Benign breast conditions

There are a number of benign conditions that can affect the breasts, including congenital anomalies (e.g., supernumerary nipples), fat necrosis, mastitis, fibrocystic changes, gynecomastia, mammary ductal ectasia, and neoplasms such as fibroadenoma, phyllodes tumor, and intraductal papilloma. Fibrocystic changes result in the most common benign lesion of the breast, and, like the rest of these lesions, primarily affect women between the third and fifth decades of life. Although benign breast conditions may cause symptoms that mimic breast cancer, the majority of these lesions do not increase the risk of malignant disease. They are usually diagnosed with ultrasound and mammogram, but in some cases biopsy is required. Because of the benign character of these conditions, treatment does not generally involve surgery.

The mammary ridge regresses in the 7^th–8^th week of embryonal development. Disorders during this stage of development may lead to the following anomalies:

• Amastia: absence of breast tissue and nipples
• Polymastia: presence of accessory breast tissue
• Athelia: absence of nipples
• Polythelia: presence of accessory nipples
• Poland syndrome ^[3]
  • Unilateral aplasia/hypoplasia of the pectoralis muscles and breast with associated fingers abnormalities (e.g., brachysyndactyly)
  • Most commonly develops on the right side

Overview

• Definition: benign changes characterized by the formation of fibrotic and/or cystic tissue ^[4][5]
• Epidemiology
  • Most common benign lesion of the breast
  • Primarily in premenopausal women 20–50 years of age
  • Up to 50% of women are affected during their lifetime.
• Etiology: unknown

Histologic subtypes ^[6]

• Nonproliferative lesions
  • Cysts: dilated, fluid-filled ducts (blue dome cysts)
  • Stromal fibrosis (no malignant potential)
  • Apocrine metaplasia
• Proliferative lesions (occur with or without atypical cells)
  • Sclerosing adenosis
    • Proliferation of small ductules and acini in the lobules
    • Stromal fibrosis ^[7]
    • Calcifications (slightly increased risk of breast cancer)
  • Ductal epithelial hyperplasia (ductal hyperplasia)
    • Epithelial hyperplasia of terminal duct cells and lobular epithelium
    • Presence of atypical cells is associated with an increased risk of breast cancer.
    • Papillary proliferation (papillomatosis) is a type of ductal hyperplasia that has a papillary histopathological appearance.

Clinical features

• Premenstrual bilateral multifocal breast pain
• Tender or nontender breast nodules
• Clear or slightly milky nipple discharge

Diagnostics ^[8]

• Physical exam
• Ultrasound and mammography (first-line)
  • Ultrasound
    • Findings range from normal appearance to focal regions of thick parenchyma.
    • Сysts may be present.
  • Mammography (not recommended for women < 30 years)
    • Round or oval masses with clear borders
    • In some cases, dispersed calcifications
• Fine-needle aspiration (after imaging confirms a cystic lesion): indicated if the patient is symptomatic and/or requests the procedure
• Biopsy: confirms diagnosis if imaging is inconclusive

Treatment ^[9]

• If symptoms are mild, treatment is not required.
• In case of severe symptoms: oral contraceptives, tamoxifen, or progesterone
• Fine-needle aspiration or surgery
  • If a cyst causes severe pain, discomfort, or disfiguration
  • In the case of proliferative lesions with atypical cells
• Reevaluate the cyst after 4–6 weeks.

Prognosis

Depends on the histologic subtype:

• Nonproliferative lesions do not increase the risk of cancer.
• Proliferative lesions with atypical cells (e.g., ductal epithelial hyperplasia) are associated with an increased risk of cancer.

Benign inflammatory conditions of the breast include infectious mastitis and noninfectious inflammatory mastitis (e.g., fat necrosis of the breast, mammary duct ectasia).

