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BENIGN BREAST CONITIONS
1. FIBROCYSTIC CONDITION
This is the most common reason for dense, lumpy and painful breasts.
The symptoms are cyclic and seem to be worse during the second half
of the menstrual cycle. During each cycle the breast tissue goes through
a period of stimulation and regression. There is an association with
caffeine use. Patients with severe fibrocystic condition may benefit
from decreasing their caffeine intake and use of anti-inflammatory medication,
or Primrose oil for relief.
Some fibrocystic changes may increase the risk of breast cancer. The
finding of a new lump needs to be evaluated to establish its benign
nature. The presence of a fibrocystic condition may make the detection
of a breast cancer difficult.
2. BENIGN BREAST TUMORS
A Fibroadenoma is the most common breast lump. It is usually asymptomatic
and progresses slowly. Phylloides Tumor is a more aggressive variant
and grows to a larger size.
Malignant variation can occur in both but is rare. A biopsy is needed
to establish its benign nature. They can be excised with ultrasound
guidance in the office, treated with Cryoablation or surgical excision.
3. NIPPLE DISCHARGE
Nipple discharge, which occurs spontaneously from a single breast
or a single duct, needs to be investigated with a physical evaluation,
mammogram, ultrasound, and ductogram, to establish its source. About
10% of patient with nipple discharge can have breast cancer. Most of
the cancers are low-grade. Bilateral breast discharge can be secondary
to excessive hormones.
A majority of nipple discharges are from benign conditions like fibrocystic
disease, duct ectasia, infection, inflammation or a benign breast tumor
like a duct papilloma. If the work up documents a benign breast tumor,
it may still need excision.
4. PAGETS DISEASE
This condition usually presents as nipple excoriation, eczema, ulceration
or discharge. It may be associated with a low-grade breast cancer.
Full breast examination, mammogram, ultrasound and nipple biopsy are
needed to establish accurate diagnosis. Treatment options are surgical
excision, with a partial mastectomy or a simple mastectomy.
5. BREAST PAIN
This is a source of distress. Breast pain when cyclical is most likely
secondary to fibrocystic condition and is usually worse in the second
half of the woman’s menstrual cycle. The pain is secondary to
retention of excess fluid in the breast cysts and tissues. Hormones
play a very important role in exacerbation of breast pain.
A full work-up is needed to establish the cause of breast pain.
Patients will benefit from decreasing caffeine intake, decreasing the
hormone dose, Primrose oil, use of anti-inflammatory medications, diuretics
and Danazol.
Postmenopausal women on hormone replacement may experience breast pain.
The symptoms may or may not be cyclical. Decreasing the dose of hormone
can be helpful in controlling the pain.
Rarely patients with breast cancer will present with breast pain.
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