Updated: 12/1/2021

Benign Breast Conditions

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  • Snapshot
    • A 13-year-old boy presents to his pediatrician due to noticing a lump under the nipple of his left chest. He reports mild pain when touched. There is no breast discharge or changes in the skin. On physical examination, pubic hair is Tanner stage IV and has a testicular volume of 9 mL bilaterally. Palpation of the left chest shows a 3.5 cm mass beneath the nipple. (Pubertal gynecomastia)
  • Breast Abscess
    • Clinical definition
      • pus accumulation in breast tissue that can result from
        • mastitis or cellulitis that does not respond to treatment
    • Epidemiology
      • incidence
        • 0.4-11% in lactating mothers
          • can also occur in non-lactating women
    • Presentation
      • symptoms
        • localized pain of the breast
        • malaise
      • physical exam
        • fever
        • palpable mass that is
          • fluctant and tender
    • Treatment
      • drainage of abscess
      • antibiotic therapy
        • empiric therapy should cover Staphylococcus aureus
  • Mastalgia
    • Clinical definition
      • breast pain
    • Etiology
      • cyclical mastalgia
        • typically diffuse and bilateral
        • causes include
          • physiologic
          • pharmacologic hormonal agents
      • noncyclical mastalgia
        • typically unilateral
        • causes include
          • inflammatory breast cancer
          • ductal ectasia
          • mastitis/abscess
    • Treatment
      • symptomatic
        • well-fitting brassiere
        • warm compresses, cold packs, and massage
      • medication
        • acetaminophen
        • nonsteroidal antiinflammatory drug (NSAID)
        • danazol
          • FDA approved for mastalgia
  • Fat necrosis
    • Clinical definition
      • breast lesion that can be seen after breast trauma or surgical intervention
        • can be confused for malignancy on physical exam and on mammography
    • Management
      • with any palpable mass, breast cancer must be excluded
        • ultrasound (< 30 years old) or mammogram (> 30 years old)
          • oil cysts or (later) calcified oil cysts
        • if imaging suspicious or inconclusive
          • fine needle aspiration
            • oily fluid
          • biopsy
            • lipid-filled macrophages ("foamy macrophages"), fibrosis and inflammatory cells
      • conservative treatment (observation and reassurance)
      • excision only if symptomatic or disfiguring
  • Mondor's Disease
    • Clinical definition
      • thrombophlebitis of the superficial veins of the anterior chest wall which be seen in
        • complications after breast cancer surgery and breast augmentation
        • malignancy
    • Epidemiology
      • incidence
        • ~1% in patients after receiving breast cancer surgery and breast augmentation
      • demographics
        • mostly between 30-60 years of age
        • more common in females than males (3:1)
      • prognosis
        • typically benign and a self-limiting disease
    • Presentation
      • physican exam
        • cord-like thrombosed vein that can be tender or non-tender
    • Treatment
      • symptomatic management
  • Male Gynecomastia
    • Clinical definition
      • a benign condition that results in glandular proliferation in the male breast caused by
        • increased relative estrogen to androgen activity
    • Etiology
      • physiologic gynecomastia
      • pseudogynecomastia
        • due to obesity
        • there is no glandular proliferation
      • medications
        • spironolactone
        • ketoconazole
        • cimetidine
        • gonadotropin-releasing hormone (GnRH) agonists
        • 5α-reductase inhibitors
        • estrogens
      • drugs of abuse
        • alcohol
        • marijuana
        • heroin and methadone
        • amphetamine
      • idiopathic
      • cirrhosis
      • testicular malignancy
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(M2.GN.17.4747) A 13-year-old boy is brought to his pediatrician due to a left breast lump under his nipple. He noticed it last month and felt that it has increased slightly in size. It is tender to touch but has no overlying skin changes. There is no breast discharge. The patient has cryptorchidism as an infant and underwent a successful orchiopexy. In addition, he was recently diagnosed with ADHD and is currently on methylphenidate with improvement in his symptoms. He has a family history of type I diabetes in his father and breast fibroadenoma in his mother. On exam, the patient is at the 82nd percentile for height, 79th percentile for weight, and 80th percentile for BMI. He has tanner IV pubic hair. Testicular volume is 7 mL on each side, and both testes are smooth and freely mobile. Breast exam shows a normal right breast and a 3-centimeter round, firm, and slightly tender discrete mass under the left nipple. Which of the following is the most likely etiology of this patient’s condition?

QID: 108673
1

Klinefelter syndrome

7%

(3/42)

2

Glandular tissue enlargement

55%

(23/42)

3

Lipomastia (pseudogynecomastia)

31%

(13/42)

4

Testicular cancer

0%

(0/42)

5

Medication side effect

7%

(3/42)

M 6 C

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