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Benign Breast Disease Information

There are many benign diseases of the breast. They can cause a number of symptoms such as lumps, swelling, skin changes, pain or tenderness and nipple discharge. The surgeons at Brisbane Breast and Endocrine Surgeons are experienced in the assessment and management of breast disease and determining whether symptoms are due to a benign disease or a cancer.

Common benign breast conditions managed include:

Benign Breast Lumps – Fibroadenomas, Cysts

Breast Cysts
Breast cysts make up 15% of all breast lumps. They are fluid filled lumps in the breast. The incidence of breast cysts increases up until menopause. They can be multiple and occur in both breasts. Cysts can appear suddenly. They are influenced by female hormones and can fluctuate in size. They are not associated with an increased risk of breast cancer. Sometimes management includes aspiration of the cyst.

A complex cyst is one that has an unusual appearance on ultrasound. It may have a solid component or a septation (band of tissue within it). A complex cyst is usually investigated with aspiration or biopsy. Occasionally it may require surgery.

Fibroadenomas
Fibroadenomas are a benign tumour of the breast and the most common cause of a breast lump in young women.

Management of fibroadenomas usually involves a biopsy to confirm the diagnosis and then observation. Excision may be performed if there are any doubts as to the nature of the lump, if it is large, if it is increasing in size or if it is causing symptoms. It may be a patient’s preference to have a fibroadenoma excised.

It can be difficult to differentiate between a fibroadenoma and another type of breast tumour called a phyllodes tumour. Phyllodes tumours can be benign, borderline or malignant. If a fibroadenoma is found to be enlarging, excision is usually recommended in order to exclude a phyllodes tumour.

Fibroadenomas contain breast cells and like anywhere else in the breast can develop cancer. The risk of developing a cancer in a fibroadenoma is no more than elsewhere in the breast.

Fibrocystic Change

Fibrocystic change occurs in up to 90% of women. It used to be known as fibrocystic disease however it actually represents an exaggerated response of the breast tissue to hormones and growth factors circulating in the body. This results in the formation of both small and large cysts, increased amounts of fibrous tissue and on a microscopic level, changes in the cells.

Fibrocystic change can cause breast pain, lumpiness and tenderness. Because the tissue is dense and lumpy it can make both examination by your doctor and imaging difficult to interpret.

Breast Pain (Mastalgia)

Mastalgia is a very common condition, affecting up to 70% of women at some time in their lives. In fact, it is so common that it is considered to be a normal condition of the breasts rather than a disease. It can be accompanied by tenderness, lumpiness, fullness, heaviness or a noticeable change in breast size. It is commonly associated with fibrocystic change. Reassuringly it is rarely a sign of breast cancer. Only 5% of breast cancers present with pain.

Cyclical mastalgia occurs in premenopausal women and is pain fluctuating with the menstrual cycle. It can also occur in postmenopausal women on hormone replacement therapy. Discomfort tends to increase from the middle of the cycle, peaks in the week prior to menstruating and is then relieved when the period begins. It tends to be worse in the upper outer parts of the breast and may affect both or only one breast.

Mastalgia can also affect postmenopausal women. It tends to occur in one part of the breast and can have a burning, stabbing or throbbing quality. It can be intermittent or constant.

If you suffer from breast discomfort it is very useful for your surgeon if you document your pain in a diary to determine whether it is cyclical in nature.

Mastalgia can be difficult to manage. Your surgeon will do a thorough assessment to exclude other causes of your pain or discomfort and will then discuss management with you.

Nipple Discharge

Nipple discharge can be caused by a number of conditions. If occurring in both breasts it can be due to production of milk – either the result of normal lactation, due to hormonal imbalances (overproduction of prolactin, hypothyroidism) or the result of certain medications. Duct ectasia (dilation of ducts) can also cause discharge from both breasts; it tends to be green-brown in colour.

Discharge from one duct on one nipple more commonly needs surgical treatment. The most common cause is a ductal papilloma (benign polyp of the duct). Other causes include duct ectasia and breast cancer (only 5% of cases of nipple discharge). Your surgeon will assess your nipple discharge and recommend appropriate management. This usually includes a mammogram and ultrasound and may include sending some of the fluid for assessment. This is known as cytology and is obtained by smearing the discharge on a glass slide. You may require an operation to remove the abnormal duct.

Breast Infections (Mastitis)

Mastitis most often occurs in breastfeeding women. Lactational mastitis (as it is known) is due to the spread of bacteria from the baby’s mouth or mother’s skin into the breast. The milk provides an excellent environment for bacterial spread and growth. Mastitis may develop into an abscess if it is not treated appropriately.

Symptoms of mastitis include redness of the breast, pain, fever and generally feeling unwell. Early antibiotic treatment is very important. Your surgeon will examine you to determine whether an abscess is developing. Abscesses are usually treated by aspiration with a small needle. This may need to be done a number of times. Occasionally admission to hospital for intravenous antibiotics is needed. It is important to continue breastfeeding your baby during this time. If this is difficult, expressing is an alternative. The milk and antibiotics prescribed in most circumstances do not cause any harm to your baby.

Mastitis can also occur in non-breastfeeding women. This is usually in association with duct ectasia. The dilation of ducts is often associated with surrounding inflammation, which can develop into an infection. This is treated with antibiotics. Abscesses may be treated by aspiration but more commonly require surgery.

The surgeons at Brisbane Breast and Endocrine Surgeons are able to perform ultrasound guided aspiration of abscesses during your consultation.

Treatments for Benign Breast Disease

Upon consultation with your surgeon, an assessment will be made as to the likely cause of your symptoms and whether further investigation is warranted to confirm a benign condition.

 This assessment will include details of your symptoms and past history along with a careful breast examination. Referral for imaging such as ultrasound and mammogram may be organised if not already performed. A biopsy may be required and in some circumstances surgery may be recommended.

Assessment of abnormal breast screening results

Your general practitioner may refer you to Brisbane Breast and Endocrine Surgeons for assessment of abnormal breast screening. A thorough assessment will be made and may require further investigations including biopsy.

The specialists are able to perform ultrasound assessments of the breast, and needle biopsies (if required).

Surgery may be required to determine the nature of the abnormality.

Please note that all care has been taken in providing the information on this site. It is intended for background information and should not be used to make any medical care decisions. You should always consult with your medical providers for all specific advice on your medical treatment.