Benign Breast Disease

Related Subjects: | Assessment of the Causes of Breast Tenderness/Pain (Mastalgia) | BRCA Genes (Familial Breast Cancer) | Breast Anatomy and Examination (OSCE) | Breast Cancer | Benign Breast Disease | Malignant Breast Disease | Breast Lumps: Clinical Approach | Mastitis and Breast Abscess | Malignant Breast Disease

✅ Benign breast disease = a group of non-malignant conditions that commonly cause lumps, nodularity, and nipple symptoms. 🎯 OSCE focus: describe the lump, look for red flags (skin/nipple changes, fixed mass, axillary nodes), and explain that many patients are assessed via a one-stop breast clinic to exclude cancer.

🧭 Clinical Approach (OSCE-ready)

• 🧾 History: age, cyclical change, pain (mastalgia), pregnancy/breastfeeding, nipple discharge (bloody? unilateral?), growth rate, trauma/surgery, family history, HRT/COCP.
• 🩺 Examination: size, site (quadrant), shape, surface, consistency, mobility, tenderness, skin tethering/dimpling, nipple inversion/discharge, axillary/supraclavicular nodes.
• 🧠 Key rule: “Benign-sounding” ≠ benign. A new persistent lump or red flags → triple assessment pathway.

🚩 Red Flags (say these out loud in exams)

• ⚠️ Hard/irregular/fixed lump
• 🍊 Peau d’orange, skin tethering, new ulceration
• 🩸 Spontaneous unilateral bloody nipple discharge
• 🔻 New nipple inversion or eczema-like nipple change (consider Paget’s)
• 🧊 Persistent axillary node enlargement
• ⏱️ Rapid progressive swelling/erythema not settling as expected

🧩 Benign Breast Conditions (High-yield summaries)

🌸 Fibrocystic Change

Definition: increased nodularity of breast tissue in response to hormonal change.

• Buzzwords: 👩 30–50 years; diffuse nodularity; size fluctuation; cyclical mastalgia.
• Investigations: USS/mammogram typically show no concerning features; FNAC/biopsy rarely needed.
• Differentials: fibroadenoma, ductal adenoma, lipoma, DCIS, invasive breast cancer.
• Management: 😌 analgesia + 👙 well-fitted supportive bra; safety-net if symptoms change.

🏐 Fibroadenoma (“breast mouse”)

Breast fibroadenoma is a common benign tumour in young women 👩‍🦰. Most are harmless ✅, but careful assessment + reassurance reduce anxiety 😟 and ensure safety.

About: Fibroadenomas are the most common benign breast tumour, usually in ages 15–30. They are made of glandular + stromal tissue and are classically smooth, firm, well-defined, and highly mobile.

⚙️ Aetiology

• 🔄 Hormonal influence (often noticed during pregnancy/COCP use; tends to regress after menopause).
• 🧬 Composition: glandular + stromal tissue.
• 🗂️ Types:
  • ✅ Simple: typical mobile solitary lump.
  • ⚠️ Complex: may contain cysts/calcifications/sclerosing adenosis → slightly ↑ future cancer risk (still low overall).

👩‍⚕️ Clinical Presentation

• 🎯 Typical features: smooth, rubbery/firm, well-defined, mobile, usually painless.
• 🧭 Often upper outer quadrant; may be single or multiple.
• 🚫 Usually no skin tethering, nipple retraction, or pathological discharge.

🔍 Investigations

• 🖐️ Clinical exam: document size, site, mobility, and absence of red flags.
• 📡 Ultrasound first-line in younger women; mammogram more common in older patients.
• 🧪 Biopsy if atypical imaging, enlarging, or diagnostic doubt.

🛠️ Management

• 🤝 Reassure + safety-net; many are monitored rather than removed.
• 🔪 Consider excision if large, rapidly growing, symptomatic, or ongoing diagnostic uncertainty.

🧬 Ductal Adenoma

Definition: benign glandular tumour.

• Buzzwords: 👵 >50 years; painless nodular lump.
• Investigations: imaging may mimic malignancy → biopsy often required to exclude cancer.
• Differentials: fibroadenoma, lipoma, DCIS, invasive breast cancer.
• Management: conservative or surgical excision if diagnostic uncertainty.

🟡 Lipoma

Definition: benign adipose tumour.

• Presentation: soft, mobile lump.
• Investigations: mammogram classically radiolucent with no calcification; biopsy only if enlarging/uncertain.
• Differentials: fibroadenoma, ductal adenoma, DCIS, invasive breast cancer.
• Management: usually reassurance; if very large (e.g. >5 cm) or atypical → consider imaging/appropriate specialist pathway.

🩸 Intraductal Papilloma

Definition: benign intraductal lesion.

• Buzzwords: 40–50 years; subareolar lump; bloody or clear nipple discharge.
• Investigations: USS may show dilated duct; mammogram may show ductal calcifications; biopsy often required to exclude malignancy.
• Differentials: duct ectasia, ductal adenoma, DCIS, invasive breast cancer.
• Management: excision (microdochectomy or major duct excision depending on extent).

🟢 Ductal Ectasia

Definition: dilated ducts (often with debris/inflammation); may calcify.

• Buzzwords: perimenopausal/increasing age; sticky/green discharge; possible lump; nipple retraction.
• Investigations: mammogram may show calcified ducts; biopsy may show plasma cells (if sampled).
• Differentials: papilloma, Paget’s, DCIS, invasive breast cancer.
• Management: reassurance if mild; duct excision if persistent troublesome symptoms or malignancy concern.

🌿 Phyllodes Tumour

Definition: rare fibroepithelial tumour (benign or malignant spectrum).

• Buzzwords: rapid growth; can become large.
• Investigations: core biopsy shows “leaf-like” architecture.
• Differentials: fibroadenoma (key mimic), DCIS, invasive breast cancer.
• Management: wide local excision with clear margins; mastectomy if very large.

🧠 Mini OSCE “Talk-through” (30–45 seconds)

• 👋 “I would confirm symptoms (lump, pain, discharge), timing/cyclical change, growth rate, pregnancy/breastfeeding, medications (COCP/HRT), trauma, and family history.”
• 🩺 “On exam I’d assess lump features, nipple/skin changes, and lymph nodes.”
• 📌 “If any red flags or persistent new lump, I’d arrange urgent breast clinic assessment/triple assessment.”
• ✅ “If features are typical for benign disease and imaging is reassuring, management is reassurance, analgesia if needed, and safety-netting.”

📚 References

• NICE CKS: Breast symptoms / breast lump pathways (UK primary care approach).
• NHS breast clinic and screening information (UK context).
• Core surgical/clinical texts for benign breast disease patterns and differentials.