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Galactoceles
Galactoceles are milk-filled cysts that can occur in women who are pregnant or lactating. As with other cysts,
galactoceles are always non-cancerous. They often appear as smooth, moveable lumps, although they can also be
hard or unmoveable. Galactoceles are treated the same way as cysts: usually by leaving them alone. If the
diagnosis is uncertain or the galactocele is causing discomfort, it can be drained with a thin needle (fine needle aspiration).
Fibroadenomas
Fibroadenomas are common benign breast tumors often too small to feel
by hand, though occasionally, they may grow to be several inches in diameter.
Fibroadenomas are made up of both glandular and stromal (connective) breast tissue and
usually occur in women between 20-30 years of age. According to the American Cancer
Society, African-American women are affected with fibroadenomas more often than women of
other racial or ethnic groups. The tumors tend to be round and have borders that are
distinct from the surrounding breast tissue, so they often feel like a marble within the
breast. Some women have only one fibroadenoma while others may have multiple tumors.
Fibroadenoma are usually diagnosed by fine needle
aspiration or core needle biopsy.
Fibroadenomas often stop growing or
even shrink on their own without any treatment. In these cases, doctors may recommend not
having the tumors removed. Fibroadenoma surgery may involve removing a margin of
surrounding breast tissue. The risk of surgery is that scarring could occur that could distort the shape and
texture of the breast and make future physical examination and mammography more difficult
to interpret. On the other hand, if fibroadenomas do not stop growing, they usually need to be
surgically removed. Sometimes one or more new fibroadenomas will grow after one is
removed.
Phyllodes
Tumors
Phyllodes tumors (also spelled as phylloides) are also benign breast
tumors in the glandular and stroma (connective) breast tissues but are far less common
than fibroadenomas. The difference between phyllodes tumors and fibroadenomas is that
there is an overgrowth of the fibro-connective tissue in phyllodes tumors. Phyllodes
tumors are usually benign but on very rare occasions, they may be malignant (cancerous)
and could metastasize (spread).
Treatment of phyllodes tumors involves
removing the mass and a one-inch margin of surrounding breast tissue. Cancerous phyllodes
tumors are also surgically removed by either lumpectomy or mastectomy, but do not typically respond well to chemotherapy or radiation therapy.
Intraductal Papillomas
Intraductal papillomas are
non-cancerous wart-like growths with a branching or stalk that has grown inside the
breast. A papilloma often involves the large milk ducts near the nipple, causing bloody nipple discharge. Occasionally, multiple papillomas may be found
further from the nipple.
Papillomas are usually diagnosed by imaging the breast duct with a galactogram (also called ductogram) or removing a portion of the affected duct (duct
excision). Typically, surgeons remove the
papilloma and a segment of the duct where the papilloma is found, usually through an
incision at the edge of the areola (the pigmented region surrounding the nipple).
Of the benign conditions that cause
suspicious nipple discharge, approximately half are due to papillomas, and the other half
are a mixture of fibrocystic conditions or duct ectasia, the widening and hardening of the
duct due to age or damage (See the section on duct ectasia for more information).
Granular Cell Tumors
Granular cell tumors are usually found
in the mouth or skin but may rarely be detected in the breast. Most granular cell tumors
of the breast are identified as movable, firm lumps, measuring between one-half and one
inch in diameter. Doctors typically diagnose grandular cell tumors by a fine needle or needle core biopsy and then surgically remove
the tumors along with a surrounding margin of breast tissue. Granular cell tumors do not
indicate higher risk for developing breast cancer.
Duct Ectasia
Duct ectasia, widening and hardening of
the duct, is characterized by a thick green or black nipple discharge,
typically affecting women in their forties and fifties. The nipple and surrounding tissue
may be red and tender. Duct ectasia is a benign condition but can sometimes be mistaken as
cancer if a hard lump develops around the abnormal duct. Opalescent (clear) nipple discharge is
often due to duct ectasia or cyst.
