This document summarizes several benign breast diseases: Duct ectasia is dilatation of lactiferous ducts due to muscular relaxation, presenting with greenish discharge from the nipple. Fibroadenoma is a common benign encapsulated tumor in young women, appearing as a painless breast lump. Phylloides tumor is a rare fibroepithelial tumor that can be benign or malignant, presenting as a rapidly growing breast mass. Traumatic fat necrosis, galactocele, and antibioma are other self-limiting benign breast conditions addressed briefly. Mondor's disease involves spontaneous thrombophlebitis of superficial chest wall veins, appearing as a cord-like structure on the breast or chest

1. BENIGN BREAST
DISEASE
DR. P. TIWARI
PROFF. DEPARTMENT OF SURGERY
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2. DUCT ECTASIA:
 It is dilatation of lactiferous ducts due to muscular relaxation (myoepithelial
relaxation) of duct wall with periductal mastitis.
 It is also called 'plasma cell mastitis' as periductal inflammation
contains plasma cells.
 Hormonally induced myoepithelial relaxation with
poor ductal absorption of secretions and
desquamated cells causing obstruction are the
probable other causes and features.
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3.  FEATURES:
 Greenish discharge or creamy/paste like from the nipple.
 lndurated mass under the areola which is often tender.
 Retraction of nipple which occurs at later
stage of the disease.
 Slit like retraction of nipple due to fibrosis
occurs.
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4.  More common in smokers-in relation to arterial pathology.
 Common in multiple pregnancies, perimenopausal/ age,
hyperprolactin status.
 May present as mastalgia.
 Axillary nodes may be palpable as nonspecific.
 Investigations:
 Discharge study, FNAC.
 Mammography.
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5.  Treatment:
 It is important to stop smoking.
 Cone excision of involved major ducts (Adair-Hadfield operation).
 Antibiotics.
 Melhem Novel modified breast ductal system excision.
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6. FIBROADENOMA :
 A benign encapsulated tumor occurring commonly in young
females of 15-25 years
age group-older definition.
 Presently, it is considered as hyperplasia of a single lobule of the
breast (classified
under ANDI)
 most common benign tumor of the breast.
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7.  TYPES:
 Gross:
1. Soft-common after 30 years; more cellular; often bilateral.
2. Hard-common below 30 years; more fibrous.
3. Giant (> 5 cm in size)-common in Africa.
 Microscopy:
1. Lntracanalicular - large and soft-mainly cellular. Stroma with
distorted duct.
2. Pericanalicular - small and hard- mainly fibrous. Stroma with
normal duct.
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8.  CLINICAL FEATURES:
 painless swelling in one of the quadrants,
which is smooth, firm, nontender,
well-localised and moves freely
within the breast tissue (mouse in the breast).
 Axillary lymph nodes are not enlarged.
 INVESTIGATIONS:
 Mammography (well-localised smooth regular shadow). It
may show popcorn calcification on mammography.
 Ultrasound (to confirm solid nature) well defined
with smooth outline.
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9.  TREATMENT:
 Excision through a circumareolar incision ( Webster's) or
submammary incision
(Gaillard Thomas incision) is done under general or local
anesthesia.
 Fibroadenoma which is small ( <3 cm)/single/age <30 years
can be left alone with regular follow-up with USG at 6
monthly interval.
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10. PHYLLOIDES TUMOUR:
(CYSTOSARCOMA PHYLLOIDES/SEROCYSTIC DISEASE OF BRODIE)
 They are not simply giant fibroadenoma. It is commonly nonepithelial;
occasionally
fibroepithelial.
 Depending on mitotic index and degree of pleomorphism they are
graded as low
grade to high grade tumors.
 When malignant (sarcoma) spreads to lungs or bone.
 Phylloides tumor is the most commonly occurring nonepithelial
neoplasm of the
breast, although it represents only about 1 % of tumors in the
breast. It can also often
be fibroepithelial.
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11.  Gross:
 Large capsulated area with cystic spaces and
cut surface shows soft, brownish, cystic areas.
 Microscopy:
 It contains cystic spaces with leaf like projections,
hence the name (Phylloides-Greek-leaf-like).
 Cells show hypercellularity and pleomorphism.
 It may be a variant of intracanalicular fibroadenoma of breast
(Giant type).
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12.  FEATURES:
 middle aged or elderly
 usually unilateral, grows rapidly to attain a large size with
bosselated surface
 Skin over the breast is stretched, red and with dilated
veins over it.
 Tumor is warmer, not fixed to skin or deeper muscles
or chest wall. Nipple retraction is absent. Lymph nodes
are usually not involved. These are the differentiating features
from carcinoma.
 Tumor grows rapidly; undergoes necrosis at various places.
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13.  Investigations:
 Ultrasound;
 Mammography.
 FNAC, core biopsy
 Chest X-ray CT chest in malignancy to see secondaries.
 Treatment:
 Wide excision with 1 cm margin or subcutaneous mastectomy to
avoid recurrence.
 If malignant (sarcoma) total mastectomy is indicated with adjuvant
chemotherapy;
but carries poor prognosis.
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14. TRAUMATIC FAT NECROSIS:
 It may be due to either direct or indirect trauma (trauma may not
be noticed many
times).
 Pathogenesis:
 Capillary ooze causes triglyceride in the fat to dissociate into
fatty acids. It combines with calcium from the blood resulting in
saponification which causes inflammatory reaction and later
presents as a nonprogressive swelling in the breast.
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15.  Features:
 Painless swelling in the breast which is smooth, hard, nontender and
adherent to
breast tissue.
 It is nonprogressive, nonregressive.
 Investigations:
 FNAC shows chalky fluid with fat globules.
 Mammography to rule out malignancy.
 Treatment:
 Excision.
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16. GALACTOCELE:
 Seen in lactating women.
 Occurs during cessation of lactation. Often up to 10 months
after lactation.
 It is due to the blockage of lactiferous duct resulting in
enormous dilatation of lactiferous sinus.
 It contains milk and epithelial debris within.
 It is a retention cyst in subareolar region attaining large size.
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17.  Features:
 Lump in the lower quadrant of the breast which is usually unilateral,
unilateral, large, soft, fluctuant, with smooth surface.
 It is usually nontender.
 It may get precipitated, inspissated or get calcified. When it is
calcified it mimics carcinoma breast.
 When it is cystic other cystic swelling in the breast should be ruled
out.
 Treatment:
 Aspiration of the content; Excision (submammary incision);
 Abscess when formed should be drained under cover of antibiotics.
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18. ANTIBIOMA:
 If intramammary mastitis is not drained but only treated by antibiotics, pus localizes
and becomes sterile (flaques) with a thick fibrous tissue cover and it is called as
antibioma.
 Features:
 Previous history of mastitis treated with antibiotics.
 Swelling which is painless, smooth, nontender, hard, fixed to breast tissue without
involving the pectorals and chest wall.
 Treatment:
 Excision (Submammary incision). Later antibiotics are given. It should be sent for
histology.
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19. MONDOR'S DISEASE:
 spontaneous thrombophlebitis of the superficial veins of the breast and
anterior chest
wall.
 Presents as a thrombosed subcutaneous cord (2-3 mm sized)
which is attached to the skin.
 On raising the arm above, a narrow, shallow subcutaneous
groove appears alongside the cord like thrombosed vein.
 Thoracoepigastric vein, the lateral thoracic vein, and the superior epigastric
vein- are involved.
 The upper, inner portions of the breast are never involved.
 It is often a self-limiting disease without any recurrence, complication or
deformity.
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