Breast Lumps
| Common | % |
| Mammary Dysplasia | 32 |
| Fibroadenoma | 23 |
| Cancer | 22 |
| Cysts | 10 |
| Breast abscess / periareolar inflammation | 2 |
| Less common – mammary duct ectasia, duct papilloma, lactation cysts, Paget disease of the nipple, fat necrosis/fibrosis, sarcoma, lipoma |
mammary dysplasia
(aka fibrocystic disease) = most common in women 30 – 50yrs & is hormone related
– Sx: pain/tenderness, swelling, unilateral or bilateral, usually settles after period, nipple discharge may occur usually green-grey. OE find nodularity +/- a discrete mass.
– Mx: ix as triple test if lumps. Once dx made reassure & rx as for mastalgia.
breast cyst
= common in women 40-50yrs (usually 5yrs before menopause), ax w mammary dysplasia & tends to regress after menopause. Pain & tenderness variable. Has a 1 in 1000 chance of cancer
– Ix: triple test but USS the test of choice
lactation cysts (galactoceles)
= occur during pregnancy + post partum w milk containing cysts.
– Mx: aspiration of cysts
fibroadenoma
= discrete asymptomatic lump that is firm, smooth & mobile (‘breast mouse’) that doubles in size every 12 months. Most common in 20s
– Ix: triple test, def requires biopsy
– Mx: as a rule the lump is removed in all pt’s to be certain of the dx. It may be left in females in late teens with 90% of lesions spontaneously regressing. If not excised 6 monthly USS.
phyllodes tumour
= giant fibroadenoma-like tumour that are usually benign but 25% are malignant & metastasise.
– Mx: complete excision
fat necrosis
= end result of a large bruise or trauma. It can resemble breast Ca due to skin or nipple retraction.
– Mx: if untreated it usually disappears but dx can only be made on excision biopsy.
duct papillomas
= benign hyperplastic lesions within large mammary ducts & are not pre-malignant. They are not usually palpable but instead pt presents with blood stained nipple discharge.
– Ix: need to be differentiated from carcinoma but mammogram not usually helpful
– Mx: involved duct + affected breast segment should be excised
mammary duct ectasia
– Sx: whole breast quadrant indurated & tender w lump usually near the margin of the areola. Pt may have toothpaste like nipple discharge. Most common around menopause.
– Mx: tendency for recurrence w abscess formation + fistula. Many cases settle but req surgical intervention for dx.