1. Benign Breast Conditions
NURS 541: Women’s Healthcare – Diagnosis and Management

2. Benign Breast Conditions
Most common breast conditions
Mastalgia
Nipple discharge
Benign breast masses
Sensitive topic for women!
Fears and concerns re: breast cancer first and foremost

3. Mastalgia Etiologies Benign in >90% of cases of breast pain
Classified as cyclic (~70%) and non-cyclic (~30%)
Etiologies
Menstrual cycle hormone changes
Hormonal contraception methods, hormone replacement
Other medications (antidepressants, digoxin, methyldopa, spironolactone, oxymetholone, chlorpromazine)
Fibrocystic breast changes

4. Mastalgia History Diagnostic testing Differential diagnosis
Cyclic or non-cyclic
Pregnancy test!
Timing and character
Mammogram if indicated, to rule out malignancy
Unilateral or bilateral
Differential diagnosis
Quality of pain
Physical exam
Chest wall abnormalities
Costochondritis
Comprehensive breast exam
Pleuritis
Exam of chest wall
Mastitis
Shingles

5. Mastalgia Management Non-pharmacologic measures Pharmacologic measures
Reassurance!!
Reduction in caffeine, fat (mixed evidence)
Wearing a supportive, well-fitting bra (strong evidence)
Pharmacologic measures
Changing hormonal method, dose, route
Danazol, tamoxifen, bromocriptine effective (Danazol only FDA approved treatment for mastalgia)
Significant side effects may outweight benefits
Evening primrose oil, Agnus castus, isoflavones (mixed evidence)

6. Nipple Discharge Classified as: Etiologies Normal lactation
Milky discharge unrelated to childbearing
Non-milky discharge (pathologic discharge)
Etiologies
Pregnancy/lactation
Galactorrhea
Intraductal papilloma
Mammary duct ectasia
Cancer

7. Nipple Discharge History Diagnostic testing Exam
Unilateral or bilateral
Spontaneous, bilateral, milky discharge:
Duration, timing
Pregnancy test
Character of discharge
Serum prolactin, TSH
Spontaneous or expressed
Brain MRI if prolactin
One or more ducts
Spontaneous, unilateral, uniductal discharge:
Other breast symptoms
Exam
Mammogram or ultrasound
Expressed only
Comprehensive breast exam
None needed
If discharge is spontaneous, bilateral, do pregnancy test, prolactin, TSH
If discharge is spontaneous, unilateral,uniductal or associated with mass, do mammogram or ultrasound
If discharge is expressed only, non-milky, encourage limited breast contact and reassess in 3-4 months

8. Nipple Discharge Differential diagnosis Management Sexual stimulation
Infection, abscess
Paget’s disease
Management
Reassurance if lactation, colostrum, physiologic causes
Galactorrhea
Depends on cause – pituitary tumor, hypothyroidism
Medication management would require long term treatment
Surgical modalities for intraductal papilloma, ectasia

9. Benign Breast Masses Common types of benign breast masses
Fibroadenomas
Non-tender, encapsulated, round, moveable, firm
Often seen in younger women, decreasing with age
Cysts
Fluid-filled, soft, moveable
Often seen with women years old
Lipomas
Fatty tissue
Increasing incidence with age
Fat necroses
Result of trauma to the breast (surgical or external force)

10. Benign Breast Masses Common types of benign breast masses (continued)
Phyllodes tumors
Large, fast-growing, firm, palpable mass
From periductal stromal cells (may be benign or malignant)
Hamartomas
Glandular tissue, fat, fibrous tissue
Seen in older women
Galactoceles
Milk-filled cysts, from duct dilation
Occur during or after lactation

11. Benign Breast Masses History Diagnostic testing Physical exam
Onset, duration
Age < 30: ultrasound
Other breast symptoms
Age ≥ 30: mammogram
Menstrual/medical/family history
If mass suspicious for malignancy, order both
Biopsy
Physical exam
Differential diagnosis
Comprehensive breast exam
Fibrocystic changes
Describe mass
Tender, moveable, skin changes
Infection/abscess
Malignancy
Lymphadenopathy

12. Benign Breast Masses Management Fibroadenomas, cysts, lipomas
Expectant management – monitor for changes
Phyllodes tumors
Excisional biopsy recommended
Hamartomas
Biopsy needed for diagnosis, expectant management
Galactocele
Aspiration for diagnosis and treatment

13. Special Considerations
Breast cancer is the fear for women presenting with breast concerns
Primary objective is to rule out breast cancer
Secondary objective is to assess, identify concern, and provide guidance for women with benign breast conditions
Breast cancer topic covered in another module