Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Benign Breast Disorders

Mastalgia Breast pain

Most common breast-related complaint Cyclic mastalgia coincides with menstrual

cycle and is related to hormonal sensitivity Noncyclic mastalgia can be constant or

intermittent May be due to trauma, fat necrosis, duct

ectasia, costochronditis, or arthritic pain

Benign Breast Disorders

Mastitis Lactational mastitis

Inflammatory condition that occurs most frequently in lactating women Localized area that is erythematous, painful,

and tender to palpation Fever is often present Organisms obtain access through cracked nipple Can be cured with antibiotics in early stages

Benign Breast Disorders

Lactational breast abscess From persistent lactational mastitis

Palpable mass with red, edematous skin over involved breast; possibly fever

Drainage of abscess is necessary Cultured and treated with appropriately

sensitive antibiotics Breastfeeding can usually continue

Benign Breast Disorders

Fibrocystic changes Benign condition with tissue changes

Development of excess fibrous tissue Hyperplasia of the epithelial lining of the

mammary ducts Proliferation of mammary ducts Cyst formation

Exaggerated response to hormones

Benign Breast Disorders

Fibrocystic changes Not linked to breast cancer risk↑ Occur most commonly in 35- to 50-

year-old women Women with premenstrual abnormalities,

nulliparity, history of spontaneous abortion, no use of oral contraceptives, with early menarche and late menopause

Palpable round, well-delineated, freely movable lumps

Nursing/Collaborative ManagementFibrocystic Changes

Excisional biopsy No fluid on aspiration Fluid is hemorrhagic Residual mass remains after fluid

aspiration Treat with good support bra, dietary

therapy, vitamin E, analgesics, danazol, diuretics, hormone therapy, antiestrogen

Benign Breast Disorders

Fibroadenoma Common cause of discrete benign

breast lumps in young women Occurs between 15 and 40 years of age Most frequent cause of breast masses

in women younger than 25 May be due to estrogen sensitivity↑

Benign Breast Disorders

Fibroadenoma Easily detected on physical

examination Definitively diagnosed by biopsy Treat with

Observation Excision Cryoablation

Nipple Discharge

Galactorrhea Milky secretion due to inappropriate

lactation May result from

Drug therapy Endocrine problems Neurologic disorders Idiopathic causes

Nipple Discharge

Serous, grossly bloody, or brown to green secretions Malignant or benign disease Cytology slide to determine disease

Malignancies, cystic disease, intraductal papilloma, ductal ectasia

Treatment depends on cause Usually not related to malignancy

Intraductal Papilloma

Benign, soft, wartlike growth In mammary ducts Usually unilateral Bloody discharge from nipple Difficult to palpate Usually found in 40- to 60-year-old

women May be associated with risk of cancer↑

Ductal Ectasia

Duct dilation Benign breast disease of

perimenopausal and postmenopausal women

Involves ducts in subareolar area Multicolored, sticky nipple discharge Not associated with malignancy Treatment: warm compresses and

antibiotics

Gynecomastia in Men

Transient, noninflammatory enlargement of 1 or both breasts Most common breast problem in men Usually a temporary, benign condition Not a risk factor for breast cancer

May signal hormonal problems or drug effects

Senescent Gynecomastia

Occurs in many older men Probably caused by plasma estrogen

elevation Tender, firm, centrally located

enlargement Usually regresses in 6 to 12 months Biopsy can rule out breast cancer

Gerontologic Considerations

Pendulous breasts Loss of subcutaneous fat Loss of structural support Atrophy of mammary glands

↓ Glandular tissue density ↑ Incidence of breast cancer