Most breast conditions and lumps are benign (non-cancerous). Benign breast conditions include cysts, fibroadenomas, phyllodes tumours, fibrocystic disease, nipple discharge, mastitis, and breast abscesses.
Fibroadenomas are not cancerous and do not significantly increase your risk of developing breast cancer. They are very common particularly in women under the age of 30.
In most cases there will be a single lesion, but some patients may have multiple lesions including in both breasts.
Fibroadenomas contain some normal breast tissue cells, and these can develop unto cancer but the rate of this is no higher than the chances of cancer developing elsewhere in the breast.
Fibroadenomas may be found as a lump that is felt or on imaging that is performed for other reasons. They are best seen o ultrasound but can also less commonly be seen on mammogram.
Many fibroadenomas have a typical appearance eon ultrasound and many will require a biopsy (fine needle or core) to confirm the diagnosis. Occasionally small lesions may be followed with ultrasound to serve as confirming their diagnosis.
Most fibroadenomas will feel like an oval, firm, lump that is mobile (moves freely). Many will remain stable in size, but others will decrease in size, disappear completely or increase in size.
Fibroadenomas that have an atypical appearance on imaging, atypical cells on biopsy or that are large (3cm or bigger) may require surgical removal. In other situations, removal may be indicated if the fibroadenoma is painful or cosmetically sensitive.
Phyllodes tumours are rare and account for <1% of all breast tumours. Most Phyllodes tumours are non-cancerous, but some may be borderline or (more rarely) malignant. Many Phyllodes tumours present as a palpable breast lump, but they can also be found incidentally on breast imaging. It can be hard to tell the difference between a Fibroadenoma and Phyllodes tumour on imaging alone and even sometimes on core biopsy. Surgery (most commonly lumpectomy) is usually indicated for Phyllodes tumours even if they are benign because they can grow locally, and it can be difficult to confirm the type of Phyllodes on core biopsy alone. It is rare for a Phyllodes tumour to spread to lymph nodes and lymph node surgery is not typically required. Malignant Phyllodes tumours are very rare, and their treatment is different to the other forms of Breast cancer.
Mastitis is Inflammation and/or infection of the breast. Mastitis is most common in women who are breastfeeding and is due blocked milk ducts in but can also occur in the non-breastfeeding women.
Initial symptoms of mastitis may include a red or inflamed area of the breast that is warm and tender to touch. This can rapidly spread to cover a larger area of the breast, or it may remain localised and form a painful lump. You may also have systemic symptoms such as fever or temperature as well as chills or body aches and nausea.
In breastfeeding women, you should seek review with your doctor early and antibiotics are usually indicated. It is safe to continue to Breastfeed during an episode of mastitis and this is encouraged to facilitate emptying of the breast and helps prevents further blockages of milk ducts. You may wish to feed more frequently than normal to help with this process. A warm pack or massage to the affected area prior to feeding may help relieve blockages. Occasionally an abscess may form within the breast, and these can require further interventions such aspirations or drainages.
The management of mastitis in non-lactational (non-breastfeeding) women also involves antibiotics but there are other less common types of mastitis (such as granulomatous mastitis) that may require other different treatments.
It is important to arrange a follow-up appointment with your doctor after an episode of mastitis and often Breast imaging will be required after the episode has settled to exclude any underlying causes or lesions.
Breast cysts are localised fluid collections within the breast. They can be single or there may be multiple within each breast and are a common finding. Although they can develop at any age, they are most common in younger women (<50 years). Some cysts are diagnosed on imaging only but occasionally cysts can be palpable lumps if they are large or close to the skin surface. Many cysts can persist, but they can also resolve on their own. It is not clear why some women form cysts and others do not.
There is no consensus on the management of cysts, but an aspiration of a cyst may suggest if it is palpable, causing discomfort or if there are atypical features on imaging that cause concern for a different diagnosis. Most cysts are benign (non-cancerous) and do not carry an increased risk of developing cancer. Most cysts do not need surgical removal unless they are recurrent despite multiple aspiration or show atypical or concerning features on biopsy or imaging.