Mastitis

• Definition: inflammation of the breast parenchyma ^[10]
• Epidemiology: : occurs in up to 10% of nursing mothers (particularly 2–4 weeks postpartum)
• Etiology
  • Staphylococcus aureus (most common)
  • Other pathogens (e.g., Streptococcus, Escherichia coli) are rare.
• Pathophysiology
  • Nipple fissures; facilitate the entry of bacteria located in the nostril and throat of the infant or on the skin of the mother into the milk ducts during breastfeeding.
  • Prolonged breast engorgement; (due to overproduction of milk ) or insufficient drainage of milk; (e.g., due to infrequent feeding, quick weaning, illness in either the baby or mother) result in milk stasis, which creates favorable conditions for bacterial growth within the lactiferous ducts.
• Clinical features
  • Tender, firm, swollen, erythematous breast (generally unilateral)
  • Pain during breastfeeding
  • Reduced milk secretion
  • Flu-like symptoms, malaise, fever, and chills
  • In some cases, reactive lymphadenopathy
• Diagnostics
  • Clinical diagnosis
  • Breast milk cultures or imaging may be required if there is no response to initial treatment.
• Treatment ^{[11] [12]}
  • In nursing mothers, breastfeeding with alternate breasts is recommended every 2–3 hours.
  • Analgesics (e.g., ibuprofen)
  • Cold compresses
  • Antibiotic treatment
    • Oral penicillinase-resistant penicillin or cephalosporin (e.g., dicloxacillin or cephalexin)
    • In the case of methicillin-resistant Staphylococcus aureus (MRSA): clindamycin or trimethoprim-sulfamethoxazole (TMP-SMX) or vancomycin for severe cases
  • In the case of inadequate response to initial treatment:
    • Initiate treatment according to breast milk culture results.
    • Consider an underlying breast abscess, which requires surgical drainage.
• Prevention
  • Anticipatory lactational counseling ^[13]
  • To prevent recurrence: oral Lactobacillus probiotic ^[14]

Patients with mastitis should continue breastfeeding to reduce the risk of a breast abscess.

Breast abscess ^[15]

• Definition
  • An encapsulated accumulation of pus within the breast tissue
  • The main complication of mastitis
• Clinical features
  • Breast pain, erythema, and edema
  • Purulent discharge from the nipple of the affected breast
  • Fluctuating mass on palpation
  • Possibly overlying skin necrosis
  • Fever
  • Nausea
• Treatment
  • Needle aspiration: for abscesses with intact overlying skin
  • Incision and drainage: if overlying skin necrosis is present
  • Antibiotic treatment (see “Antibiotic treatment” for mastitis above)

A fluctuant mass may indicate a breast abscess.

• Definition: benign nonsuppurative inflammatory lesion affecting adipose tissue of the breast
• Epidemiology
  • Incidence: < 3% of all breast lesions
  • Peak incidence: 50 years
• Etiology: trauma; (positive history is highly variable) ^[16]
• Clinical features
  • Nontender periareolar mass with irregular borders
  • Breast skin retraction, erythema, or ecchymosis
• Diagnostics ^[17][18]
  • Mammography and/or ultrasound
    • Fluid-filled oil cyst
    • Coarse rim calcifications
  • Biopsy (if any suspicious or inconclusive imaging findings)
    • Foam cells and multinucleated giant cells
    • Necrotic fat cells
    • Hemosiderin deposition and chronic inflammation
• Treatment: : not required

• Definition: subareolar periductal chronic inflammatory condition defined by dilated mammary ducts which are eventually clogged ^[19]
• Epidemiology
  • Most common in perimenopausal women
  • Peak incidence: 40–50 years
  • Risk factors: tobacco use, congenital nipple malformations
• Etiology: inspissated luminal secretion stasis leading to periductal inflammation and fibrous obliteration
• Clinical features
  • Unilateral, sticky, multicolored discharge (e.g., gray, greenish or bloody discharge)
  • Nipple inversion
  • Firm, stable, painful mass under the nipple (may mimic breast cancer)
  • May progress to a breast abscess
• Diagnostics
  • Mammography and/or ultrasound: can be used to determine mammary duct diameter ^[20]
  • Biopsy (if any suspicious or inconclusive imaging findings) can show the following:
    • Central cavity filled with neutrophils and secretion
    • Pericentral inflammation and/or fibrotic breast parenchyma
    • Obliteration of the ducts
• Treatment
  • Usually not necessary (most cases resolve spontaneously)
  • Antibiotic therapy if infected
  • Surgical excision for persistent lesions

Mammary duct ectasia is the most common cause of greenish nipple discharge.

Fibroadenoma

• Definition: benign breast tumor with fibrous and glandular tissue ^[21]
• Epidemiology
  • The most common breast tumor in women < 35 years of age
  • Peak incidence: 15–35 years
• Etiology: unknown, but a hormonal relationship has been established; (increased estrogen, e.g., during pregnancy or before menstruation, may stimulate growth )
• Clinical features: usually, a well-defined, mobile mass
  • Most commonly solitary
  • Nontender
  • Rubbery consistency
• Diagnostics ^[22]
  • Ultrasound: well-defined mass
  • Mammography: well-defined mass that may have popcorn-like calcifications
  • Core needle biopsy or fine needle aspiration to confirm the diagnosis: fibrous and glandular tissue
• Treatment: regular check-ups
  Prognosis ^[23]
  • Generally good
  • Most fibroadenomas are not associated with an increased risk of breast cancer.

