Management of benign breast disease

Abstract

The purpose of identifying and treating benign breast disease is twofold: To identify underlying breast cancer or exclude its presence and treat symptoms. The most common breast complaints are breast masses, breast pain, nipple discharge, and breast infections. A palpable breast mass should be evaluated by the triad of clinical breast exam (CBE), imaging (ultrasound in all patients with the addition of mammogram in patients over 30), and biopsy. Mastalgia is the most common breast complaint. A thorough evaluation should be performed to exclude malignancy. Nipple discharge may be physiologic, especially if bilateral, multiple ducts, seen only with expression and clear, green, or black. Medications, especially centrally acting or psychotropic drugs, and nipple stimulation are potential causes of non-pathologic discharge. Nipple discharge that is spontaneous, unilateral, single duct, clear or bloody, or associated with a palpable mass is especially concerning for underlying malignancy. Mastitis is a common occurrence even in non-lactating women. Inflammatory cancer must be ruled out, especially in an inflammation not responding to antibiotics and supportive measures. Lactating women with a breast infection must drain the breast regularly to prevent milk stasis that encourages bacterial growth. Antibiotic therapy should be guided by what is safe for the nursing infant. Skin flora is the most common pathogen. Referral for specialty services should be provided to patients with atypical biopsies, discordant biopsies, breast cancer, biopsy findings that require excision, nonhealing abscesses, and hereditary breast and ovarian cancer syndromes.