Benign breast disease

Question 1

Define benign breast disease

Answer 1

Breast tissue changes ranging from normal to abnormal, either in development, cyclical change or involution (shrinking of organ in old age phases)

Question 2

Types of benign breast disease

8

Answer 2

Fibrocystic change

Breast cysts

Fibroadenomas = result from hypertrophy of a breast lobule

Sclerosing adenosis = aberration of normal involution

Intraductal papillomas = small benign tumour that forms in a milk duct

Duct ecstasia = when central ducts become dilated w/ ductal secretions (due to blockage of lactiferous ducts), these may leak into periductal tissues & causes inflammatory reaction —>

Periductal mastitis

Fat necrosis

Question 3

Aetiology of benign breast disease

2

Answer 3

Related to changes in hormone levels

Fat necrosis occurs secondary to TRAUMA

Question 4

Risk factors for benign breast disease

2

Answer 4

May be less common in patients on the OCP

SMOKING risk factor for periductal mastitis

Question 5

Epidemiology of benign breast disease

prevalence x2, fibroadenoma age

Answer 5

Very COMMON
Diffuse fibrocystic changes are very common (60% women)
Fibroadenomas are more common in age 15-35 yrs

Question 6

Presenting symptoms of benign breast disease

4

Answer 6

History of breast discomfort or pain (may be cyclical)
Swelling or lump
Nipple discharge - if bloody, malignancy suspected
Assess risk factors:
FH
Exposure to oestrogens (menarche, menopause, children, OCP/HRT)

Question 7

Signs of benign breast disease on physical examination

general + fibroadenoma + duct ectasia

Answer 7

Focal or diffuse nodularity of breast

Fibroadenoma
Smooth, well circumscribed & mobile lumps (“breast mouse”)

Duct ectasia
Yellow/green discharge

Question 8

Features of malignancy absent in benign breast disease

3

Answer 8

dimpling
peau d’orange
enlarged axillary lymph nodes

Question 9

Investigations for benign breast disease

3

Answer 9

TRIPLE ASSESSMENT -
Clinical examination
Imaging
mammogram (2 view)
US (< 35yrs old)
Cytology/histology
fine needle aspiration (cytological analysis)
excision biopsy (histological analysis)

Question 10

Management of benign breast disease

2 groups

Answer 10

Conservative

Surgery

Question 11

Management of benign breast disease - conservative

2

Answer 11

Symptomatic treatment (e.g. analgesia for mastalgia)
Fibroadenomas can be treated conservatively

Question 12

Management of benign breast disease - surgery

4

Answer 12

Removal or excision biopsy of breast lump
Wide local incision if there’s any suspicion of lump NOT being benign
Microdochectomy - for intraductal papillomas
Hadfield’s procedure - for duct ectasia

Question 13

Complications of benign breast disease

2

Answer 13

Pain

Recurrence

Question 14

Prognosis of benign breast disease

2

Answer 14

GOOD

Recurrence common