Phyllodes tumor ^[24]

• Definition: rare fibroepithelial tumor with histology similar to that of fibroadenoma
• Epidemiology
  • Peak incidence: 40–50 years
  • Most commonly benign
  • Approx. 0.4% of all breast tumors
• Etiology: unknown
• Clinical features
  • Painless, smooth, multinodular lump in the breast, with an average size of 4–7 cm
  • Variable growth rate: may grow slowly over many years, rapidly, or have a biphasic growth pattern
• Diagnostics
  • Ultrasound and mammography findings are similar to fibroadenoma, but phyllodes tumors tend to be larger and grow faster than fibroadenomas.
  • Despite the fact that the lesion is typically benign, a suspected phyllodes tumor should be considered a suspicious mass until proven otherwise.
  • If a phyllodes tumor is suspected, perform a core needle biopsy ;.
    • Leaf-like architecture with papillary projection of epithelium-lined stroma
    • Connective tissue and cysts
    • Varying degrees of atypia and hyperplasia
• Treatment
  • Surgical excision
  • In case of recurrence: total mastectomy
• Prognosis
  • After excision of benign tumors: excellent prognosis
  • Lesions that show signs of malignancy on histology may recur and metastasize.

Intraductal papilloma

• Definition: solitary or multiple benign lesions that arise from the epithelium of the lactiferous breast ducts ^[25]
• Epidemiology: peak incidence: 40–50 years
  • Multiple lesions: ∼ 41 years
  • Solitary lesions: ∼ 48 years
• Etiology: unknown
• Clinical features ^[26]
  • Solitary lesions (also known as central papilloma)
    • Most common cause of bloody or serous nipple discharge ^[27]
    • Palpable breast tumor close to or behind the nipple or areola
    • Large, central lesion
  • Multiple lesions (also known as peripheral papilloma)
    • Usually asymptomatic but may cause nipple discharge in rare cases
    • Peripheral lesions
    • Smaller compared to solitary lesions
• Diagnostics
  • Ultrasound and/or mammography
  • • Ultrasound: well-defined solid nodule or intraductal mass ^[28]
    • Mammography: classically normal
  • If lesion is palpable: Core needle biopsy ; confirms the diagnosis and rules out malignancy.
    • Fibroepithelial tumor
    • Shows papillary cells with fibrovascular core covered by both epithelial and myoepithelial cells
  • Otherwise: ductogram
    • A mammography with contrast injection to visualize the breast milk ducts.
    • Nonspecific findings such as ectasia and filling defects
• Treatment: surgical excision of the affected duct
• Prognosis
  • Generally excellent; for most lesions, there is no risk of malignant transformation
  • Lesions with atypical hyperplasia are associated with an increased risk of breast cancer

Intraductal papilloma is the most common cause of bloody nipple discharge.

Lobular carcinoma in situ (LCIS) ^[29]

• Definition: a noninvasive lesion that arises from the lobules and the terminal lactiferous breast ducts
• Epidemiology ^[30][31]
  • Peak incidence: 44–46 years of age
  • Approx. 85% of cases occur in premenopausal women.
  • LCIS is a risk factor for invasive carcinoma, with an equal predisposition in both breasts. ^[32]
  • Lower risk of subsequent invasive carcinoma compared to DCIS.
• Classification ^[33]

• Clinical features
  • Asymptomatic; no specific findings (no mass or calcifications)
  • Approx. 55% are multicentric and approx. 35% are bilateral ^[30]
• Diagnostics ^[34]
  • Usually an incidental biopsy finding
  • Immunohistochemistry
    • E-cadherin: negative
    • p120 catenin: cytoplasmic staining
• Management
  • After core needle biopsy
    • Follow-up, including imaging
    • Usually no treatment is necessary
  • Surgical excision is recommended for:
    • CLCIS with imaging-pathologic discordance
    • Nonclassic LCIS diagnosed by core needle biopsy
  • Excisional breast biopsy (i.e., following surgical excision)
    • CLCIS: no further surgery is necessary
    • Nonclassic LCIS: evaluation of surgical margins and reexcision to negative margins is recommended

Overview

• Definition: benign proliferation of mammary gland tissue in male individuals (male gynecomastia) or infants of either sex (neonatal gynecomastia) ^[35]
• Etiology: increased estrogen/testosterone ratio

