Benign breast pathology encompasses a large group of conditions that can be grouped depending on the main symptom suffered by the patient. Some of these are: palpable nodules, nipple discharge, pain, alterations in the shape of the breast and skin alterations.
What types of nodules are there?
- Fibroadenoma
These types of nodules are mainly made up of fibroepithelial tissue, the most common being fibroadenoma (the most common) and usually measure between 2 and 4 cm, although some can reach a size of more than 8 cm. They appear before the age of 40 and, if they do not increase in size or hurt, resection is not necessary. It is advisable to diagnose them at least by fine needle aspiration puncture (FNA).
- Cysts
Another very common nodule are cysts, which are accumulations of fluid with an onset between the ages of 35 and 40. The size can vary from millimeters to centimeters. The appearance of cysts is due to blockage and dilatation of the ducts by stromal edema caused by hormonal stimuli. On a large number of occasions they are related to patients presenting fibrocystic mastopathy, with an increase in size and pain before menstruation. During menopause the symptoms improve and these symptoms disappear. It is not always necessary to operate on the cysts unless they cause a lot of pain or protrude above the skin with the naked eye. In this case we will perform a fine needle puncture and proceed to empty the cyst.
Through an anamnesis, manual exploration and breast ultrasound a correct diagnosis can be made.
What does a fibrocystic mastopasty involve?
It is a benign process of the breast referred to pain that may occur cyclically and may be related to menstrual cycles. It is one of the most frequent symptoms of consultation.
When the pain is cyclical and occurs before menstruation, it is popularly known as premenstrual breast tension syndrome and is due to hormonal changes that occur in the breast, being more common among young women and bilaterally. During menstruation the pain disappears or at least improves. When the pain is not cyclical, the most frequent cause is fibrocystic mastopathy, which is related to an increase in fibrous tissue and the appearance of microcysts and fibrous plaques throughout the breast, being normal in most young women.
When does breast discharge occur?
The appearance of breast discharge in a woman usually occurs if this is specifically looked for on breast examination. During a woman’s lifetime, 50-80% of women will have some type of discharge excluding lactation. Most of the secretions can be physiological or of benign pathology due to papillomas, ductal ectasia, hyperprolactinemia, pharmacological, breast trauma… They are usually bilateral and pluriorificial. But they should always be taken into account and ruled out as a symptom of breast cancer. For a correct diagnosis it is essential to have a correct clinical history, a detailed examination, a cytological impression, a culture if needed and a breast ultrasound.
The treatment of the discharge can vary from doing nothing to medical treatment or surgical intervention as in the case of diagnosis of papillomas.
What is mastitis?
It is an inflammatory process of the breast that presents itself in two forms:
- Acute: puerperal mastitis (related to lactation) has a predominant character.
- Chronic: recurrent subacute infection being the most frequent.
Mastitis appears as a reddening of part or all of the breast causing local heat and pain. Occasionally it may cause fever. It may also be due to an underlying abscess, the most common cause being bacterial infection.
The initial and usual treatment of mastitis and abscesses will be medical treatment with antibiotics and anti-inflammatory drugs. In cases where these problems are not resolved and an abscess persists, debridement and, in recurrent cases, excision of the entire woody area and fistulous tract will be necessary.