Benign Breast Problems
At Pune Breast Care, we diagnose and treat all benign breast diseases.
Most benign conditions such as cysts, fibroadenomas or breast infections do not convert to cancer. 3 Common mistakes women make when dealing with these breast problems are:
1) Assume a condition to be benign without undergoing complete investigations.
2) Being falsely reassured by 'false negative tests' that may incorrectly label a condition to be benign.
3)Attributing a recently noted new breast lump to a known old benign problem and delaying seeking attention
Each benign breast problem is unique and requires its own systematic diagnostic approach and treatment.
Mastalgia or Breast Pain
Mastalgia is a term that refers to painful breast and is broadly of 2 types.
This type of breast pain appears to vary with your menstrual cycle and usually affects both breasts. The upper, outer areas of the breast and commonly affected. The pain is usually worse in the few days before the period, improving thereafter.
Simple measures that may help cyclical mastalgia include:
Reduce consumption of caffeine in tea coffee and sodas.
Wear a comfortable, support bra.
Apply warm or cool compresses when the breasts are painful.
Try vitamin E, evening primrose oil or GLA
If your mastalgia is severe and lifestyle limiting, you may be prescribed some additional medications.
This pain is usually localised to one specific part or parts of the breast and does not appear to vary with the menstrual cycle. This type of breast pain should be evaluated by a breast surgeon. Cysts and inflammation can cause this type of pain. If your pain is associated with redness, fevers, skin changes, swelling or lump in the breast, you should seek urgent attention.
Occasionally pain may arise from the rib cage or nerve root. Pain from Herpez Zoster or Shingles, or even a cardiac ailment can cause pain in the breast especially when felt on the left side.
Breast Feeding Problems
Swollen painful Breasts are common 2-5 days after delivery. Massaging and emptying the breasts with each feed, using a breast pump, cool compresses and occasional pain reliever medications can be used to treat engorgement. If a certain area of the breast feels persistently firm or painful or the skin appears warm and red, you should seek urgent attention. Aggressive massage and heat application should be avoided.
Cracked nipples are common during breastfeeding and can arise from poor latching and infant positioning, high intensity use of breast pump, trauma from baby’s teeth etc. These pose a risk for introducing infections into the breast. Avoiding soap to prevent drying, using purified lanolin creams, air drying the nipples, using nipple shields are measures that can be used to prevent cracked nipples.
Mastitis or infection of breast tissue, is common during breastfeeding. Bacteria from the baby’s mouth infect breast tissue through cracked nipples. Poor latching and incomplete emptying of the breasts during feeds, increases this risk. Symptoms of mastitis can include fevers, redness, warmth and pain. This should be recognised and treated early to prevent abscess formation.
Breast Abscess indicates a collection of pus on the breast. Once a pus collection develops in the breast, it rarely improves with antibiotics alone and often needs a drainage procedure.
Recurrent Breast Abscesses
Idiopathic Granulomatous Mastitis (IGM)
IGM is a recurring inflammatory condition of the breast, often presenting as recurring mastitis, abscess, sinuses and fistulae.
The exact cause is unknown and is not due to bacterial infection. It is often seen in young women who have had a prior pregnancy and is believed to be an auto-immune condition. The condition is often misdiagnosed and treated with repeated surgery which leads to loss of breast volume, scarring and deformity of the breast.
Zuska’s Disease (ZD)
ZD is an inflammatory condition specifically affecting the nipple. It presents as abscesses sinuses and fistulae around the nipple. Smoking is a common risk factor for the condition. Changes in the lining of the nipple ducts cause plugging, thick yellow discharge and infection around the nipple. The condition is not associated with pregnancy or breast feeding. It is treated with repeated courses of antibiotics and surgery for removal of sinuses and affected ducts.
Breast Tuberculosis (TB)
Tuberculosis of the Breast is a common condition in India. It causes “cold abscesses” that are typically not warm or painful. It can also present as sinus and fistulae of the breast that drain pus for prolonged periods of time. It can be diagnosed on core needle biopsy but more often than not is picked up after surgery. It needs to be distinguished from granulomatous mastitis as the two conditions are often confused with each-other. The condition does not respond to usual antibiotics and needs to be treated with anti-tubercular therapy for 6 months or more.
Milky discharge from the nipple in a woman who is not pregnant or breast feeding is called galactorrhea. It is often caused by hormonal or endocrine problems, rather than intrinsic problems of the breast itself. Common medicines can cause galactorrhea. These include some antacids, antidepressants, antipsychotics, anti-hypertensive and estrogen containing drugs. A blood levels of Prolactin and Thyroid hormones is often advised. Rarely galactorrhea may be caused by a tumor in the pituitary gland and hence a complete workup should be done by seeing a breast specialist.
A papilloma often presents as abnormal nipple discharge. Discharge is often seen coming from a single milk duct and is usually bloody or watery. Papilloma can be single of multiple wart-like growths arising from the lining of the ducts. They do not usually present as a lump or swelling and are often missed on mammography and ultrasound. Treatment of a papilloma involves removal of the involved duct system for complete pathological evaluation and treatment.Sometimes a papilloma is associated with atypia or DCIS (ductal carcinoma insitu) and hence a complete removal of the papilloma and involved duct is advised.
Duct ectasia is caused by thickening of the walls of the milk duct. The milk ducts get plugged and widen. These findings are commonly noted on ultrasound especially in the elderly and often do not need surgery or other treatment. In some patients, especially diabetics and smokers, the condition can cause repeated infections or ‘chronic periductal mastitis’.
Breast Cysts are fluid-filled sacs and are not growths or tumours. They do not increase your risk of breast cancer. They can be seen at any age but are more common in young women. ‘Simple cysts’ usually do not need any treatment, unless they are large and cause symptoms. These can be treated by aspiration with a needle.
‘Complex cysts’ or 'complicated cysts' have "debris" or a "thick wall" or a solid component associated with them. These cysts are usually aspirated with a small needle to remove the fluid. This fluid can be tested with cytology if it appears bloody. Rarely a type of breast tumor called ‘encysted papillary carcinoma’ can present as a complex cyst.
Fibroadenoma is a commonly found benign or non-cancerous growth. Fibroadenomas are often multiple. They are usually diagnosed with an ultrasound a confirmatory needle biopsy. Not all fibroadenomas needed treatment. Usually once they are larger than 2-3 cm they tend to cause pain and discomfort and can be surgically removed. The surgery can usually be done as a short-stay or day-care procedure. The scar is hidden around the areola or the fold below the breast so that it becomes invisible in a few months.
Fibroadenomas that grow rapidly or recur in the same area after surgery can in-fact be a different type of breast tumor called “Phyllodes tumor”. These should be treated by a breast surgeon who has expertise treatment of the condition.