Susan A. Seedman MD, FACS, PC Aiding in the Fight Against Breast Cancer Breast Specialty Care

Benign Breast Conditions

The breast may develop many changes and conditions that are not cancer. Some can cause discomfort or pain and require treatment, while others need no medical attention. These conditions are more common in younger women and, perhaps, related to hormonal activity. The use of hormone replacement may increase the incidence of these changes and symptoms. Below are some of the ones more commonly seen.

A collection of pus in any part of the body that may be treated with antibiotics but usually needs surgical drainage

Deposit of calcium in breast tissue secondary to inflammation, injury (trauma) or cancer

Cysts are fluid filled sacks or spaces that may represent balloon-like widening of the ducts within the breast. Their exact cause is unknown and they are almost always benign. Cysts are a common cause of nipple discharge that may be clear, yellow, green, blue, or bloody. They are diagnosed by their appearance on ultrasound or when a breast mass is punctured and fluid comes out. The fluid may be drained (aspirated) from a cyst if it is large and painful or if there is any suspicion of a malignancy inside.

Liquid (fluid) coming from the nipple. It is usually secondary to cystic breast changes and clear, yellow, green or blue in color. Bloody nipple discharge is most likely secondary to fibrocystic disease but may also be associated with an intraductal papilloma or breast cancer.

Changes in the skin caused by irritation Most of the time it is hard to say what has caused the irritation. Some causes are underlying ductal rupture and inflammation, fungal skin infection, and allergic reaction to topical products. The skin may be dry, scaly, thick and red. Usually there is severe itching (pruritus) and scratching may lead to breaks in the skin that may bleed. Most of the time this is treated with topical anti-inflammatory medications. However, occasionally a small biopsy of the area may be needed to rule out a more serious problem.

Ductal Ectasia
Widening (ectasia) of ducts found behind the nipple that leads sometimes to itching (pruritus), nipple discharge or infection (ductitis)

Ectopic breast tissue
Breast tissue found in unusual locations, most commonly under the arms (axillary) and rarely along the milk line that extends from the axilla to the groin (inguinal area). When it becomes very large or painful or when there is a worrisome change, it may be removed.

Fat necrosis
Death of fat cells and tissue due to local injury from radiation, infection, surgery or direct trauma. Rarely, it may resemble cancer on physical exam with hardening and calcification of the underlying breast tissue and puckering of the skin. Usually, it resolves completely on its own. Occasionally, it may leave residual oil containing cysts in the breast.

Solid mass in the breast that is common in younger women and not associated with an increased risk of breast cancer. Many times it is found on breast self-examination as a mobile lump that is not tender. If it is increasing in size, painful, or has any worrisome features, it may be removed. Occasionally, fibroadenomas calcify and can be easily seen on mammograms.

Fibrocystic changes
Any process in the breast that is accompanied by fibrosis and cystic breast changes. These changes may be seen on ultrasound and on pathology reports on tissue removed. This condition is also called fibrocystic mastopathy. It is a benign but may be associated with a slightly increased risk of breast cancer. In some cases it responds to the use of vitamins E and B6 and decreased caffeine intake.

Milky discharge from the breast in a patient who is not pregnant or breast-feeding. Occasionally, it may be caused by a prolactin secreting tumor (mass) of the pituitary.

Development of breast tissue in men. It may be due to abnormal hormone levels and the use of steroids, certain medications such as digitalis, and substances such as marijuana. It may also be due to abnormal liver function and testicular tumors.

A collection of blood, sometimes clotted, in the tissues, organs or body spaces resulting from any type of injury to blood vessels

An increased number of cells in an organ of the body. In the breast it may be found in the lobules or ducts. This is only diagnosed by looking at breast tissue under a microscope after a biopsy. It is usually a benign. When abnormal looking cells are seen, it is called atypical hyperplasia. This condition increases the risk of breast cancer slightly.

Protein rich fluid present diffusely within the tissues leading to changes in the overlying skin. Most commonly it is due to the removal of lymph nodes draining that specific area of the body.

A collection of lymph containing fluid in the empty space created by the removal of lymph nodes from an area of the body.

Lymphocytic mastitis
Condition in which there is inflammation in the ducts or lobules that results in changes in the breast tissue that may resemble fat necrosis and breast cancer. This is most often seen in patients with diabetes (diabetic mastopathy).

Infection of the breast tissue. It may be accompanied by an abscess. It is more common in women who are breast feeding but may occur at any age. The symptoms are pain, redness, swelling, and sometimes fever. It is treated with antibiotics and, if an abscess is present, with drainage.

Mastodynia (Mastalgia)
Breast pain. There are multiple causes including abnormal hormone levels, fibrocystic breast changes, and the use of medications such as digitalis and Aldactone. Breast pain is not usually a symptom of breast cancer. It may also respond to the use of vitamin E and B6.

Any disease or abnormality of the breast, benign or malignant

Benign lump in a duct (intraductal papilloma) usually near the nipple and found on evaluation for bloody nipple discharge. It is usually removed with a biopsy and occasionally may be malignant (cancerous) especially when there are multiple papillomas (papillomatosis).

Phylloides tumor
Fibrous mass resembling a fibroadenoma. It may become quite large before it is found. Most of the time it is benign but may be malignant especially if it returns after having been removed.

Radial scar
Abnormal looking area that may resemble cancer on a mammogram. It is found usually by chance during pathology examination of tissue removed for other reasons.

Sclerosing adenosis
A condition in which the cells that make up the glands (glandular) become distorted and form thickened nodules (small lumps/masses)

Sebaceous cyst
Oil containing sac that develops when the opening to an oil containing gland of the skin becomes clogged. The oil accumulates and may become hard. If infection develops, it may require drainage. It is sometimes removed to prevent enlargement or infection.

Mass (lump) due to the accumulation of serum (liquid from the vascular spaces) in body tissues secondary to surgery. Usually it resolves spontaneously, although occasionally it may need to be drained.