BENIGN BREAST DISEASES 

SANTHOSH.S
S6 UNIT
 CLASSIFICATION
CONGENITAL INJURY INFLAMMATION/INFECTION 
 AMAZIA/ATHELIA  HAEMATOMA
 ANDI(Aberrations of normal
 POLYMAZIA/  TRAUMATIC FAT differentiation and involution)
POLYTHELIA NECROSIS • Cyclical nodularity and mastalgia
 INVERTED NIPPLE • Cysts
• Fibroadenoma
• Duct ectasia

 PREGNANCY-RELATED
• Galactocele
• Lactational abscess
 CONGENITAL ABNORMALITIES
 AMAZIA
Congenital absence of breasts on one or both sides.

 POLYMAZIA 
• Accessory breasts present mostly in axilla ,they have 
been known to function during lactation. 
• Other sites: groin, buttock, thigh.

 INVERTED NIPPLE
• Failure of mammary pit to elevate above the skin,
shortens subareolar duct leading to inversion of nipple.
• Treated manually/by surgical correction. 
 INJURIES TO BREAST

 HAEMATOMA
• Collection of blood within the breast following trauma,
gives rise to a lump.
• If small hematoma it resolves ,if large hematoma requires drainage.
 TRAUMATIC FAT NECROSIS
• Occurs as a result of trauma /surgery/radiotherapy.
• Mimics carcinoma of breast.
• Diagnosed by biopsy ,Treatment is excision.
• Histologically: Lipid laden macrophage, scar tissue, chronic
inflammatory cells.
• In MAMMOGRAPHY and USG CALCIFICATIONS(Lead pipe) present.
 INFLAMMATION / INFECTION
BACTERIAL MASTITIS:
AETIOLOGY:
Most common causative agent is S.AUREUS.
ASCENDING INFECTION       DUCT BLOCK        MILK CLOTTING        MULTIPLICATION OF ORGANISM . 

CLINICAL FEATURES: Classical signs of acute inflammation , Early features of cellulitis,

                                    Later abscess forms.
TREATMENT: 
 Antibiotics
 Support of the breast ,local heat,analgesia
 Aspiration
 Incision and drainage.

If an antibiotic is given in the presence of undrained pus ,an ANTIBIOMA may form.
DD: Inflammatory carcinoma of breast.
Diagnosis: Pus aspirated and sent to bacterial culture.
DUCT ECTASIA/PERIDUCTAL MASTITIS:
Dilatation of breast ducts often associated with periductal inflammation. 
Common in smokers.

PATHOGENESIS:

Dilatation of large lactiferous duct.

Filled with stagnant brown or green secretion.

Irritant reaction in surrounding tissues.

Periductal mastitis/abscess and fistula formation.

Fibrosis develops- slit like nipple retraction.

CLINICAL FEATURES:

• Nipple discharge
• Subareolar mass
• Abscess
• Mammary duct fistula 
• Nipple retraction

TREATMENT:

• Antibiotic
• Surgical excision of all major ducts
(Hadfield’s operation).
 Aberration of normal development and
involution(ANDI)
ANDI involves disturbances in the breast physiology extending from pertubation of
normality to well defined disease processes.
PATHOLOGY:
 Cysts formation
 Fibrosis
 Hyperplasia of epithelium in the lining of ducts and acini
 Papillomatosis
CLINICAL FEATURES:
 Lump
 Mastagia
1.Cyclical mastagia
2.Non-cyclical mastagia
 FIBROADENOMA
 Most common benign breast lump.
 Hyperplasia of single lobule [2 to 3 cm in size].
 Common among 15 to 25 years of age.

CLINICAL FEATURES:
 Firm, smooth, non-tender ,well localised lump.
 Freely moves over the breast [breast mouse].

SUBTYPES OF FIBROADENOMA:
• Giant fibroadenoma [> 5cm].
• Juvenile fibroadenoma.
INVESTIGATION
1.USG
2.MAMMOGRAM (Popcorn calcification)
3.FNAC

TREATMENT:
1. SURGERY
  Peri-areolar incision
  Inframammary incision [Gillard thomas incision]
  INDICATION:
  Cosmetic
  Giant fibroadenoma
  Rapid increase in size
  Family history suggestive of breast cancer
2. CRYOABLATION
3. ECHOTHERAPY
4. MAMMOTOME [LARGE CORE VACUUM BIOPSY SYSTEM]
 PHYLLODES TUMOUR
 Also known as “Serocystic disease of Brodie” or “Cystosarcoma phyllodes”.
 Common in 4th decade of life.
CLINICAL FEATURES:
 Large with unevenly bosselated surface.
 Ulceration over skin can occur.
 Mobile on the chest wall.
INVESTIGATION:
 USG
 MAMMOGRAM
 BIOPSY
TREATMENT:
SURGERY:
 Lumpectomy or wide local excision.
 Simple mastectomy [recurrence ,massive tumour ,malignant type].
 BREAST CYST
 Breast cyst are due to non-integrated involution of stroma and epithelium.
 Age: Last decade of reproductive life.
 Cyst can be multiple, bilateral, mimic malignancy.

CLINICAL FEATURES:
Smooth, Soft lump associated with cyclical changes during mensural period.

INVESTIGATION:
 USG
 FNAC
 CORE BIOPSY

   If non blood stained and resolves completely  -  No treatment required.

   If blood stained and presence of residual lump  -  Core biopsy and local excision
      for histological diagnosis is done.
 MASTALGI
 Mastalgia means breast pain. A
 It can be cyclical or non-cyclical.
 Cyclical mastalgia increase in both lumpiness and tenderness before menstrual
period.
 Non-cyclical mastalgia common among perimenopausal women.
INVESTIGATION:
USG
MANAGEMENT:
 GALACTOCELE
 Rare condition.
 Presents as a solitary ,subareolar cyst.
 Common after 6 to 10 months of cessation of lactation due to inspissation of
milk within ducts.
 Treated by withdrawal of milky secretion through needle aspiration.

MONDOR'S DISEASE
 Thrombophlebitis of superficial veins of the breast and
 anterior chest wall.
 Thrombosed subcutaneous cord like structure under the skin.
 A narrow, shallow ,subcutaneous groove alongside the cord.
 Treatment : Restrict arm movements, anti-inflammatory
medications and warm compress.
 TUBERCULOSIS OF BREAST

 Infection reaches through blood /lymphatic.

 CLINICAL FEATURES:
1. Swelling with cold abscess, sinuses.
2. Bluish appearance of surrounding skin.
3. Matted lymph nodes in ipsilateral axilla.

 Diagnosed by bacteriological /Histologically examination.

 Treatment: Anti-tuberculous chemotherapy, drainage of cold abscess.
PAPILLOMAS
: True polyps of epithelial lined breast ducts.
 Appears close to nipple.
 Associated with bloody discharge.
 Treatment: Excision.

PAPILLOMATOSIS:
• Hyperplasia of epithelium.

• Younger women associated with fibrocystic change.

REFERENCES 
 BAILEY AND LOVE 27th edition
 SABISTON 21st edition
THANK YOU