Types and pathophysiology ^[36][37]

Physiological gynecomastia

• Neonatal gynecomastia ^[38]
  • Occurs in ∼ 90% of neonates due to placental transfer of maternal estrogens
  • Gynecomastia is bilateral, sex independent, and spontaneously resolves within a few weeks or months.
• Pubertal gynecomastia ^[39]
  • Epidemiology: occurs in ∼ 50% of adolescent boys
  • Pathophysiology: caused by pubertal estrogen/androgen imbalance
  • Clinical features
    • Small, mobile, firm plaques of breast tissue in the subareolar region that develop during puberty
    • Can be tender, unilateral/bilateral, and associated with fatty development around the nipple
    • Spontaneously resolve by 17 years of age
  • Management
    • Reassurance of benign nature of the condition
    • Surgical removal of the breast glandular tissue is indicated for pubertal gynecomastia which persists after 17 years of age (persistent pubertal gynecomastia).
• Senile gynecomastia: occurs in ∼ 50% of men > 50 years

Pathological gynecomastia

• Due to estrogen excess
  • Malignancies
    • Leydig cell tumor
    • Sertoli cell tumor
    • Ectopic hCG-producing tumors (e.g., lung cancer, hepatocellular carcinoma)
    • Adrenocortical tumors
  • Liver cirrhosis: due to increased conversion of adrenal androgen precursors to estrogen
  • Hyperthyroidism: due to ↑ peripheral conversion of androgens to estrogens and ↑ hepatic production of sex hormone binding globulin (SHBG), which has a higher affinity for testosterone → ↓ free testosterone and a relative increase in estrogen ^[40]
  • Refeeding (after prolonged starvation) ^[41]
• Due to decreased testosterone
  • Klinefelter syndrome
  • Chronic kidney disease ^[42]
  • Testicular disorders (e.g., mumps orchitis, castration, trauma to both testes)
  • Starvation
• Due to drugs ^[43]
  • Inhibitors of testosterone receptors
    • Antiandrogens; (e.g., finasteride, bicalutamide, cyproterone acetate, flutamide)
    • High-dose cimetidine (H₂ receptor blocker)
    • Spironolactone
  • Inhibitors of testosterone synthesis
    • Ketoconazole
    • Spironolactone
    • Chemotherapy drugs (e.g., cyclophosphamide, methotrexate, bleomycin, cisplatin, vincristine)
  • Exogenous androgens and androgenic steroids ^[44]
    • Exogenous testosterone
    • Androgen precursors (e.g., DHEA, androstenedione)
    • Androgenic steroids
  • Estrogen receptor stimulators
    • Estrogens
    • Digitalis compounds
  • Marijuana
  • cART drugs

Some Hormones Cause Fulminant Kleavage: Spironolactone, Hormones, Cimetidine, Finasteride, Ketoconazole cause gynecomastia.

Idiopathic gynecomastia

• Up to 25% of patients

Clinical features

• Firm, concentric mass at the nipple-areolar complex that may be tender
• In pathological gynecomastia: possible features of undervirilization, hyperthyroidism, liver/kidney disease, etc.

Diagnostics ^[45]

• Laboratory studies
  • Serum levels of testosterone, estradiol, luteinizing hormone, and hCG: indicated in patients with pathological/idiopathic gynecomastia
  • Other tests based on history and examination findings:
    • Liver function tests
    • Renal function tests
    • Thyroid hormone assay
• Imaging
  • Mammography and ultrasound-guided biopsy
    • Indicated in patients with suspected breast cancer
    • Gynecomastia appears as normal breast tissue behind the nipple on mammography. ^[41]
  • Testicular ultrasound: indicated in patients with abnormal findings on testicular examination, signs of undervirilization, features of primary hypogonadism, or ↑ hCG levels

Differential diagnoses

• Pseudogynecomastia
• Male breast cancer
• Mastitis
• Lipoma

Treatment ^[46]

• Treat the underlying cause.
  • Discontinue the offending drug (if possible).
  • Treat hyperthyroidism, hypogonadism, chronic liver or kidney disease.
• Observation: indicated in physiological and recent-onset (< 6 months) pathological gynecomastia
• Medical therapy: indicated for cosmesis or tender gynecomastia in select patients
  • Testosterone replacement: in patients with hypogonadism
  • Selective estrogen receptor modulators (e.g., tamoxifen): in patients with severe pubertal gynecomastia or idiopathic gynecomastia > 3 months that causes substantial breast enlargement with tenderness and/or psychosocial distress
• Surgery (subcutaneous mastectomy): indicated for cosmesis in persistent gynecomastia (> 1 year)

