SU25.2 | Benign Breast Disease — Summary & Reflection

KEY TAKEAWAYS

Benign breast disease is the commonest reason for breast referral and is best classified mechanistically: ANDI (fibrocystic change, cysts) — exaggerations of normal hormonal physiology; benign tumours (fibroadenoma the mobile 'breast mouse' in 15-35-year-olds; duct papilloma causing bloody single-duct discharge; phyllodes tumour, which can be benign/borderline/malignant and grows large); inflammatory/infective disease (lactational abscess from Staphylococcus aureus; periductal mastitis); duct ectasia (older women, cheesy discharge, nipple retraction); and fat necrosis (post-trauma, mimics cancer). Benignity is confirmed by triple assessment, never assumed, because several conditions mimic cancer; a cyst is aspirated, with a bloody/residual/refilling cyst needing further work-up. Management ranges from reassurance (small fibroadenoma, fibrocystic change) through aspiration (cyst), microdochectomy (papilloma) and wide local excision (phyllodes — not enucleation) to antibiotics + continued breast emptying + aspiration/incision and drainage for an abscess, always excluding inflammatory carcinoma in atypical cases.

REFLECT

Recall a woman you have seen with a benign breast complaint, or imagine the next one you will clerk. Could you place her condition in the right group — ANDI, a benign tumour, an infection, duct ectasia or fat necrosis — and explain its pathogenesis in plain terms to her? When you next examine a lump that 'feels benign', would you still complete triple assessment, knowing that fat necrosis and phyllodes are deliberate mimics? And if a breastfeeding mother presented with an abscess, could you confidently start antibiotics, arrange ultrasound-guided aspiration and reassure her to keep emptying the breast? Reflect on one habit — perhaps always proving benignity rather than assuming it — that will keep your reassurance safe.