Overview of common breast conditions

Last updated: November 25, 2022

Summary

A number of conditions affect the breasts, including disorders of breast development (e.g., congenital anomalies, breast hypertrophy), fibrocystic breast changes, inflammatory conditions (e.g., mastitis, mammary ductal ectasia), benign neoplasms (e.g., fibroadenoma, phyllodes tumor), breast cancer, and breast cysts. Mastalgia is a common symptom that is often caused by an underlying benign etiology. This article provides a brief overview of common breast conditions. Each condition is detailed in the respective articles.

See also “Palpable breast mass” and “Nipple discharge.”

Benign neoplasms

Overview of benign neoplasms of the breast
Disorder	Epidemiology	Clinical features	Diagnostics	Management
Fibroadenoma ^[1]^[2]^[3]	Most common breast mass in women < 35 years Peak incidence: 20–30 years	Solitary, well-defined, nontender, rubbery, and mobile mass Typically 1–2 cm in size Generally do not increase in size	Ultrasound and/or mammography Well-defined mass Popcorn-like calcifications may be seen Confirmatory studies : core needle biopsy, fine needle aspiration, or excisional biopsy Fibrous and glandular tissue	Expectant management or surgical excision ^[2]^[3]
Phyllodes tumor ^[1]^[4]	Rare Peak incidence: 40–50 years	Painless, smooth, multinodular lump Variable growth rate Average size: 4–7 cm	Ultrasound and/or mammography Well-defined solid mass that may contain cysts Confirmatory studies: core needle biopsy or excisional biopsy Leaf-like architecture	Surgical excision
Intraductal papilloma ^[5]	Peak incidence: 30–50 years	Solitary lesions Bloody or serous nipple discharge Palpable breast tumor close to or behind the nipple or areola Multiple lesions Usually asymptomatic	Ultrasound and/or mammography ^[5] Well-defined mass within a dilated lactiferous duct Confirmatory study: core needle biopsy ^[5] Papillary structure with fibrovascular core	No atypia: surveillance or surgical excision With atypia: surgical excision to rule out concomitant malignancy ^[5]
Lobular carcinoma in situ (LCIS) ^[6]^[7]^[8]^[9]	Approx. 85% of cases occur in premenopausal women. ^[7]^[9] LCIS is a risk factor for invasive carcinoma.	No specific findings (no mass or calcifications)	Usually an incidental biopsy finding ^[1]^[9] Immunohistochemistry ^[9] E-cadherin: negative p120 catenin: diffuse cytoplasmic staining	Expectant management: clinical and imaging follow-up ^[9] Surgical excision in select cases ^[9] Breast cancer risk-reduction options in select cases: chemoprevention, bilateral prophylactic mastectomy ^[6]^[7]

Benign breast conditions most commonly affect women between the third and fifth decades of life.

Malignant neoplasms

Overview of malignant neoplasms of the breast
	Clinical features	Breast imaging	Biopsy
Invasive ductal carcinoma	Firm, fixed mass with irregular borders Skin changes (e.g., retraction, dimpling, thickening) Axillary lymphadenopathy Bloody nipple discharge	On ultrasound Irregular mass Indistinct borders Echogenicity: heterogeneous or hypoechoic On mammography (or DBT) Noncircumscribed hyperdense mass Poorly defined margins Spiculated margins Clustered microcalcifications	Malignant cells within the lactiferous duct Stromal invasion Microcalcifications Fibrosis in surrounding tissue
Invasive lobular carcinoma			Malignant cells in lobules Monomorphic cells in a single file pattern
Inflammatory breast cancer	Rapidly growing breast mass Erythematous and edematous (peau d'orange) skin plaques directly above the breast mass Tenderness, burning sensation Axillary lymphadenopathy		Dermal lymphatic invasion, angioinvasion
Paget disease of the breast	Erythematous, scaly, or vesicular rash affecting the nipple and areola Pruritus, burning sensation, nipple retraction Possibly a firm, rigid mass with irregular borders		Paget cells

Cysts and fibrocystic changes

Overview of breast cysts and fibrocystic breast changes
Disorder	Epidemiology	Clinical features	Diagnostics	Management
Fibrocystic breast changes ^[1]^[10]	Most common benign breast condition	Premenstrual breast tenderness Multiple breast nodules bilaterally	Age-appropriate imaging of a palpable breast mass: ultrasound and/or mammography ^[1] Distorted breast parenchyma, scattered coarse calcifications ^[11]^[12] Clustered microcysts, simple breast cysts, complicated breast cysts ^[12]^[13]^[14]^[15] Concern for malignancy: image-guided core needle biopsy ^[16]	Symptomatic management Proliferative breast lesions with atypia: surgical excision followed by close surveillance for breast cancer ^[1]
Breast cysts ^[1]^[17]^[18]	Peak incidence: 35–50 years of age	Single or multiple breast masses Variable size (microcysts, gross cyst, clusters) and texture (smooth, soft, firm) May be tender Usually mobile	Ultrasound is preferred. ^[1]^[16] Simple breast cyst Complicated breast cyst Complex breast cyst Concern for malignancy : image-guided biopsy	Simple breast cysts: no intervention needed unless symptomatic ^[1]^[3] Complicated breast cysts: surveillance or biopsy ^[1] Complex breast cysts: biopsy ^[1]^[17]^[18] Benign: surveillance Malignant: surgical excision
Galactocele	Frequently occurs during or after lactation Most common benign breast lesion in lactating women	Painless, firm subareolar mass	Primarily a clinical diagnosis ^[1]^[19] Imaging: ultrasound , mammography ^[20] Variable findings Simple cyst with a fat-fluid level is characteristic Fine-needle aspiration : milky aspirate ^[20]	Asymptomatic: usually resolve spontaneously ^[21] Symptomatic: needle aspiration or drainage catheter placement ^[22] Infected: drainage and empiric antibiotic therapy for breast infections ^[19]^[22]

