Implants And Lumps

Question 1

What are PIP implants?

Answer 1

PIP implants are a type of silicone breast implant that were banned in 2010 after it came to light that they had been manufactured using industrial grade (rather than medical grade) silicone

Question 2

What is the problem with PIP implants?

Answer 2

• PIP implants are 2 to 6 times more likely to rupture than standard silicone implants.
• This doesn’t pose a serious risk to your health, but it can cause some unpleasant symptoms.

Question 3

What are the signs of implant rupture?

Answer 3

o lumpiness or swelling in and around the breast  
o a change in the shape of the breast
o redness
o pain and tenderness
o a burning sensation
o enlarged lymph nodes in the armpit

Question 4

What are the signs of intracapsular rupture?

Answer 4

• asymptomatic breast implant normal appearances of the implant shell with anechoic (black) appearances of the implant contents.
• with rupture, there are multiple abnormal linear areas within the implant. These are features of intracapsular rupture, where silicone has leaked out of the implant shell but is held in place by the fibrous capsule formed by the body around the implant.

Question 5

Would the NHS pay for the removal of PIP implants?

Answer 5

• Normally the NHS will pay for removal of PIP implants fitted by a private health provider but will not pay to replace them (except in Wales).
• Some private clinics have agreed to replace PIP implants free of charge, but others have refused.

Question 6

What is the most worrying thing about the detection of a breast lump?

Answer 6

The detection of a lump in the breast causes understandable fear of a cancer diagnosis.

Question 7

Are most breast masses benign or malignant?

Answer 7

• Breast masses are a common clinical finding, and may be palpable or non-palpable, benign or malignant.
• The majority of palpable breast masses are benign, but 10% of women who present with this finding will have a diagnosis of cancer.

Question 8

What are the causes of breast masses?

Answer 8

Breast cancer 
Fibroadenoma
Phylloides tumours 
Fibrocystic breast 
Fat necrosis 
Breast abscess 
Intraductal papilloma

Question 9

When do fibroadenomas occur?

Answer 9

• The most common cause of breast mass is fibroadenoma. Fibroadenomas occur more commonly during the early reproductive years. Their development is thought to be hormonally related.

Question 10

What are phylloides tumour?

Answer 10

• Phylloides tumours are rare growths of the breast that can have benign or malignant characteristics.

They generally present as a rapidly growing, painless breast mass. Phylloides tumours are sometimes difficult to distinguish histologically from fibroadenomas.

Increased cellularity, atypia, mitoses, and positive margins are often associated with an increased risk of local recurrence for phylloides tumours.

Question 11

What is fibrocystic breast?

Answer 11

• Fibrocystic breast is most commonly found in premenopausal and perimenopausal women.

The condition encompasses a spectrum of pathological changes: as well as cysts, it includes epithelial hyperplasia, apocrine metaplasia, and cystic dilation and fibrosis.

Question 12

What is fat necrosis?

Answer 12

• Fat necrosis occurs secondary to injury of the breast. The source may be iatrogenic (e.g., breast biopsy, breast reduction or augmentation) or traumatic (e.g., seat belt injury to the breast). Many women who present with fat necrosis have no recollection of breast trauma.

Question 13

What is fibroadenoma?

Answer 13

• These are benign tumours that are common in young women, with incidence peaking at 20-24 years of age.
• They are the most common type of breast lesion. Fibroadenomas arise in breast lobules and are composed of fibrous and epithelial tissue.

Question 14

How do fibroadenoma present?

Answer 14

• They present as solid, firm, non-tender, highly mobile palpable lumps.

Question 15

What is the aetiology of fibroadenoma?

Answer 15

Hormones seem to be involved in aetiology, and hormone replacement therapy (HRT) increases the incidence.

Question 16

Investigations of fibroadenoma

Answer 16

• As with all unexplained lumps, referral should be made to a specialist
breast clinic.

Women are assessed by the triple assessment of examination, imaging (first-line choice is ultrasound before age 40, mammogram after) and needle biopsy (not necessarily required under the age of 25).

Question 17

What do fibroadenomas look like macroscopically?

Answer 17

Macroscopically, fibroadenomas are round or ovoid masses with a rubbery cut surface and are composed of relatively uniform pale brown tissue.

They have well-circumscribed margins, and are often lobulated, with duct structures within the lesion seen as slit-like spaces.

Question 18

Treatment of fibroadenoma

Answer 18

They are often treated with surgical excision but this may not be necessary if they are small and the diagnosis is confirmed. Most stop growing at about 2 or 3 cm.

• In certain circumstances, excision of a fibroadenoma may be considered if the lesion is very large (>4cm), if it is growing, or if the patient requests it.

Question 19

Do fibroadenomas stay the same size?

Answer 19

• Generally, fibroadenomas stay the same size. However, some do get smaller with time, and some do increase in size, especially in teenage girls and in pregnant women.

Question 20

What happens to fibroadenomas in olde women?

Answer 20

• In postmenopausal women, fibroadenomas are prone to involution and often develop characteristic calcification known as ‘popcorn calcification’. This mammogram shows multiple calcified fibroadenomas in a postmenopausal woman.

Question 21

When do fibroadenomas convey an increased risk of breast cancer?

Answer 21

• Complex and multiple fibroadenomas are associated with an increase in the risk of breast cancer.