• Definition: a condition characterized by proliferation of breast connective tissue, glandular hypertrophy, and/or excess fatty tissue causing abnormal breast enlargement.
• Etiology: Typically idiopathic, but specific causes include:
  • Hypersensitivity of estrogen, progesterone, or growth factor receptors
  • Excess hormonal production (e.g., hyperprolactinemia)
  • Aromatase excess syndrome
• Risk factors
  • Immune disorders (e.g., myasthenia gravis, chronic arthritis, Hashimoto thyroiditis) ^[47]
  • Endocrine disorders (e.g., hypercalcemia due to excessive PTHrp)
  • Medications (D-penicillamine, bucillamine, cyclosporine)
  • Severe obesity (BMI > 40)
• Classification ^[48][49][50]
  • Neonatal gynecomastia (see “Gynecomastia” above)
  • Juvenile breast hypertrophy: the rapid enlargement of one or both breasts that usually begins around menarche
  • Gestational breast hypertrophy: breast enlargement during pregnancy
  • Drug-induced breast hypertrophy
• Clinical features
  • Enlarged breasts (symmetrical or asymmetrical)
  • Mastalgia
  • Tension sensation around the neck, shoulders, and upper back
  • Trapezius muscle hypertrophy
  • Overstretching of the skin
  • Skin infections and erythema in intertriginous areas
• Diagnostics ^[47]
  • Clinical features
  • Laboratory studies to rule out other underlying conditions
    • CBC
    • Comprehensive metabolic panel
    • Hormone profile: estrogen, progesterone, and prolactin.
  • Imaging: ultrasound and/or mammography may be performed to rule out other underlying conditions (e.g., fibrocystic changes, mammary duct ectasia, breast cancer)
• Management ^[47]
  • Supportive measures
    • Use of proper fitting, supportive brassiere
    • Analgesics
  • Medical therapy
    • Progesterone or antiestrogen therapy (e.g., tamoxifen)
    • Bromocriptine therapy in patients with gestational breast hypertrophy
  • Surgery
    • Reduction mammoplasty or bilateral total mastectomy
    • Indicated in patients with chronic back pain, gestational breast hypertrophy, or for cosmetic reasons
• Complications
  • Skin ulceration
  • Neuropathy of the upper extremities (e.g., ulnar nerve)
  • Related to surgery: cellulitis, seromas, hematomas, breast asymmetry

References: ^[51]

Overview

• Definition: milk retention cyst located in the mammary gland
• Epidemiology
  • Frequently occurs during or after lactation
  • Most common benign breast lesion in lactating women
• Pathophysiology: obstruction of lactiferous duct → distention of the duct due to collection of milk and epithelial cells → cyst formation

Clinical features

• Firm, nontender mass, typically located in the sub-areolar region
• Pain suggests secondary infection.

Diagnostics ^[52]

Primarily a clinical diagnosis

• Fine needle aspiration: milky substance (diagnostic and therapeutic)
• Ultrasound
  • Complex mass
  • Findings depend on the fat and water content of the cyst
• Mammography (rarely indicated): Galactoceles may appear as an indeterminate mass or a mass with the classic fat-fluid level.

Differential diagnosis

Treatment

• Usually not necessary (most cases resolve spontaneously)
• Repeated needle aspiration or surgical excision for symptomatic cysts

Prognosis

• Usually good
• No increased risk of subsequent breast cancer

Overview

• Definition: breast discomfort or tenderness caused by physiological changes (e.g., hormonal effects) or disease (e.g., breast cancer).
• Epidemiology ^[2]
  • Peak age: 30–50 years of age
  • Approx. 70% of women are affected during their lifetime.
• Classification
  • Cyclical mastalgia
    • Primary breast pain associated with the menstrual cycle
    • Etiology: hormonal fluctuations of the menstrual cycle, postmenopausal hormone therapy, and oral contraceptive use
  • Noncyclical mastalgia
    • Primary breast pain not associated with the menstrual cycle
    • Etiology: breast lesions or cysts, chest wall trauma, hormone replacement therapy, pendulous breasts, previous breast surgery
  • Extramammary pain
    • Secondary breast pain referred from extramammary locations
    • Etiology: chest wall or spinal disorders and trauma

