Breast development begins in the womb, and at birth, the breast in males and females is the same, containing only major milk ducts. It continues to develop during adolescence and completes its development during pregnancy.
Hormones such as estrogen, progesterone, prolactin, thyroid hormones, cortisol, and growth hormones play a significant role in breast development. The breast consists of 15-20 lobules, which are glandular structures that produce milk, as well as ducts that transport the produced milk to the nipple. The breast also contains fatty supporting tissue, with the nipple and areola making up the majority of it. In males, milk ducts are present, but milk-producing glands are absent.
Complaints related to breasts are quite common among women. Almost one in every two women experiences breast-related complaints at some point in their lives.
The majority of women experience breast diseases or symptoms at some point in their lives. Breast examination should be performed by a specialist physician and with ultrasound once a year after adolescence. When a woman reaches the age of 40, annual breast examinations are conducted, which include mammography in addition to clinical examination and ultrasound. Patients should also actively participate in breast monitoring by performing self-breast examinations monthly.
If the patient has a family history (close relatives with breast cancer),the age for mammography may be lowered. In the case of a history of cancer in multiple close relatives, genetic research can be conducted.
While breast cancer is often the first thing that comes to mind when talking about breast diseases, benign breast conditions are more commonly observed. Patients tend to seek solutions for every breast complaint with the fear and concern of cancer.
Many of the symptoms of benign breast conditions resemble those of breast cancer. Therefore, treatment should only be initiated after ruling out breast cancer. Not every lump that is felt in the breast is cancer. Patients most commonly visit the doctor with the complaint of a breast lump. However, a clear distinction must be made. Among these lumps:
We refer to the ones filled with fluid as cysts,
Those filled with different tissues as solid masses.
The most common lesions in the breast are breast cysts. They result from the expansion of the milk duct glands in the breast. They are more common in women aged 25-45. They can be solitary or multiple. Solitary cysts that reach a certain size can be drained with a needle after a control examination, and the fluid from the cyst is subject to pathological examination.
Surgery may be required depending on the nature of the fluid obtained from the cyst. After the cyst is drained, surgery is also recommended for recurring cysts. They are usually detected in the breast due to pain and a palpable lump. Cysts can multiply, grow, or disappear, and they are not considered as indicative of cancer.
Surgical Indications for Cysts:
Fibroadenomas are the second most common cause of palpable breast masses after cysts. They are frequently seen in individuals under the age of 30 and tend to enlarge during pregnancy. They are well-defined, firm, and mobile masses with variable sizes. Generally, surgical removal is recommended for fibroadenomas that are 2-3 cm or larger. For the majority of cases, observation is sufficient.
Fibroadenomas do not transform into cancer. Rapid growth can occur. Surgical removal is recommended for fibroadenomas seen during adolescence and those larger than 5 cm. Surgical intervention may also be suggested if they cause deformity or discomfort for the patient. The use of birth control pills does not increase the risk of fibroadenomas. Fibroadenomas do not tend to resolve on their own and should only be monitored as long as they do not reach large sizes.
Breast pain is the most common breast complaint in women. A significant portion of it is related to physiological pain caused by hormonal changes before menstruation. The association of breast pain with cancer is rare. Breast cancers usually progress without causing pain. The most frequent cause of breast pain is hormonal changes. However, it is the complaints that most disturb and worry patients, leading them to seek medical attention. Patients often have difficulty distinguishing between muscle pain and breast pain, so they tend to consider complaints of muscle pain as breast pain.
Women with fibrocystic breast tissue often experience menstrual pain in the days leading up to their periods. Every patient with breast pain should be evaluated by a physician. If the examination and tests yield a normal result, symptomatic treatment is administered. In some cases, recommendations may include caffeine, salt, and fat restriction, as well as the use of supportive bras. Medical treatment can also be beneficial. The association of breast pain with cancer is rarely observed.
Nipple discharge is also a common complaint among women and can occur at various times. Discharge from squeezing the breast and nipple is considered normal. To be taken seriously and associated with cancer, nipple discharge must occur spontaneously. Procedures like breast stimulation, where discharge is observed from the nipple, do not necessarily indicate a medical condition.