Benign inflammatory disorders

Overview of benign inflammatory disorders of the breast
	Epidemiology	Clinical features	Diagnostics	Management
Mastitis	Most common in nursing mothers	Tender, firm, swollen, erythematous breast (generally unilateral) Flu-like symptoms Reactive lymphadenopathy	Usually clinical ^[22] If no response to empiric antibiotic therapy for mastitis, consider: ^[1] Breast milk cultures ^[22] Breast imaging ^[16]^[23]^[24] Biopsy ^[25]	Puerperal mastitis ^[22]^[26]^[27] Supportive therapy (breastfeeding on demand, analgesics, cold compresses) If no improvement after 12–24 hours of supportive therapy: empiric antibiotic therapy for mastitis (e.g., dicloxacillin) Nonpuerperal mastitis: Initiate empiric antibiotic therapy for mastitis. ^[1]^[28]
Breast abscess	Commonly a complication of puerperal mastitis ^[23]^[29]	Breast pain, erythema, and edema Fluctuant tender mass Systemic signs (e.g., fever, chills, nausea)	Usually clinical Breast ultrasound ^[12]^[23] Irregular, hypoechoic fluid-filled lesions Echogenic rim Posterior acoustic enhancement FNAC and culture of the aspirate	Abscess drainage Empiric antibiotics for breast infections ^[1]^[30] Analgesics
Fat necrosis	< 3% of all breast lesions Often associated with soft tissue trauma	Irregularly defined breast mass Often periareolar in location Skin retraction, erythema, and/or ecchymosis	Breast ultrasound and/or mammography ^[25]^[31] Oil cyst Coarse rim calcifications Biopsy ^[25] Foam cells Multinucleated giant cells	Typically not needed ^[25]^[31]
Mammary duct ectasia	Most common in perimenopausal women Peak incidence: 40–50 years	Unilateral, nonmilky gray, greenish, or bloody discharge Nipple inversion Firm, tender subareolar mass may be present	Breast ultrasound and/or mammography ^[1]^[32] Dilated subareolar ducts Biopsy if imaging findings are concerning for malignancy ^[1]^[32] Periductal inflammation Foamy histiocytes	Usually not necessary ^[33] Surgical duct excision for persistent symptoms or to rule out malignancy ^[32]
Mondor disease of the breast	Rare, self-limited condition	Sudden onset Painful, thickened, cord-like lesion Overlying erythema of the superficial veins of the breast and/or anterior chest wall	Clinical diagnosis Age-appropriate breast imaging should be performed in all patients to exclude underlying malignancy. ^[1]^[34] Superficial tubular structure with a beaded appearance	Conservative measures ^[1] Well-fitting bra Topical analgesics

Mastalgia

Overview of mastalgia
Disorder	Epidemiology	Clinical features	Diagnostics	Management
Cyclical mastalgia ^[1]^[32]^[35]	Very common (esp. in women 30–50 years of age)	Bilateral, diffuse breast pain (upper outer breast quadrant) Usually worsens the week prior to the onset of menstruation	Imaging is not routinely required.	Identify and treat the underlying etiology. Initial: nonpharmacological measures (e.g., well-fitting bra) and analgesics Moderate to severe or refractory symptoms: Consider hormonal therapy (e.g., danazol, tamoxifen)
Noncyclical mastalgia ^[1]^[32]^[35]	Very common (esp. in women 30–50 years of age)	Unilateral or bilateral breast pain, usually located over the costal cartilages Sharp or burning pain and/or soreness	Breast imaging often indicated : See “Diagnostics” in “Mastalgia” for details.

Disorders of breast development

Overview of breast development disorders
Disorder	Epidemiology	Clinical features	Diagnostics	Management
Congenital anomalies of the breast	Affect 1–6% of the general population ^[36]	Amastia: absence of breast tissue and nipples Polymastia: presence of accessory breast tissue Athelia: absence of nipples Polythelia: presence of accessory nipples Poland syndrome ^[37] Unilateral aplasia/hypoplasia of the pectoralis muscles and breast with associated finger abnormalities (e.g., brachysyndactyly) Most commonly develops on the right side	Clinical	Surgical correction
Breast hypertrophy ^[38]^[39]^[40]	Rare	Enlarged breasts (symmetrical or asymmetrical) Mastalgia Muscular discomfort and/or pain in the neck, shoulder, and/or upper back Skin infections and erythema in intertriginous areas Deep, painful brassiere strap grooving	Mainly clinical	Surgery: reduction mammoplasty (standard of care) or bilateral total mastectomy (alternative) Conservative: use of proper fitting, supportive bra Medical therapy: progesterone or antiestrogen therapy, bromocriptine
Gynecomastia ^[41]^[42]^[43]	Physiological gynecomastia: common in neonates, male adolescents, and men > 50 years Drug-induced gynecomastia: most common type of pathological gynecomastia	Firm, concentric subareolar mass May be tender	Mainly clinical Pathological gynecomastia: Evaluate for the underlying etiology.	Physiological gynecomastia: reassurance Pathological gynecomastia: Treat the underlying cause. Persistent symptoms Medical therapy (off-label): selective estrogen receptor modulators Surgery (subcutaneous mastectomy)

References

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