Breast Mass Resident Survival Guide

Overview

A breast mass is described as a mass that develops in the breast tissue. The breast consists of many different types of tissue, like mammillary glands, and mammillary ducts, and tubes. Additionally, fibrous tissue, fatty tissue, nerves, blood vessels, and lymph nodes also form important constituents of the breast. As a result, the breast mass differs widely in sizes and textures, and symptoms like pain, tenderness, or discharge . They can be large or small and may either feel hard or spongy. Most of the breast masses are discovered incidentally, either by women on self-breast examination , physical examination by the practitioner , or if an imaging study was done for some other diagnosis. Sometimes, the diagnosis is made while the annual mammography is done to detect possible suspicious lesions. Women of the reproductive age group are more prone to develop breast lumps or masses. Breast masses can be physiological like adenosis or pathological like malignancy or cancer. Occasionally, breast masses can be associated with hormonal changes, which have a waxing and waning course. Breast masses, although uncommon, can occur in men . Most of the breast masses are benign. Imaging studies like mammograms, ultrasound , Magnetic Resonance Imaging, Fine Needle Aspiration Cytology, and Biopsy are used for confirming the diagnosis . If the diagnosis of cancer is confirmed, modalities like lumpectomy, mastectomy, chemotherapy, or radiation are used to treat that.

Causes

Life Threatening Causes

• Breast cancer
  • Breast cancer is a type of cancer that originates in the breast tissue and occurs when the breast tissue starts growing at an uncontrollable rate. Although it is predominantly present in females, cases have been seen in men also. Often it presents as a mass or lump in the breast which can also have associated symptoms like discharge, discoloration, pain, itching, induration, and lymph engorgement. Breast cancer can be either ductal when it involves the mamillary ducts, or lobular when it starts in the glands.

Common Causes

• Breast cysts
  • These are the fluid-filled, sacs in the breast tissue. They can be either round or oval-shaped and of varied sizes. In the majority of cases, they are palpable as a smooth, round, movable mass, which can present with symptoms like pain and tenderness. Mostly seen in women in their reproductive years, like in the 30s and 40s. The size of the cyst can vary intermittently based on hormonal influences, like menstruation and pregnancy. The cysts can be simple, which are just comprised of fluid, or complex, which have a combination of both fluid and solid components. The exact diagnosis can be confirmed by biopsy.
• Adenosis
  • Adenosis is basically a nonmalignant breast condition, which is categorized by enlargement and increase in the number of the milk-producing glands. These are more predominant in women with underlying fibrosis and cysts. A biopsy is needed for definitive diagnosis.
• Galactocele
• Fat Necrosis
  • Fat necrosis is a benign non-cancerous condition affecting the breast, which occurs after damage or injury to the fatty tissue of the breast. Moreover, it can be a side effect of breast surgery or any radiation therapy.
• Fibroadenoma
  • Fibroadenomas are known as benign, non-malignant breast masses, which are made up of a combination of both glandular and stromal connective tissue. These lesions are more common in the women in the age group of the 20s and 30s and often show a regressing pattern after menopause. The biopsy is needed for a definitive diagnosis.
• Hamartoma
• Intraductal papilloma
  • Intra-ductal papillomas are non-cancerous, tumors that grow inside the mammillary ducts of the breast. They comprise of glandular tissue, fibrous tissue, and various blood vessels. These can be either solitary or multiple papillomas. The solitary papillomas are single tumors, growing in the larger mammillary ducts close to the nipple. They present with a nipple discharge, which can be clear or bloody. The multiple papillomas are present in breast tissue, which is farther away from the nipple. Ductograms, ultrasound, and mammograms are used for the diagnosis, which can be often confirmed by biopsy.
• Lipoma
• Mastitis
  • Mastitis is defined as the inflammation or swelling in the breast tissue, preceded by an infection. The infection is caused by either an obstructed or clogged milk duct, which does not drain the milk completely, leading to stagnation and bacterial colonization. Sometimes, cracks or breaks in the skin surrounding the nipple can also lead to bacterial infection. Mostly it affects breastfeeding women and the involvement is unilateral. The affected part is swollen, engorged, painful, and warm to the touch. Also, constitutional symptoms like fever, headache, and fatigue can be seen. Treatment involves mainly milk expression to avoid stagnation of milk in the ducts and glands and antibiotics.
• Trauma