Benign Breast Conditions
This article should be read in conjunction with the breast cancer article.
Benign Breast Tumours
The suspected breast cancer referral pathway also applies to benign breast tumours
| Refer via the suspected breast cancer pathway if: |
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| CONSIDER refer via suspected breast cancer pathway if: |
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| Consider non-urgent referral if: |
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Fibroadenoma
Definition
Fibroadenoma is a benign breast tumour characterised by a biphasic proliferation of stromal and epithelial components
Aetiology
The exact cause is incompletely understood and is considered multifactorial
Current evidence suggests that fibroadenomas arise from a hormone-driven process, with a role for oestrogen sensitivity and genetic mutations
Diagnosis – Triple Assessment
Fibroadenoma is the most common benign breast tumour in <25 y/o [Ref]
- Peak incidence: 20-30 y/o
- Risk is highest in <35 y/o and declines after menopause
| Triple assessment component | Findings / description [Ref1][Ref2] |
|---|---|
| Clinical examination |
The term “breast mouse” is sometimes used to describe the typical feel and mobility of a fibroadenoma in palpation. The mass is highly mobile, such that on palpation it seems to slip away / move under the fingers, like a mouse running under the skin |
| Imaging | Ultrasound is typically 1st line (as fibroadenoma is rare in >40 y/o) (rule of imaging for breast mass)
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| Biopsy | Gold standard: core needle biopsy
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Complications
Malignant transformation of fibroadenoma is extremely rare (<0.1%) [Ref]
Management
Conservative management (reassurance + education + discharge) for biopsy-proven fibroadenoma without atypia. [Ref]
Excision is NOT routinely indicated. Some indications for excision: [Ref]
- Patient’s request
- Symptomatic (discomfort / pain)
- Rapid growth
- >4 cm may warrant excision to exclude a phyllodes tumour (it can be difficult to differentiate between a fibroadenoma and phyllodes tumour, even with biopsy) or other pathology
- Radiological / pathological discordance
Phyllodes Tumour
Definition
Phyllodes tumour is characterised by a biphasic proliferation of neoplastic stromal and non-neoplastic epithelial components
Importantly, phyllodes tumour can be either benign (more common) or malignant (it is not a 100% benign tumour)
Phyllodes tumours and fibroadenomas have similar clinical and histological features (both are fibroepithelial neoplasms.) It is difficult to distinguish between a phyllodes tumour and a fibroadenoma, even with a biopsy.
Importantly, phyllodes tumour has the potential for recurrence or malignancy
Diagnosis – Triple Assessment
Most common in 35-55 y/o [Ref]
| Triple assessment component | Findings / description [Ref] |
|---|---|
| Clinical examination |
|
| Imaging | Rule of imaging for breast mass
|
| Biopsy | Gold standard: core needle biopsy
|
Both phyllodeous tumour and fibroadenoma present with a well-circumscribed, mobile breast mass which can be difficult to distinguish both clinically and histologically.
Typical factors that are helpful for exams:
- Phyllodes tumour is more likely in older women, with larger, rapidly growing masses
- Fibroadenoma is more common in younger women, with smaller, stable masses
Complications
The most important complications associated with benign phyllodes tumour are local recurrence and, in malignant cases, distant metastasis
Management
Surgical excision is the cornerstone of management for ALL phyllodes tumours (due to risk of recurrence / distant metastasis) [Ref]
Intraductal Papilloma
Definition
Intraductal papilloma is a benign breast tumour that arises from the epithelium of the lactiferous ducts
Diagnosis – Triple Assessment
Intraductal papilloma is relatively uncommon, accounting for ~4-5% of breast biopsies [Ref]
- Median age of diagnosis: 50-60 y/o [Ref]
| Triple assessment component | Findings / description [Ref] |
|---|---|
| Clinical examination |
|
| Imaging | Rule of imaging for breast mass
|
| Biopsy | Gold standard: core needle biopsy
|
Management
All intraductal papilloma with atypia (biopsy-proven) should be excised (due to risk of associated malignancy) [Ref]
Surgical excision is NOT routinely indicated for intraductal papilloma without atypia [Ref]
- A common indication for excision is troublesome symptoms
Other Benign Breast Conditions
Note that mastitis and breast abscess are also important benign breast conditions, but are covered in a separate article.
| Condition | Presentation | Management |
|---|---|---|
| Fibrocytic breast disease | Most common type of benign breast condition
Clinical features:
Ultrasound findings:
|
Conservative management for most patients
Surgical excision is necessary for those with atypia (e.g. atypical ductal hyperplasia) |
| Breast cyst | Most common in peri-menopausal women
Ultrasound is used to differentiate between cystic and solid breast masses
|
A simple breast cyst doesn’t need any specific management
Complicated / complex breast cysts needs surveillance +/- excision (due to risk of malignncy) |
| Galactocele | Galactoceles are cysts that form from milk retention during lactation
Presents as a firm mass in the subareolar region that typically occurs after lactation |
A galactocele doesn’t need any specific management
|
| Fat necrosis of the breast | Typically occurs after breast trauma / surgery / radiation
Presents as a poorly defined breast mass with irregular borders (may mimic breast cancer)
Imaging +/- biopsy is often necessary to exclude malignancy |
Fat necrosis doesn’t need any specific management if magliancny is excluded by biopsy |
| Mammary duct ectasia | Most common in peri-menopausal women
Typical presentation:
|
Mammary duct ectasia doesn’t need any specific management
Consider surgical duct excision in those with persistent symptoms / nipple discharge |
| Mondor’s disease of the breast | This is superficial thrombophlebitis of the breast
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Conservative management |