Breast - Benign

Question 1

What are the main causes of mastalgia?

Answer 1

Cyclical pain:
- hormone changes e.g. menstruation or HRT
Non-cyclical pain:
- medication e.g. contraception, sertraline, haloperidol
Extramammary pain:
- chest wall, shoulder pain

Question 2

How can mastalgia be managed?

Answer 2

Reassurance
Pain control:
- oral ibuprofen or paracetamol

Question 3

What is mastitis and what causes it?

Answer 3

Inflammation of the breast tissue

Most commonly staph aureus

Question 4

How is mastitis classified?

Answer 4

Lactational mastitis (more common)
- usually in first 3 months of breastfeeding or during weaning

Non-lactational mastitis (less common)

Question 5

What is the main risk factor for non-lactational mastitis?

Answer 5

Smoking

Question 6

What are the clinical features of mastitis?

Answer 6

Tenderness, swelling or induration, and erythema
Lactational mastitis associated with cracked nipples and milk stasis
Abscess formation can occur

Question 7

What is the management for mastitis?

Answer 7

Antibiotics and simple analgesia

Continue milk drainage or breastfeeding

Question 8

How does a breast abscess present?

Answer 8

Tender, fluctuant and erythematous mass
May have a puncutum
Associated fever and lethargy

Question 9

How is a breast abscess managed?

Answer 9

Antibiotics + US guided needle aspiration

If advanced, incision and drainage under local anaesthetic

Question 10

How do breast cysts present?

Answer 10

May be single or multiple, affecting one or both breasts
Distinct, smooth masses
May be tender

Question 11

How is a breast cyst diagnosed?

Answer 11

Mammography –> typical halo shape

USS definitive diagnosis –> fluid filled cavity

Question 12

How are breast cysts managed?

Answer 12

Usually self resolve

Large cysts can be aspirated for aesthetic reasons or patient reassurance

Question 13

What is mammary duct ectasia?

Answer 13

Dilation and shortening of the major lactiferous ducts in peri-menopausal women

Question 14

How does mammary duct ectasia present?

Answer 14

Coloured green/yellow nipple discharge
- if blood stained –> triple assessment
Palpable mass
Nipple retraction

Question 15

How is mammary duct ectasia diagnosed?

Answer 15

Mammography –> dilated calcified ducts, without features of malignancy
If biopsied –> multiple plasma cells (plasma cell mastitis)

Question 16

How is mammary duct ectasia managed?

Answer 16

Conservatively unless unable to exclude malignancy

Duct excision if unremitting nipple discharge

Question 17

What is fat necrosis and what causes it?

Answer 17

Acute inflammatory response in breast –> ischaemic necrosis of fat lobules
Associated with blunt trauma or previous surgical/radiological intervention

Question 18

What are the clinical features of fat necrosis?

Answer 18

Usually asymptomatic or presents with lump
Less commonly - discharge, skin dimpling, pain and nipple inversion

Can lead to chronic fibrotic change –> solid irregular lump

Question 19

How is fat necrosis diagnosed?

Answer 19

Positive traumatic history + hyper echoic mass on USS

May mimic carcinoma on examination/mammography so core biopsy to definitively rule out malignancy

Question 20

What is the management of fat necrosis?

Answer 20

Analgesia + reassurance

Question 21

What is the most common type of benign breast lump and what are the other types?

Answer 21

Fibroadenoma (most common)
Adenoma
Papilloma
Lipoma
Phyllodes Tumour

Question 22

What are the features of a fibroadenoma?

Answer 22

Women of reproductive age
Highly mobile (breast mouse)
Well defined and rubbery
Usually less than 5cm
Very low malignant potential

Question 23

What are the indications for excision of a fibroadenoma?

Answer 23

> 3cm diameter

Patient preference

Question 24

What are the features of an adenoma?

Answer 24

Benign glandular tumour
Older females
Nodular and easily mimic malignancy (so usually triple assessment)

Question 25

What are the features of a papilloma?

Answer 25

Females 40-50s
Subareolar region (usually less than 1cm away from the nipple)
Often present with bloody or clear nipple discharge
Similar to ductal carcinoma on imaging so biopsy

Question 26

What are the features of a lipoma?

Answer 26

Soft + mobile benign adipose tumour
Low malignant potential
Only removed if enlarging or symptomatic

Question 27

What is a Phyllodes tumour and what are the features?

Answer 27

Rare fibroepithelial tumours
Large, comprise of both epithelial and stroll tissue
Often grow rapidly
1/3 have malignant potential so wide excision (or mastectomy if large)