With some benign breast conditions, surgery may be required.
Because of improvements in breast imaging, widespread education, and awareness about women's health and cancer, breast abnormalities are being found at earlier stages.
Depending on the abnormality, surgery may be recommended. A biopsy is a common type of surgery ordered to obtain additional studies so that a determination can be made as to a diagnosis. During a biopsy, tissue is removed and sent for examination by a pathologist. This is usually done in a surgeon's office or by a radiologist in an outpatient or hospital setting.
The goal of the biopsy is to obtain a definitive diagnosis. However, it does not remove the lesion or area of concern that has been identified with a physical exam and breast imaging.
Excisional biopsies or other types of surgical procedures to remove abnormalities may be recommended for other potentially operable conditions that include:
Breast Abscess:
Mastitis is an infection that affects breast tissue. For example, this can happen during breastfeeding when a milk duct becomes clogged and doesn't drain properly. This condition can cause the breast to be red, swollen, and painful, especially in a specific area. In addition, this kind of infection can cause flu-like symptoms, including fever, body aches, and fatigue.
A sebaceous cyst develops in the sebaceous gland, which secretes sebum, an oil that lubricates a person's hair and skin. When this type of breast cyst is infected, it will appear red, swollen, and painful.
There are rare cancers that can present similar to a breast abscess, so it's important to be closely followed by a breast specialist or breast surgeon with any breast abscess.
Fibroadenoma:
The most common type of benign breast tumor is a simple fibroadenoma. They are usually diagnosed in younger, premenopausal women. However, women at any age can develop a fibroadenoma.
African American women have a higher incidence of developing fibroadenomas more frequently and at a younger age.
Younger girls and teenagers can develop juvenile fibroadenomas. They tend to be large and grow rapidly.
Complex fibroadenomas may have areas of calcification, cysts, or other changes within them.
Not every fibroadenoma requires surgery. Instead, breast surgeons consider the size, the amount of pain it is causing, if it's growing, or if the pathology is uncertain to determine whether it should be removed surgically.
For fibroadenomas that are not removed, regular follow-up with breast ultrasound studies can be used to monitor whether it is increasing in size.
The risk of developing breast cancer in most women diagnosed with this benign breast tumor is not increased.
Skin Conditions
Dermatologic conditions such as ingrown hair, eczema, or skin rashes can affect the breast, nipple, or axilla. Because certain cancers can affect the breast skin, follow-up with a breast specialist is recommended so that a breast exam can be done, and additional tests such as mammograms, ultrasound, or skin biopsy can be done to determine a diagnosis.
Supernumerary Nipple
Some people may also have an extra nipple called a supernumerary nipple. Typically, they don't pose a health risk and are not a cause for concern. They can, however, be a sign of a congenital breast defect and may indicate an underlying condition, including tumor growth or cancer, although this is rare. The genetic disorder that causes an extra nipple can make it possible for breast cancer to develop in the third nipple, just like it would in a regular breast.
When necessary, noninvasive outpatient surgery can be performed to remove the nipples.
Nipple Discharge
Discharge from the nipple that is not breast milk can occur. Both women and men can have nipple discharge. The discharge can range from a clear fluid to one that is bloody, has a yellow, green, dark brownish appearance, or even black. There are several possible causes for a nipple discharge that can occur from one or both nipples.
Any time a nipple discharge is noticed that is not breast milk, follow-up with a healthcare professional is important. Then, they can order proper testing to determine the reason for the discharge and to rule out breast cancer as a cause.
Lactating Adenoma
This is the most common cause of a breast mass in a woman who is pregnant or breastfeeding. Made primarily of glandular tissue, it can be triggered by the hormonal changes experienced during pregnancy and breastfeeding.
Gynecomastia
This condition in men results in the enlargement of both breasts (not just on one side). It is usually not associated with cancer. Gynecomastia can be caused by medical conditions, including a hormonal imbalance, testicular or adrenal gland tumors, hyperthyroidism, hypoandrogenism, hypogonadism, kidney failure, and liver disease. Certain medications, poor nutrition, heavy alcohol, marijuana or other drug use, weight gain, or obesity can also cause it.
Radial Scar
A radial scar is not actually a scar. It is an overgrowth of cells in the breast that looks like a scar when viewed with a microscope. Often, radial scars are discovered when a breast biopsy is performed for another reason. If they are large enough, they can be seen on a mammogram and look like breast cancer. Larger radial scars can contain cancer cells. A biopsy is done to differentiate radial scars from cancer.
Radial scars are thought to cause a slightly to moderately increased cancer risk.
Intraductal Papilloma
This condition is most commonly diagnosed in women over the age of 40. However, men can also develop intraductal papillomas. In men, though, it is very rare. Gland, fibrous tissue, and blood vessels in the breast can form a benign, wart-like tumor that grows within the breast's milk ducts. They are a common cause of nipple discharge that is either clear fluid or bloody discharge, especially when the discharge is only from one of the breasts. Sometimes a small lump can be felt just behind or next to the nipple and can be painful.
Typically, intraductal papillomas do not increase the risk of developing breast cancer. It is possible, however, for atypical cells (abnormal cells) to be present, which can slightly increase the risk of developing future breast cancer. Having multiple intraductal papillomas may also slightly increase a person's risk.
Atypia
With atypical hyperplasia, cells increase in number and don't look normal when examined under a microscope. Atypical ductal hyperplasia (ADH) and atypical lobular hyperplasia (ALH) are considered high-risk conditions as these lesions greatly increase the risk of developing breast cancer in the future. Therefore, surgery is often recommended to remove the cells and the surrounding area. A close follow-up is also recommended.
Flat epithelial atypia (FEA) is another type of atypical hyperplasia. However, the risk of developing invasive breast cancer is lower.
Discordant Biopsy
On breast imaging, sometimes benign lesions can look like malignant lesions. When the radiologist suspects a breast malignancy, a core needle biopsy is done to confirm the radiologic findings. When there is a discrepancy between what is seen on imaging and the pathologic results from the biopsy, a surgical biopsy may be recommended as a repeat biopsy because the findings from an initial core needle biopsy were inconclusive. "False-negative" results can happen with a core needle biopsy because a smaller amount of tissue is removed than with a surgical biopsy.
