St Marks Breast Centre
Private Service Radiology
Benign Breast Conditions
Benign breast disease is very common and in many cases does not require any treatment other than diagnosis and an explanation of the condition.
Any breast symptom can cause alarm however, and it is important that they are checked out promptly and referred for specialist evaluation when required.
The most common breast condition for which a woman will see her doctor is breast pain (mastalgia). This is extremely common, and will affect up to 90% of women at some stage. It is the only symptom of breast cancer in less than 2% of cases. In most cases mastalgia is self limiting and only a small proportion of cases will require treatment.
Mastalgia is divided into cyclical (i.e. shows a definite relationship to menstruation) and non-cyclical. Non-cyclical mastalgia often has an origin outside of the breast, and a search should be made for chest wall tenderness or Tietze’s syndrome.
Cyclical breast pain is often bilateral, radiates into the arm and may be associated with cyclical nodularity. If mild to moderate, it often responds well to evening primrose oil. More severe pain may need specialist assessment and drug treatment with tamoxifen, danazol or bromocriptine may be considered.
Most breast lumps are benign, and many can be considered as aberrations of normal development and involution (ANDI). For example, fibroadenomas are an aberration of normal lobular development in the early reproductive years, and cysts are an aberration of lobular involution. For this reason, these lumps rarely require excision.
Cyclical nodularity is seen in many women and may be associated with mastalgia. A woman may notice a particular nodule which feels more prominent. Often she can be reassured by a comparison with the opposite breast. If there is any doubt, an ultrasound scan will show if there is any discrete abnormality. A biopsy is rarely required.
Fibroadenomas are common, particularly in the teens and twenties. Once a diagnosis is made by triple assessment (clinical examination, imaging and needle biopsy), they only require excision if they are enlarging or if the woman wishes it. Occasionally, a biopsy may show some atypical features suggestive of a phylloides lesion, and biopsy is usually advised.
Cysts are very common in the thirties through to fifties age group. About one in ten women in this age group will get a symptomatic cyst. These are commonly multiple or recurrent. They have a very typical appearance on ultrasound. Symptomatic cysts are easily aspirated under ultrasound guidance. Cytology is only required if: the aspirate is bloodstained, there is a residual lump or the cyst refills rapidly after a previous aspiration.
Nipple discharge is a symptom which often alarms women. In most cases, it is physiological or due to duct ectasia. These harmless types of nipple discharge are often creamy in consistency and may be coloured green or brown. They are often bilateral and can be seen to come from more than one duct. Women with this type of discharge, particularly if it is not spontaneous, can usually be reassured. Intervention is only required if the discharge is profuse enough to be socially embarrassing. Prolactinomas are extremely rare, but serum prolactin should be checked if the discharge is profuse and appears milky.
Nipple discharge should be referred on if it is spontaneous, unilateral, single duct and either clear or bloodstained. The most common underlying cause is a benign duct papiloma, but malignancy needs to be excluded.
Many of these conditions do not require surgery and we will work together to find out the best treatment plan for you.