Often, duct ectasia does not need
treatment, or improves with the application of heat or antibiotic drugs. Occasionally, the
affected duct is surgically removed by an incision at the border of the areola (the
pigmented region around the nipple).
Fat Necrosis
Fat necrosis, a benign condition where
fatty breast tissue swells or becomes tender, can occur spontaneously or as the result of
an injury to the breast. When the body attempts to repair damaged breast tissue, the
affected area may sometimes be replaced with firm scar tissue. Fat necrosis may be
mistaken as cancer on a mammogram; however symptoms of fat
necrosis usually subside within a month. Biopsy can confirm fat
necrosis.
According to the American Cancer
Society, some areas of fat necrosis can have a different response to injury. Instead of
forming scar tissue, the fat cells die and release their contents, forming a sac-like
collection of greasy fluid called an oil cyst. Oil cysts can be diagnosed by fine needle
aspiration, which also serves as a treatment. While fat necrosis itself is a non-cancerous
condition, its appearance can sometimes draw attention to another suspicious area of the breast that
had not previously been discovered.
Breast Inflammation: Mastitis
Mastitis, another non-cancerous
condition, most commonly affects women while they are breast-feeding. Cracking of the skin
around the nipple allows bacteria from the skin surface to enter the breast duct where it
grows and attracts inflammatory cells. Inflammatory cells release substances to fight the
infection, but also cause breast tissue swelling and increased blood flow. Breasts
infected with mastitis often swell, become red in color, and feel warm to the touch. Most
of the time, mastitis is treated with antibiotics. However, if a collection of pus (an
abscess) from inflammatory cells and fluid results, the pus may have to be drained.
Click here for information about mastitis as a result of breast-feeding.
Click here for information about malignant (cancerous) breast inflammation, called inflammatory breast cancer.
Conclusion
This article describes a variety of
benign breast conditions and typical treatments. Women should discuss all breast concerns with
their physicians. Treatments will vary depending on specific cases, family history, and other
factors.
The American Cancer Society recommends
the following guidelines for the detection of breast cancer in women who are asymptomatic
(show no symptoms of breast cancer):
- Women 20 years of age and older should
perform breast self-examination (BSE) every month.
- Women 20-39 should have a physical examination of the breast (CBE or clinical
breast exam) at least every three years, performed by health care professional such as a
physician, physician assistant, nurse or nurse practitioner. CBE may often be received in
the same appointment as a Pap smear.
- Women 20-39 should also perform monthly
BSE.
- Women 40 and older should have a
physical examination of the breast (CBE or clinical breast exam) every year, performed by
a health care professional, such as a physician, physician assistant, nurse or nurse
practitioner. CBE can often be performed in the same visit as a mammogram.
Monthly BSE should also be performed.
- Women 40 years of age and older should
have a screening mammogram every year in addition to annual CBE and monthly BSE.
Women at high risk of breast cancer such as those
with a strong family history of breast cancer, should ask their physician whether annual mammography should begin
before age 40. For example, some physicians recommend women begin
screening mammography at an age ten years earlier than the age her mother was diagnosed
with breast cancer.
Additional
Resources and References
- The Breast Book: The
Essential Guide to Breast Care and Breast Health for Women of All Ages (1996) by
Miriam Stoppard, MD and Rache Simmons. This book covers a variety of topics and breast
health concerns, including benign and malignant conditions.
- For more information on both benign and
malignant nipple discharge, please visit http://www.imaginis.com/breasthealth/nipple.asp.
- http://www.cancer.org/.
The American Cancer Society provides detailed information on benign breast conditions.
- O’Grady, Lois et al, A Practical Approach to Breast
Disease, Boston: Little Brown and Company, 1995, 186-187. A good source of
information on breast pain, nipple discharge, and benign breast conditions.
 The American Medical Association Encyclopedia of
Medicine, Charles Clayman, Ed, New York, Random House, 1989, 666. - For more information on high risk
factors for breast cancer, please visit http://www.imaginis.com/breasthealth/bc_risks.asp.
Updated: January 23, 2008
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