Benign Breast Diseases - Diagnosis & Management

Benign Breast Conditions

1. 
Benign Breast Conditions
NURS 541:
Women’s
Healthcare –
Diagnosis and
Management

2. Benign Breast Conditions
Most common breast conditions
Mastalgia
Nipple discharge
Benign breast masses
Sensitive topic for women!
Fears and concerns re: breast cancer first and foremost

3. Mastalgia
Benign in >90% of cases of breast pain
Classified as cyclic (~70%) and non-cyclic (~30%)
Etiologies
Menstrual cycle hormone changes
Hormonal contraception methods, hormone replacement
Other medications (antidepressants, digoxin, methyldopa,
spironolactone, oxymetholone, chlorpromazine)
Fibrocystic breast changes

4. Mastalgia
History
Cyclic or non-cyclic
Timing and character
Unilateral or bilateral
Quality of pain
Physical exam
Comprehensive breast
exam
Exam of chest wall
Diagnostic testing
Pregnancy test!
Mammogram if indicated,
to rule out malignancy
Differential diagnosis
Chest wall abnormalities
Costochondritis
Pleuritis
Mastitis
Shingles

5. Mastalgia
Management
Non-pharmacologic measures
Reassurance!!
Reduction in caffeine, fat (mixed evidence)
Wearing a supportive, well-fitting bra (strong evidence)
Pharmacologic measures
Changing hormonal method, dose, route
Danazol, tamoxifen, bromocriptineeffective (Danazolonly FDA
approved treatment for mastalgia)
Significant side effects may outweightbenefits
Evening primrose oil, Agnuscastus, isoflavones(mixed evidence)

6. Nipple Discharge
Classified as:
Normal lactation
Milky discharge unrelated to childbearing
Non-milky discharge (pathologic discharge)
Etiologies
Pregnancy/lactation
Galactorrhea
Intraductalpapilloma
Mammary duct ectasia
Cancer

7. Nipple Discharge
History
Unilateral or bilateral
Duration, timing
Character of discharge
Spontaneous or expressed
One or more ducts
Other breast symptoms
Exam
Comprehensive breast
exam
Diagnostic testing
Spontaneous, bilateral, milky
discharge:
Pregnancy test
Serum prolactin, TSH
Brain MRI if prolactin
Spontaneous, unilateral,
uniductaldischarge:
Mammogram or ultrasound
Expressed only
None needed

8. Nipple Discharge
Differential diagnosis
Sexual stimulation
Infection, abscess
Paget’s disease
Management
Reassurance if lactation, colostrum, physiologic causes
Galactorrhea
Depends on cause –pituitary tumor, hypothyroidism
Medication management would require long term treatment
Surgical modalities for intraductalpapilloma, ectasia

9. Benign Breast Masses
Common types of benign breast masses
Fibroadenomas
Non-tender, encapsulated, round, moveable, firm
Often seen in younger women, decreasing with age
Cysts
Fluid-filled, soft, moveable
Often seen with women 30-50 years old
Lipomas
Fatty tissue
Increasing incidence with age
Fat necroses
Result of trauma to the breast (surgical or external force)

10. Benign Breast Masses
Common types of benign breast masses (continued)
Phyllodestumors
Large, fast-growing, firm, palpable mass
From periductalstromal cells (may be benign or malignant)
Hamartomas
Glandular tissue, fat, fibrous tissue
Seen in older women
Galactoceles
Milk-filled cysts, from duct dilation
Occur during or after lactation

11. Benign Breast Masses
History
Onset, duration
Other breast symptoms
Menstrual/medical/family
history
Physical exam
Comprehensive breast exam
Describe mass
Tender, moveable, skin
changes
Lymphadenopathy
Diagnostic testing
Age < 30: ultrasound
Age ≥ 30: mammogram
If mass suspicious for
malignancy, order both
Biopsy
Differential diagnosis
Fibrocystic changes
Infection/abscess
Malignancy

12. Benign Breast Masses
Management
Fibroadenomas, cysts, lipomas
Expectant management –monitor for changes
Phyllodestumors
Excisional biopsy recommended
Hamartomas
Biopsy needed for diagnosis, expectant management
Galactocele
Aspiration for diagnosis and treatment

13. Special Considerations
Breast cancer is the fear for women presenting with breast
concerns
Primary objective is to rule out breast cancer
Secondary objective is to assess, identify concern, and provide
guidance for women with benign breast conditions
Breast cancer topic covered in another module