There are many non-cancerous and common changes which may occur in a woman’s breasts throughout her lifetime. These changes are referred to as benign (non-cancerous) breast disease. Fibrocystic disease, another term which is often used, includes lumps or lumpiness, breast discomfort and pain, sensitive nipples or itching.
Important to Know
Our expert team of breast care specialists includes renowned breast surgeons, cancer risk experts, breast pathologists and nurse practitioners. Our specialists evaluate women with benign breast conditions at three locations:
Breast imaging is available at BWH, BWFH, Dana-Farber/Brigham and Women’s Cancer Center in clinical affiliation with South Shore Hospital, Dana-Farber/Brigham and Women’s Cancer Center in Boston, Brigham and Women’s Health Care Center in Brookline and Brigham and Women’s/Mass General Health Care Center in Foxborough.
Many non-cancerous changes in a woman’s breasts will be identified on a routine breast imaging study (such as a mammogram). In some instances, our breast specialists will recommend that these abnormal findings be further evaluated.
At Brigham and Women’s Hospital and Brigham and Women’s Faulkner Hospital, we offer patients the benefit of having their breast images reviewed by breast imaging experts who utilize the most advanced technology. These can include digital mammography which captures images of the breast that can be seen on a computer screen, and computer-aided detection (CAD) software which can search digitized mammographic images for abnormal areas of the breast that require further analysis.
A breast abscess is an infection of the breast caused by bacteria, usually staphylococcus aureus. The bacteria enter through a crack in the skin of the breast or on the nipple resulting in an infection which invades the fatty tissue of the breast, leading to swelling and pressure on the milk ducts. A breast abscess can also be referred to as mastitis.
Breast infection can affect all women but occurs most often in women who are breastfeeding. Fewer than three percent of breastfeeding (lactating) women experience an abscess. Women who aren’t breastfeeding can also develop mastitis if bacteria enter the milk ducts through a sore or cracked nipple, or a nipple piercing.
Seek Medical Care if you are experiencing the following symptoms:
Seek Immediate Medical Care (call 911) if you are breastfeeding and develop the following symptoms suggestive of a widespread infection:
Breasts have lobules, which make milk, and ducts, which carry the milk to the nipple. The lobules and ducts are both lined by two layers of cells. When the cells grow, the collection of cells is called hyperplasia. Usual hyperplasia poses no risk, but when the cells grow in an irregular pattern they can become problematic. This irregular pattern is known as atypia.
Atypical hyperplasia isn't cancer, but if you have atypical hyperplasia you have a higher risk of developing a future breast cancer than someone without atypia.
Atypical Ductal or Lobular Hyperplasia
Atypical ductal hyperplasia (ADH) involves the ducts of the breast tissue, while atypical lobular hyperplasia (ALH) involves the lobules of the breast tissue. When either of these conditions is seen on a core needle biopsy performed for an abnormal mammogram or ultrasound, an open surgical biopsy may be recommended as core needle biopsy samples can miss breast cancer 10-20% of the time.
Atypia found on an open surgical biopsy does not require another operation.
If you are concerned about your risk of breast cancer or want to learn more about your diagnosis of ADH or ALH, specialists at our Breast Cancer Personalized Risk Assessment, Education and Prevention (B-PREP) Program will help patients like you understand your risk.
Two of the most common causes of breast lumps are cysts and fibroadenomas.
A cyst is a fluid-filled sac that develops in the breast tissue that is rarely malignant. They are most likely to occur in women between the ages of 35 and 50 and are most frequent in those approaching menopause. Cysts typically enlarge and become painful and tender just before the menstrual cycle and may seem to appear overnight.
Cysts can feel either hard or soft, and when close to the surface of the breast can feel like a large blister. However, when they are deeply embedded in breast tissue, cysts will feel like hard lumps because they are covered with tissue.
Fibroadenomas are benign lumps that are most commonly found in women between the ages of 20 and 40. They are also seen in postmenopausal women who are on replacement hormone therapy. These painless, smooth, firm lumps feel rubbery and move around freely, and often are found by the woman herself. Fibroadenomas vary in size and can grow anywhere in the breast tissue.
Most times, breast pain signals a non-cancerous (benign) breast condition and rarely indicates breast cancer. Still, unexplained breast pain that does not go away after one or two menstrual cycles or that persists after menopause and occurs in one specific area of your breast should be evaluated by your doctor.
Breast pain (also called mastalgia) is generally classified as either cyclical (associated with menstrual periods) or non-cyclical.
