Benign Breast Diseases

Benign Tumour

FIBROIDS
Description: A fibroid is a benign tumour of the breast and is very similar to the fibroid found in the uterus. It is a very common in young and middle-aged women. When examined using hands, breast fibroids feel firm and rubbery. They are moveable, hence are referred to as breast mouse.
The causes of breast fibroids are not completely understood. However, there are several factors that play a significant role in the development of the disease, such as:

  • Monthly changes in the levels of oestrogen and progesterone may affect the breast tissues by causing cells to grow and multiply.
  • Hormones like prolactin, growth factor, thyroid hormone and insulin may also influence the development of breast fibroids.

Symptoms:

  • Lump in the breast
  • Heaviness in the breast
  • Occasional dull ache or severe pain
  • Tenderness during periods
  • Breast discomfort, either persistent or intermittent
  • Changes in nipple sensation

Diagnosis:
Breast fibroid is diagnosed using either digital mammography or breast ultrasound.
Treatment:

  • If you don’t experience symptoms, or your symptoms are mild and the size of the fibroid is less than 3 cms, no treatment is needed for the fibroid. You just need to undergo a breast ultrasound once every year to follow-up for increase in size.
  • If the size of the tumour is more than 3 cms, it can be removed without undergoing surgery. In such cases, the fibroid can be removed with the help of Vacuum Assisted Biopsy (VAB). This is a scarless and painless procedure done under local anaesthesia in the OPD without the need for hospital admission. The procedure lasts for a few minutes. You therefore need not be anxious or worried about this procedure. It is quick, easy, and causes no harm to you in any way.

Painful fibroids or fibroids associated with large cysts may warrant further treatment like surgery depending on the size of tumour.

CYSTS
Description:A cyst is a water filled cavity which is thought to occur with age, due to changes in the normal levels of hormones leading to changes in the breast.

Diagnosis:
Breast cysts can be diagnosed on an ultrasound or by fine needle aspirations (a type of biopsy procedure).

Symptoms:

  • Lump in the breast.
  • Occasional dull ache or severe pain.
  • Tenderness around the time of menstrual periods.
  • Breast discomfort, which may be either persistent or intermittent.
  • Nipple discharge, which is usually clear, yellow or dark brown in colour.

Treatment:

  • Most cysts are ‘simple’, hence are completely benign. In this case, the patient does not need any treatment.
  • Some cysts (about 10-15%) may be ‘complex’. This would require a biopsy to rule out.
    1. a small lurking precancerous lesion or
    2. a papilloma or
    3. a papillary carcinoma. The papillary carcinoma can be a local cancer (carcinoma-in situ) or can spread to other parts (invasive cancer). Therefore, early diagnosis of these cysts becomes very important.

Vacuum Assisted Biopsy (VAB) is the preferred biopsy procedure.

GRANULOMATOUS MASTITIS
Description:Granulomatous refers to an inflammatory tumour that is composed of granulation tissue (the tissue that forms on wounds for healing), while mastitis means inflammation of the mammary gland in the breast. Granulomatous mastitis, therefore, is an immunological and inflammatory condition in which the body creates antibodies for the breast tissue to fight the infection in the tissue, and produces abscess (or pus accumulation, that happens when a wound is infected) over a period of time. Granuloma is the collection of immune cells in the tissue formed to fight a foreign substance in the tissue. This granuloma then gets secondarily infected to form an abscess. Multiple abscesses keep on arising in the breast over a period of time. This makes the condition very challenging to treat, but it does not lead to mortality. Granulomatous mastitis is a very common finding. At Orchids, we see about 4-5 patients every month with granulomatous mastitis and in at least 90% of patients, excellent results with just medications are achieved.
Symptoms:

  • Lump in the breast.
  • Occasional dull ache or severe pain.
  • Breast discomfort, either persistent or intermittent.
  • Redness of the overlying skin.
  • Fever.

Treatment:

  • Surgical excision is not the first treatment of choice for this.
  • Needle aspirations (or biopsies to remove the tissue sample for examination) and drainage of the pus from the boils or abscesses is advisable.
  • To prevent abscess formation due to secondary infection, antibiotics are the initial choice for treatment. Antibiotics are specifically given to prevent abscess formation. This is followed by cleaning the abscess with concentrated potassium iodide (KI) solution.
  • A few resistant cases can be treated with steroids on a short term basis.
  • We suggest complementary Homeopathy treatment – in our experience this has worked very well with 90% patients achieving excellent results.

Only about 10% of the people with granulomatous mastitis need a procedure which is usually limited to excision of the abscesses without deforming the breast. This is a day care procedure where the patient can come in the morning and can go home in a couple of hours. This procedure is painless, scarless and quick, thus assuring the patient of no harm and more relief.

PAPILLOMA
Description:A papilloma is a benign tumour that grows like a wart or finger-like fronds, projecting outwards in the milk ducts.
It can occur in one duct (solitary papilloma) or in multiple ducts (papillomatosis).
Multiple papillomas can pose a higher risk of developing breast cancer.
Symptoms:

  • Lump in the breast.
  • Occasional dull ache or severe pain.
  • Breast discomfort, either persistent or intermittent.
  • Nipple discharge.

Diagnosis:
Ultrasound is the best way to diagnose a papilloma.
Treatment:

  • Surgery is performed to remove the papilloma and part of the duct surrounding the tumour (also known as microdochectomy).
  • Smaller lesions can be excised with a Vacuum Assisted Biopsy (VAB).

If more than one duct is involved, extensive surgical excision is done to remove the papilloma. The surgery is usually a day care procedure, therefore, rest assured, the patient should not be worried about being admitted to the hospital. Since it is simply an excision, there are no scars, and no pain, as well.

PAINFUL BREAST SYNDROME (MASTALGIA)
Description:Breast pain, also known as mastalgia, mammalgia or mastodynia, includes a dull ache, heaviness, tightness in the breast or breast tenderness. It is hypersensitivity and the pain is either in one or both the breasts.
It is usually prominent during menstrual periods and hence, is known as cyclical breast pain.
Cyclical breast pain is often unpredictable – it may well just go away in time, and then come back periodically during menstrual cycles.
If the breast gets infected or the breast ducts are blocked, the condition is called mastitis. It is most common in breastfeeding women and usually occurs within the first three months after giving birth.
Treatment:

  • In majority of cases, it is possible to solve cyclical breast pain by taking painkillers and wearing well-fitted bras.
  • Vitamin E, Vitamin B6 and Primrose oil are helpful in this condition.