Understanding Types of Benign Breast Changes

Inflamed nipples and lumpiness make this list

Mature female doctor explaining breast exam to senior patient
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Common benign breast changes fall into several broad categories. These include generalized breast changes, solitary lumps, nipple discharge, and infection and/or inflammation.

Generalized Breast Changes

Generalized breast lumpiness is known by several names, including fibrocystic disease changes and benign breast disease. Such lumpiness, which is sometimes described as "ropy" or "granular," can often be felt in the area around the nipple and areola and in the upper-outer part of the breast.

Such lumpiness may become more obvious as a woman approaches middle age and the milk-producing glandular tissue of her breasts increasingly gives way to soft, fatty tissue. Unless she is taking replacement hormones, this type of lumpiness generally disappears for good after menopause.

The menstrual cycle also brings cyclic breast changes. Many women experience swelling, tenderness, and pain before and sometimes during their periods. At the same time, one or more lumps or a feeling of increased lumpiness may develop because of extra fluid collecting in the breast tissue. These lumps normally go away by the end of the period.

During pregnancy, the milk-producing glands become swollen and the breasts may feel lumpier than usual. Although very uncommon, breast cancer has been diagnosed during pregnancy. If you have any questions about how your breasts feel or look, talk to your doctor.

Solitary Lumps

Benign breast conditions also include several types of distinct, solitary lumps.

Such lumps, which can appear at any time, may be large or small, soft or rubbery, fluid-filled or solid.

Cysts are fluid-filled sacs. They occur most often in women ages 35 to 50, and they often enlarge and become tender and painful just before the menstrual period. They are usually found in both breasts.

Some cysts are so small they cannot be felt; rarely, cysts may be several inches across. Cysts are usually treated by observation or by fine needle aspiration. They show up clearly on ultrasound.

Fibroadenomas are solid and round benign tumors that are made up of both structural (fibro) and glandular (adenoma) tissues. Usually, these lumps are painless and found by the woman herself. They feel rubbery and can easily be moved around. Fibroadenomas are the most common type of tumors in women in their late teens and early twenties, and they occur twice as often in African American women as in other American women.

Fibroadenomas have a typically benign appearance on mammography (smooth, round masses with a clearly defined edge), and they can sometimes be diagnosed with fine needle aspiration. Although fibroadenomas do not become malignant, they can enlarge with pregnancy and breast-feeding. Most surgeons believe that it is a good idea to remove fibroadenomas to make sure they are benign.

Fat necrosis is the name given to painless, round and firm lumps formed by damaged and disintegrating fatty tissues.

This condition typically occurs in obese women with very large breasts. It often develops in response to a bruise or blow to the breast, even though the woman may not remember the specific injury. Sometimes the skin around the lumps looks red or bruised. Fat necrosis can easily be mistaken for cancer, so such lumps are removed in a surgical biopsy.

Sclerosing adenosis is a benign condition involving the excessive growth of tissues in the breast's lobules. It frequently causes breast pain. Usually the changes are microscopic, but adenosis can produce lumps, and it can show up on a mammogram, often as calcifications. Short of biopsy, adenosis can be difficult to distinguish from cancer. The usual approach is surgical biopsy, which furnishes both diagnosis and treatment.

Nipple Discharge

Nipple discharge accompanies some benign breast conditions. Since the breast is a gland, secretions from the nipple of a mature woman are not unusual, nor even necessarily a sign of disease. For example, small amounts of discharge commonly occur in women taking birth control pills or certain other medications, including sedatives and tranquilizers. If the discharge is being caused by a disease, the disease is more likely to be benign than cancerous.

Nipple discharges come in a variety of colors and textures. A milky discharge can be traced to many causes, including thyroid malfunction and oral contraceptives or other drugs. Women with generalized breast lumpiness may have a sticky discharge that is brown or green.

The doctor will take a sample of the discharge and send it to a laboratory to be analyzed. Benign sticky discharges are treated chiefly by keeping the nipple clean. A discharge caused by infection may require antibiotics.

One of the most common sources of a bloody or sticky discharge is an intraductal papilloma, a small, wartlike growth that projects into breast ducts near the nipple. Any slight bump or bruise in the area of the nipple can cause the papilloma to bleed. Single (solitary) intraductal papillomas usually affect women nearing menopause.

If the discharge becomes bothersome, the diseased duct can be removed surgically without damaging the appearance of the breast. Multiple intraductal papillomas, in contrast, are more common in younger women. They often occur in both breasts and are more likely to be associated with a lump than with nipple discharge. Multiple intraductal papillomas, or any papillomas associated with a lump, need to be removed.

Infection or Inflammation

Infection or inflammation, including mastitis and mammary duct ectasia, are characteristic of some benign breast conditions.

Mastitis (sometimes called "postpartum mastitis") is an infection most often seen in women who are breast-feeding. A duct may become blocked, allowing milk to pool, causing inflammation and setting the stage for infection by bacteria. The breast appears red and feels warm, tender and lumpy.

In its earlier stages, mastitis can be cured by antibiotics. If a pus-containing abscess forms, it will need to be drained or surgically removed.

Mammary duct ectasia is a disease of women nearing menopause. Ducts beneath the nipple become inflamed and can become clogged. 

Mammary duct ectasia can become painful, and it can produce a thick and sticky discharge that is grey to green in color. Treatment consists of warm compresses, antibiotics and, if necessary, surgery to remove the duct.

A word of caution: If you find a lump or other change in your breast, don't use this article to try to diagnose it yourself. There is no substitute for a doctor's evaluation.

Adapted from the National Cancer Institute, National Institutes of Health

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