fat intake, lower salt intake, avoid chocolates and soy.
Treatment for noncyclical pain will depend on the cause of the breast pain. Once the cause is identified, your doctor will prescribe specific related treatments.
Treatment of Nipple Discharge
Many women get spontaneous and persistent nipple discharge in response to hormonal changes.
Things to note:
- Bilateral vs. Unilateral
Color – green, bloody, clear, milky
Spontaneous vs stimulated
Single duct vs. multiple ducts
Causes of Nipple discharge
1.Physiological Causes:
Hyperprolactinemia: Some medicines such as antidepressants, antihypertensives and synthetic hormones can stimulate the pituitary gland to release prolactin and trigger nipple discharge.
2.Pathological Causes:
- Intraductal papilloma: This is a wart-like growth that grows in the milk duct of the breast and is the most common cause of single duct bloodstained nipple discharge, usually in just one breast.
- Duct ectasia: With age, the milk ducts in the breasts become shorter, wider and harder. Duct ectasia is the most common cause of multi-duct thick, bloodstained or clear nipple discharge in women reaching the menopause.
- Mastitis or an abscess can cause pus-like nipple discharge.
- Breast cancer. A rare type of cancer called Paget’s disease of the nipple can cause nipple discharge. Only one breast is usually affected and the nipple discharge may be bloodstained.
Treatment:
The treatment options depend on the cause and type of the discharge.
Microdochectomy is a surgical procedure in which a single duct is removed from the nipple areolar complex. It is usually undertaken when a patient has nipple discharge from a single duct.
Total Duct Excision is a surgical procedure for patients who have discharge from multiple ducts
Treatment of Breast Abscess
A breast abscess is a localised collection of pus in the breast tissue. It is usually caused by a bacterial infection. Mastitis or breast abscess most often affects breastfeeding women. It can also happen in women who are not breastfeeding, but this is less common.
Treatment of Acute Mastitis or Breast Abscess:
You will have an ultrasound scan of your breast to check for an abscess. The pus can be drained from an abscess with either:
• Simple Needle Aspiration using a wide bore needle under local anesthesia
• Ultrasound guided drainage with drain placement
• Large abscesses may need to be treated with a small surgical cut in your skin
• Antibiotics are usually needed to treat the infection that caused the infection.
Can I still breast feed with an abscess or mastitis?
• If you have mastitis, it is usually safe to continue to breast-feed your baby as normal from both breasts. Breast feeding will help to clear the milk ducts in the affected breast, relieve symptoms and help prevent a breast abscess.
• If you have a breast abscess breast feeding may be painful or difficult. Breast feeding can continue from the affected breast as long as any drainage procedure does not interfere with breastfeeding. It may be recommended that you express breast milk using a breast pump.
Treatment of Atypical Hyperplasia
This is a precancerous condition that affects cells in the breast. Atypical hyperplasia isn’t cancer, but if you’ve been diagnosed with atypical hyperplasia, you have an increased risk of developing breast cancer in the future.
It can affect ducts—atypical ductal hyperplasia or lobules—atypical lobular hyperplasia.
This is generally treated with surgery to remove the abnormal cells and to make sure no in situ or invasive cancer also is present in the area. We often recommend more intensive screening for breast cancer and medications to reduce your breast cancer risk.
Accessory Breast Excision
A prominent axillary mound may first become symptomatic during pregnancy. Such mounds may also undergo cyclic changes during the menstrual period. Occasionally, they are totally asymptomatic. This is often misdiagnosed, with lipoma.
Patients diagnosed with accessory axillary breast tissue generally request surgical removal of the mass for cosmetic reasons.
Gynecomastia
The enlargement of breast tissue in males is called gynecomastia. Gynecomastia occurs when there is an imbalance of hormones estrogen and testosterone.
There is enlargement in the breasts due to enlargement of glandular tissue and not the fat tissue. It is a common condition among boys and men.
Gynecomastia is not a serious condition but it is a condition that might be embarrassing to cope with.
Causes of Gynaecomastia:
• Natural hormonal changes
• Medications such as anti anxiety medications, steroids and heart drugs
• Drugs such as heroin and marijuana
• Alcohol
• Obesity
• Health conditions such as aging, tumors, kidney failure
• Liver disease
• Use of herbal products such as tea tree oil or lavender oil.
Treatment of Gynecomastia:
In most cases of gynecomastia, no treatment is required. It regresses itself over a period of time. If it is caused due to medication, stopping the medication will restore the hormonal balance and the condition gets treated. Surgical treatments are successful in men with painful and persistent gynecomastia.
Surgery Options of Gynecomastia:
• Liposuction.
• Excisional surgery.
• Minimally invasive surgery
• Combined suction lipectomy with gland excision.
What is the success rate of Gynecomastia surgery?
The results of Gynecomastia surgery are permanent. Taking care of self with diet and exercise will help sustain the results achieved.
