Benign Breast Disease

Home / Benign Breast Disease

 

As a breast and endocrine surgeon, Dr Murugappan specialises in the management of breast cancer and non-cancerous breast conditions. This page is intended to provide further detail on some of the common breast symptoms we see and the benign (non-cancerous) breast conditions that may cause them.

At your appointment, Dr Murugappan will discuss your case, including symptoms, investigation results, and treatment recommendations. Any recommended surgical procedures will be discussed in detail, including risks, benefits, and alternative treatment options. To arrange an appointment, please do not hesitate to contact us.

Breast Lumps

 

Finding a lump in your breast can be a stressful time and it is important that all breast lumps are investigated quickly to find out the underlying cause. Thankfully, most breast lumps are benign, meaning they are caused by conditions other than cancer.

If you have identified a lump in your breast, your doctor should investigate it by performing a physical examination and ordering imaging, such as an ultrasound or mammogram. Depending on the results of the imaging, tissue samples may need to be taken in order to confirm the diagnosis. This is commonly done in the form of a core biopsy – a local anaesthetic is given and then a needle is used to extract a sample of tissue from the abnormal area.

The table below outlines many of the common benign breast conditions which may cause breast lumps. For further details on breast cancer and its treatment please refer to our breast cancer information page.

Causes of Benign Breast Lumps
Breast ConditionDetailsTreatment
Fibrocystic ChangeFibrocystic change, previously known as “fibrocystic disease” is a normal variation of breast tissue seen in some patients. This type of breast tissue can feel ropey and nodular despite being completely benign and having no association with cancer. No surgical treatment is necessary for this condition. Given the inherent difficulties in self-detecting cancerous lumps amongst this nodular tissue, these patients must ensure they stick to recommended screening guidelines.
Breast CystsBreast cysts are fluid filled spaces within the ends of the ducts in the glandular tissue of the breast. Breast cysts are often multiple and affect both breasts. Based on their ultrasound appearance, breast cysts are classified as “simple” or “complex”. Simple cysts don’t need to be aspirated unless they are very large and causing pain. Complex cysts can have irregular features on ultrasound and may need a biopsy and aspiration to confirm the diagnosis
FibroadenomaA common benign lump arising from an overgrowth of the cells supporting breast tissue and lining the small milk ducts. Fibroadenomas are typically mobile, smooth, firm and rubbery, and are most common in young women in their 20’s. They can grow in response to hormonal changes, and hence grow in pregnancy and with changes in the menstrual cycle. Having a fibroadenoma does not increase the risk of cancer and most fibroadenomas do not require surgical removal. Surgical removal can be considered if a fibroadenoma is painful, cosmetically concerning, or large in size.
Sclerosing AdenosisSclerosing adenosis is a very common finding on breast biopsy. It develops when there is an increased number of cells lining the lobules of the breast with associated fibrous tissue. On mammogram, this may be seen as areas of microcalcification.Whilst sclerosing adenosis is in itself benign, areas of sclerosing adenosis are associated with a 1.5-2 fold increased risk of developing cancer. For this reason, it is adviseable to surgically remove any areas of sclerosing adenosis.
Radial Scars and Complex Sclerosing AdenosisThese lesions are characterised by areas of central scarring in the terminal ducts of the breast. Areas with this change less than 1cm are called “radial scars”, and those greater than 1cm are called “complex sclerosing adenosis”. There is a 2-fold increased risk of developing breast cancer in these lesions. As above, the recommendation is for surgical removal.

Breast Pain

Breast pain, medically known as mastalgia, is the most commonly experienced breast symptom. It can occur due to a variety of reasons and can be mild or so severe that it impacts on quality of life. In the absence of other symptoms, breast pain is unlikely to be caused by breast cancer, however a mammogram and/or ultrasound scan is often indicated to rule this out as a possibility.

Generally, breast pain can be classified as “cyclical” or “non-cyclical” mastalgia.

  • Cyclical Mastalgia

Cyclical mastalgia is the term given to breast pain that changes in relation to your menstrual cycle. It can feel like a dull, burning or aching pain in both breasts, though one side may feel more painful than the other. Typically, this pain starts 5 days prior to menstruation, however some patients may experience pain throughout their cycle that is intensified over the premenstrual period. Most patients with this type of breast pain will have complete resolution of their symptoms with or without treatment.

  • Non-cyclical Mastalgia

Non-cyclical mastalgia occurs less frequently than cyclical mastalgia and is more likely to occur in women over forty. This pain typically occurs in only one breast and lasts for a shorter period of time than cyclical mastalgia.

The causes of non-cyclical mastalgia are varied. Breast conditions such as breast cancer, breast cysts and fibroadenomas can cause breast pain. On the other hand, it is possible for rib, shoulder and neck problems to cause pain that is referred to the breast.

Without identification of the underlying cause, management of mastalgia is directed at control of symptoms. This may include the following;

  • Symptom relief with panadol and anti-inflammatory medications
  • Avoiding foods containing methylxanthines such as coffee, tea, cola and chocolates.
  • Reducing dietary fats
  • Evening Primrose oil is useful to try for women suffering from both cyclical and noncyclical mastalgia
  • Certain medications can cause mastalgia and therefore review of medications is necessary.
  • Tamoxifen maybe used in patients suffering from severe mastalgia however one has to be mindful of the side-effects.

Nipple Discharge

Nipple discharge is another common problem women are confronted by. This may be particularly concerning for women if the discharge is bloody. Thankfully, most cases of discharge are caused by benign conditions.

For information on breast cancer, please visit our breast cancer information page.

For information on the more common causes of nipple discharge, please refer to the table below.

Benign Causes of Nipple Discharge
Breast ConditionDetailsTreatment
Intraductal PapillomaAn intraductal papilloma is an overgrowth of cells lining the large milk ducts. This can cause clear or blood-stained nipple discharge, but may also be found incidentally on breast screen imaging. From a biopsy alone, it can be difficult to tell the difference between a benign papilloma and a precancerous lesion. For this reason, surgical excision of the papilloma is recommended.
Duct EctasiaDuct ectasia is a weakening of the muscular layer of the large milk ducts that causes them to enlarge. It typically occurs in women over the age of 50 and can present with nipple discharge, nipple retraction, or a breast lump close to the nipple. Duct ectasia is benign and does not carry an increased risk of cancer. If the nipple discharge is troublesome then the involved duct can be surgically excised.