Benign Breast Surgery
Benign or non cancerous breast conditions are very common and most women suffer from them at some point in their lives. These lesions do not spread, usually do not recur and are not life threatening. Some of them increase the risk of developing breast cancer in the future.
There are many types of benign breast lesions and they are divided in to three categories
A. Non proliferative breast
lesions:
These have no increased risk of future malignancy and include cysts, ductal ectasia, mastitis, fibrosis, metaplasia and mild hyperplasia
B. Proliferative breast lesions:
These increase the risk of developing breast cancer by 1.5-2 times compared to the normal risk women of the same age. These include complex fibroadenoma, papilloma, sclerosing adenomas and moderate to severe hyperplasia.
C. Proliferative breast lesions with atypia:
These increase the risk significantly up to 4-13 times. These include atypical ductal or lobular hyperplasia.
Treatment
Procedure
The treatment of benign diseases depends on the symptoms. In cases of fibrocystic disease, the patient generally presents with pain which is more prominent during and before menses. If on ultrasound, the patient has very large simple cysts (fluid filled sacs), then the liquid can be removed with a syringe which results in significant pain relief for the patients. Some cysts like complex cysts that contain solid areas or irregular walls may need image guided or open biopsy. Other lesions like fibroadenoma can be excised using a hidden scar around the areola or in the crease under the breast.
If fibroadenomas are very small and multiple in number, present in both breasts, then they can also be kept under surveillance with regular clinical breast examination and imaging. Papillomas most often present with nipple discharge or maybe picked up routine screening mammogram. If nipple discharge is present then then entire duct can be excised through a small surgery. This gives the diagnosis and is also the cure if no cancer is seen in the excised part. There are other causes of nipple discharge as well like infection and hormonal changes and a thorough check up and detailed clinical history can reveal the root cause and guide treatment.
Advantages
The fundamental role of performing surgery for a benign lesion is verify the diagnosis and exclude presence of cancer. On occasion, the symptoms can be distressing as well, for example a profuse nipple discharge can stain the clothes, a large lump can change the size and shape of breast and painful cysts can hinder the daily routine of a lady. Hence, we believe that it is important to have well-placed and hidden scars and maintain the shape and symmetry of breasts because the treatment is largely elective and for a non life-threatening lesion. It should not deteriorate quality of life by affecting body image and confidence of a woman.