Breast Lumps

Question 1

Fibroadenomas

Answer 1

• AKA “breast mouse” because they are small and mobile
• Benign tumours of stromal/epithelial breast duct tissue
• Common in younger patients (<40 years).
• A smooth, well circumscribed, firm, mobile lump.
• Usually up to 3cm.
• Hormone dependent, and regress after menopause.
• 10% disappear every year.

Question 2

Fibrocystic Breast Disease

Answer 2

• Common in women of menstruating age
• Related to hormonal changes around menstrual cycle
• Symptoms often occur prior to menstruating (within 10 days) and resolve after wards
• Benign condition, although can vary in severity and have an effect on quality of life if severe
• Usually resolves after menopause

Question 3

Fibrocystic Breast Disease Symptoms

Answer 3

• Bilateral breast lumpiness
• Bilateral breast pain / tenderness (mastalgia)
• Fluctuation of breast size

Question 4

Fibrocystic Breast Disease Treatment

Answer 4

• Supportive Clothing
• NSAIDs
• Weight Loss
• Hormonal contraception may make it worse (consider stopping)

Question 5

Breast Cysts

Answer 5

• A discrete collection of fluid in the breast tissue
• Most common between ages 30-60.
• A smooth, well circumscribed, mobile, possibly fluctuant lump
• Benign
• Can fluctuate in size over the menstrual cycle
• Treat conservatively, with needle aspiration or local excision

Question 6

Breast Abscess

Answer 6

• An acute(usually bacterial) infection of the breast tissue
• May be associated with fever, pus discharge from the nipple and local erythema, tenderness and heat
• Treat with antibiotics. May require incision and drainage surgically.

Question 7

Fat Necrosis

Answer 7

• A lump formed by local degeneration / scarring of fat tissue
• This is an inflammatory reaction resulting in fibrosis and eventually necrosis
• Commonly caused by local trauma or breast surgery
• A firm, irregular, fixed lump. May cause skin dimpling or nipple inversion.
• Radiologically similar appearance to breast cancer
• Can be associated with an oil cyst, containing emulsified fat
• Benign condition
• May resolve spontaneously
• Treat conservatively or with surgical excision

Question 8

Lipoma

Answer 8

• A benign collection of fat
• A soft, painless and mobile lump up to 20cm in size
• Benign
• Treat conservatively with reassurance or with surgical excision

Question 9

Phyllodes Tumour

Answer 9

• Large, fast growing periductal stromal cell neoplasm.
• Most common between age 40-50.
• Can be benign (~50%), borderline (~25%) or malignant (~25%)
• 1% of breast neoplasms.
• Requires local excision.

Question 10

Breast Cancer

Answer 10

• May be hard, irregular, painless, fixed lesions
• May be tethered to the skin or the chest wall
• May cause nipple retraction
• May cause skin dimpling or oedema (peau d’orange)

Question 11

Two Week Wait Referral Criteria

Answer 11

• A discrete lump with fixation, that enlarges and/or with any concerns (e.g. family history)
• Women over 30 with a persistent breast or auxiliary lump or focal lumpiness after their menstrual period
• Previous breast cancer with new suspicious symptoms
• Skin or nipple changes suggestive of breast cancer
• Unilateral bloody nipple discharge