Clinical features

• Cyclical mastalgia
  • Often bilateral, diffuse breast pain
  • Typically, most severe in the upper outer quadrant of the breasts
  • May radiate to the medial aspect of the upper arm
  • Usually worsens the week prior to the onset of menstruation
• Noncyclical mastalgia
  • Unilateral or bilateral breast pain, usually located over the costal cartilages
  • Sharp or burning pain and/or soreness
• Extramammary pain: depends on the underlying condition

Diagnostics

• Medical history (e.g., hormone therapy, trauma, surgical history, risk factors for breast cancer)
• Physical examination: focused breast examination
  • Look for signs of infection (e.g., erythema, swelling, pain)
  • Rule out signs suggestive of breast malignancy (e.g., skin changes, mass, nipple discharge)
• Imaging
  • Breast ultrasound and/or mammography
  • Indications: depend on the patient's age and the presence of findings suggestive of malignancy
    • Women with cyclical breast pain usually do not require imaging.
    • Women with noncyclical or focal breast pain that is not extramammary should undergo breast imaging.
      • < 30 years of age: ultrasound
      • 30–39 years of age: ultrasound and/or mammography
      • ≥ 40 years of age: ultrasound and/mammography
      • See “Diagnostics” in “Breast cancer.”

Treatment

• First-line treatment: conservative
  • Provide reassurance
  • Recommend well-fitting sports bra
  • Use of warm or cold compresses
  • Analgesia (e.g., acetaminophen, NSAIDs)
• Second-line treatment: for patients with persistent (> 6 months of conservative treatment) or severe symptoms
  • Tamoxifen
  • Postmenopausal hormone therapy should be decreased or discontinued if it is the cause of breast pain.

Prognosis ^[53]

• Cyclical mastalgia
  • Usually resolves spontaneously within 3 months of onset
  • Typically relapses and remits
• Noncyclical mastalgia
  • Resolves spontaneously in approx. 50% of patients
  • Usually responds poorly to treatment

• Definition: a well-circumscribed collection of fluid within the breast that is influenced by hormonal changes
• Epidemiology ^[54]
  • 25% of all breast masses ^[55]
  • Most common in premenopausal women
  • Peak incidence: 35–50 years of age
• Classification
  • Solitary breast cyst (most common): a single, circumscribed collection of fluid within the breast
  • Multiple breast cysts: multiple, circumscribed collections of fluid within the breast
  • Simple breast cysts: smooth, thin, regularly shaped walls that are completely filled with fluid
  • Complicated breast cysts: thin-walled cysts filled with fluid and debris
  • Complex breast cysts : thick-walled or septated masses, with intracystic or other solid components
• Clinical features
  • Single or multiple breast masses
  • May be painful or tender
  • Variable size (microcysts, gross cyst, clusters) and texture (smooth, soft, firm)
  • Usually movable
• Diagnostics: The preferred initial study depends on the woman's age.
  • Breast ultrasound and/or mammography ^[56]
    • Simple cyst
      • Imperceptible wall, well-defined, round, anechoic lesion with posterior acoustic enhancement and no solid components
      • Up to 1–2 inches (2.5–5 cm) in size
      • Other findings include peripheral calcifications and reverberation artifacts
    • Complicated cysts: thin-walled, homogeneous hypoechoic mass or fluid levels, with or without posterior acoustic enhancement
    • Complex cysts: thick-walled, thickly septated, or intracystic mass with irregular or lobulated margins and posterior acoustic enhancement due to the presence of cystic components
  • Other: MRI
• Management
  • Simple and complicated cysts
    • Mostly benign; do not require intervention
    • If the cyst is large, painful, and/or has signs of infection: ultrasound-guided fine-needle aspiration
    • Rarely, complicated cysts are diagnosed as probably benign: clinical follow up in 6 months and repeat imaging
  • Complex cysts
    • May develop into breast cancer
    • Ultrasound-guided core needle biopsy

• Definition: thrombophlebitis of the superficial veins of the breast and/or anterior chest wall
• Etiology
  • Idiopathic
  • Iatrogenic (e.g., breast surgery, breast biopsy, radiation therapy)
  • Traumatic (e.g., tight brassiere use, strenuous exercise)
• Clinical features
  • Sudden onset
  • Painful, thickened, cord-like lump or mass
  • Overlying erythema of the superficial veins of the breast and/or anterior chest wall
• Diagnostics
  • Clinical features and history
  • Imaging: ultrasound and/or mammography to rule out other underlying conditions
• Management: conservative measures (e.g., warm compresses, NSAIDs, avoidance of irritating clothes)
• Prognosis: benign and self-limited disease

References: ^[57][58]