Cyclical Breast Pain
Most instances of breast pain are associated with the menstrual cycle and are nearly always hormonal. Some women begin to experience pain around the time of ovulation which continues through the beginning of their menstrual cycle. The pain can range from barely noticeable to so severe that the woman cannot tolerate close contact or wear tight-fitting clothing. The pain may be felt in only one breast or as a radiating sensation in the underarm region.
Non-cyclical Breast Pain
Non-cyclical breast pain, which does not vary with the menstrual cycle, is fairly uncommon and feels different from cyclical mastalgia. Generally, pain is felt in one specific location and is present all the time.
The main cause of non-cyclical breast pain is trauma, or a blow to the breast. Other causes include arthritic pain in the chest cavity and in the neck, which radiates down to the breast.
Causes of Breast Pain
Nipple conditions are a common benign breast condition affecting many women that may or may not be related to lactation. Nipple problems should always be reported to your health care provider for a prompt diagnosis and treatment.
Ecstasia is a normal process that takes place when a woman approaches menopause in her late 40s or early 50s. It is the process in which the mammary ducts (milk glands), which are located under the nipple, become dilated (widened).
Ectasia is a benign breast condition. In some cases, however, ectasia can lead to a blockage of the ducts, causing fluid to leak into the surrounding tissue causing infection, chronic inflammation or abscesses. If an infection (periductal mastitis) occurs, it may cause scar tissue to develop, thus drawing the nipple inward. In addition, this infection may cause breast pain and thick, sticky nipple discharge.
An intraductal papilloma is a small, wart-like growth that projects into the breast ducts near the nipple. This causes a sticky or bloody discharge. Any slight bump or bruise near the nipple can cause the papilloma to bleed. The duct can be surgically removed if the discharge becomes bothersome, often without changing the appearance of the breast.
While single papillomas typically affect women nearing menopause, multiple intraductal papillomas, which often occur in both breasts, are more common in younger women. Multiple intraductal papillomas are more likely to be associated with a lump than with nipple discharge. Any papilloma associated with a lump should be surgically removed.
Other Types of Nipple Discharge
While nipple discharge can be alarming, discharge that appears only when the nipple and breast are squeezed is usually not a cause for concern. The risk of cancer when nipple discharge is the only symptom is relatively low.
However, if there is a lump with the discharge, you should consult your doctor. Keep in mind, however, that in breastfeeding women, lactational mastitis complicated by an abscess can often cause a lump beneath the areola, as well as a discharge.
A milky discharge from both nipples that is not related to breastfeeding is called galactorrhea. This is usually caused by an increase in the hormone prolactin, which produces milk. Galactorrhea may be caused by tranquilizers, marijuana or high doses of estrogen and is often accompanied by an absence of menstrual periods.
Your health care provider will want to determine if the discharge is coming from one duct or several. Multiple duct discharge is likely due to changes like ectasia and is nearly always benign. Instances in which the discharge is coming from a single duct may be more significant. However, surgery may not be becessary if the mammography shows no abnormality.
Phyllodes tumors are a rare form of breast tumor. Although most are benign (not cancerous), some can be malignant (cancerous) or borderline. Some inherited genetic disorders increase the risk of developing a phyllodes tumor, but in most cases, the cause is unknown.
A phyllodes tumor can look like a common benign breast tumor called a fibroadenoma. Often, the pathologist needs to look at the whole tumor under a microscope to make a diagnosis.
Surgery is usually recommended to remove a phyllodes tumor, even if it is thought to be benign. Unlike other kinds of benign breast lesions, benign phyllodes tumors can grow rapidly and become very large.
You will first undergo a thorough evaluation to identify the cause and degree of your breast condition. The evaluation will establish whether medical or surgical intervention is necessary. A customized treatment plan will then be established and you will work with the appropriate BWH services which may include other BWH specialists.
If You are at Risk
If you are at risk for breast cancer or want to be proactive about your health, the B-PREP Program—a step-by-step, comprehensive and customizable program created by breast cancer specialists at Brigham and Women’s Hospital—has been designed to help patients like you understand your risk. We will work with you to develop a risk appropriate screening plan as well as provide information regarding risk-reduction strategies.
Learn more about the Breast Cancer Personalized Risk Assessment, Education and Prevention (B-PREP) Program.
Our multidisciplinary team draws on the expertise of many specialists to deliver integrated and personalized care for each patient, including breast surgeons, nurse practitioners, breast pathologists, breast radiologists, physician assistants and social workers.
When surgery is necessary, our board-certified surgeons offer extensive surgical experience, performing thousands of operations per year. Our breast surgeons are faculty members at Harvard Medical School and are active researchers who continually seek causes and investigate treatments for conditions and diseases affecting the breast.
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