Benign Breast Masses

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 Breast Imaging
• Mammogram: Every 1-2 years once patients reach age 50
(New ACOG guidelines suggest offering mammograms at 40 for all)
• Start at age 40 if first-degree relative with breast cancer
• Start at age 30 if carrier of BRCA1 or BRCA 2

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Breast Imaging

CC (0): NCI

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 3 Methods of Tissue Diagnosis
1. Fine Needle Aspiration (FNA)

CC (4.0): KGH
2. Core-needle Biopsy

3. Surgical Biopsy (Surgical Excision)

CC (4.0): KGH

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 Breast Mass
• Breast mass in women <30 years old:
• Next step is Ultrasound (solid vs. cystic)

• Breast mass in women ≥30 years old:

• Next step is Mammogram
• MRI used as adjunct in some high-risk patients (e.g. dense breasts)

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 Breast Imaging Reporting and
Database System (BI-RADS)
Score Assessment Plan
0 Incomplete Obtain additional
imaging
1 Negative Routine screening
2 Benign Routine screening
3 Probably benign F/u in six months
4 Suspicious for Tissue diagnosis
malignancy
5 Likely malignancy Tissue diagnosis
6 Malignancy Surgical excision

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 Benign Breast Masses
• Fibrocystic Changes
• Fibroadenoma
• Galactocele
• Fat Necrosis

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 Fibrocystic Changes
• Presentation: Reproductive age woman with bilateral breast pain and
swelling that
• Worsens cyclically during the premenstrual period

• Pathophysiology: Proliferation of breast stroma in response to

hormonal stimulation

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 Fibrocystic Changes
Dx: Clinical
- Multiple nodules/cysts on both breasts
- NOT a discrete mass (vs. Fibroadenoma)

Mgmt: Reassurance, wear a support bra, ↓caffeine

CC (3.0): Jeanot

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 Fibroadenoma
• Presentation: Reproductive age woman
• Solitary, well-circumscribed, rubbery, nontender mass
• May vary in size with hormonal changes (e.g. pregnancy, menopause)

• Pathophysiology: Benign tumor of breast stroma and epithelium

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 Fibroadenoma
• Dx: Ultrasound
• If ≥30 years old or family history => FNA

• Mgmt:
• If <30 and nonsuspicious ultrasound => Close f/u
• If mass >5cm or rapid growth => Surgical Excision
• If FNA inconclusive => Surgical Excision

CC (3.0): Nevit

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 Phyllodes Tumor
Presentation: Woman 40-50 years old with a solitary, well-circumscribed,
rubbery, nontender mass that grows rapidly

Pathophysiology: (Malignant) tumor with overgrowth of breast stroma

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 Phyllodes Tumor
Dx: FNA or Surgical Excision

Mgmt: Surgical Excision

CC (3.0) Nevit

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 Galactocele
• Presentation: Reproductive age woman with recent history of
pregnancy, breastfeeding, or weaning
• Well-circumscribed, subareolar mass

• Pathophysiology: Obstruction of a lactiferous duct

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 Galactocele
• Dx: Ultrasound

• Mgmt: Follow-up in 3-6 months

• If does not resolve on its own => Needle Aspiration

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 Fat Necrosis
• Presentation: Breast mass with irregular borders
• +/- Recent history of breast trauma or surgery
• +/- Nipple retraction

• Pathophysiology: Fat saponification

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 Fat Necrosis
• Dx: Mammogram => Needle core biopsy => Surgery
• Mammogram shows oil cysts and calcifications
• Pathology shows fat deposits and macrophages

• Mgmt: Surgical Excision

CC (3.0): Hussain

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