Benign breast disease

^T^^B^D: Breast tissue changes ranging from normal to abnormal, either in development, cyclical change or involution phases. Includes fibrocystic change, breast ^^ cysts, fibroadenomas, sclerosing adenosis, intraductal papillomas, duct ectasia, periductal mastitis and fat necrosis.

Related to changes in response to hormones or unknown factors.

Fat necrosis occurs secondary to trauma, which causes rupture of fat cells.

^^ |a/R: May be less common in those on OCP. Smoking is a risk factor for periductal mastitis.

Very common. Diffuse fibrocystic changes are very common, being seen in as many as 60% of women, and 70% experience mastalgia. Fibroadenomas are more common in 15-35 years.

History of breast discomfort or pain (cyclical or noncyclical mastalgia), swelling or lump. Nipple discharge (if bloodstained, malignancy should be suspected). Risk factors for breast cancer should be ascertained including family history, menstrual history, pregnancies, use of OCP or hormone replacement therapy.

Focal or diffuse nodularity of breasts.

Fibroadenomas are usually smooth, well circumscribed and mobile lumps ('breast mouse'). Yellow/green nipple discharge (duct ectasia). Features of malignancy are absent, e.g. dimpling, peau d'orange skin changes, enlarged axillary lymph nodes.

ANDI classification maps benign conditions between normality, through benign disorders to benign breast disease.

Fibroadenoma: Result from hypertrophy of a breast lobule, contains both epithelial and connective tissue elements. There may also be apocrine hyperplasia.

Fat necrosis: Irregular adipocytes with intervening pink amorphous material and inflammatory cells, including foreign body giant cells responding to the necrotic fat cells, often mimics malignancy. Sclerosing adenosis is an aberration of normal involution. Duct ectasia is when central ducts become dilated with ductal secretion; this may leak into periductal tissues and cause an inflammatory reaction (periductal mastitis).

Usually performed in the context of triple assessment:

1. Clinical examination.

2. Imaging: Mammography (craniocaudal and oblique mediolateral views) or USG in younger patients (< 35 years). Benign masses are less likely to be calcified (microcalcifications are highly suggestive of malignancy).

3. Cytology/histology: By FNA cytology or trucut or excision biopsy.

Conservative: Symptomatic treatment, e.g. analgesia, evening primrose oil (a rich source of gammalinoleic acid) for mastalgia. Advice on wearing supportive bra and diet (that is rich in PUFA are thought to suppress hormone interaction with breast tissue). Danazol is used as second-line treatment. Fibroadenomas may be treated conservatively or removed if large or on request.

Surgery: Includes removal or excision biopsy of breast lump; a wide local excision shoud be performed if there is any suspicion that it is not benign. Microdochectomy is performed for intraductal papillomas. Hadfield's (or Adair's) operation excises central ducts in duct ectasia.

Pain, recurrence.

Good, although recurrence is common.

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