For women with nipple discharge, the presence of spontaneous discharge and a brown or red color may raise concerns about cancer. Especially, bloody or brown discharge is a significant sign. In such cases, a sample of the nipple discharge should be taken for laboratory examination. However, every instance of nipple discharge should be considered pathological until proven otherwise. The majority of nipple discharges develop due to factors like birth control pills, pregnancy, menstruation, trauma, mechanical stimuli, and medications. Physiological discharges usually do not require treatment.
Ductal ectasia is a condition characterized by the dilation of the mammary ducts located beneath the nipple, accompanied by changes like inflammation and fibrosis in the surrounding tissues. It can lead to clear, bloody, or inflammatory-like discharge from the nipple. During an examination, it may be palpable as a lump. Ductal ectasia rarely requires surgical intervention. Surgical treatment typically involves the removal of the dilated mammary duct along with the surrounding tissues.
Mastisis is an infection of breast tissue caused by a pathogenic agent. It is often observed during the breastfeeding period. It occurs when bacteria enter through cracks and erosions around the nipple. Symptoms of mastitis include hardness, redness, pain, increased warmth in the breast, along with fever and general malaise. It frequently results from improper breastfeeding techniques.
If left untreated, mastitis can progress to the formation of an abscess within the breast. When signs of infection are detected before the development of an abscess, treatment involves antibiotics, and breastfeeding may be temporarily discontinued. If treatment is delayed, one or multiple abscesses may develop. In the case of an abscess, it must be drained, and appropriate antibiotic therapy is administered based on culture and sensitivity testing of a sample obtained. Infections that occur outside of breastfeeding are referred to as subareolar mastitis, which is a type of inflammation occurring around the nipple. It is associated with smoking. Patients with these symptoms should be evaluated and treated in the early stages to prevent progression.
Treatment typically involves antibiotic use. If an abscess forms, it should be drained. Recurrence is possible. Patients diagnosed with mastitis can continue breastfeeding while receiving antibiotic treatment. If it is believed that the breast is not sufficiently emptied, breast milk can be expressed using a pump, and warm compresses may be applied before the procedure. Warm compresses can help facilitate breast emptying and speed up recovery. Patients with chronic illnesses and those with suppressed immunity may develop infections in other parts of the breast as well. In such cases, treatment involves antibiotics, drainage if an abscess forms, and if any suspicious condition or lump arises, a biopsy should be performed to rule out breast cancer.
Intraductal papillomas are benign growths that form within the ducts behind the nipple. They are typically observed in individuals between the ages of 40-50 and often manifest themselves through nipple discharge. The discharge can have different characteristics. They are less likely to be palpable during a physical examination. In cases where necessary, they can be surgically removed along with the duct they are in. It is the most common cause of bloody nipple discharge.
Fat necrosis is a rare breast lesion that is typically found in breasts rich in fatty tissue. It can occur due to trauma and infection. It may be mistaken for cancer because it can form a mass or cause distortion in the nipple or skin. It is more common after radiotherapy and segmental resection. Since the clinical examination and mammography findings closely resemble those of breast cancer, a definitive diagnosis and treatment are typically carried out through biopsy or open surgery.
A phyllodes tumor is considered a type of fibroadenoma. It is larger in size at the initial presentation than fibroadenoma because it grows rapidly. This tumor is generally benign, but rarely, a malignant form can be encountered. On examination, it feels firm, mobile, and lobulated. Its size is typically greater than 3-4 cm.
For the benign form of this tumor, removal of the mass along with the surrounding breast tissue is usually sufficient for treatment. It has a cauliflower-like appearance and is characterized by a polypoid growth into cystic spaces. It cannot be distinguished from fibroadenoma on mammography. It is more commonly observed in older individuals than fibroadenoma.
Phyllodes tumors make up less than 1% of breast masses. In cases where they are malignant, a simple mastectomy is adequate for treatment. Spread to the underarm lymph nodes has not been reported; therefore, underarm surgery is not performed. It often follows a course with local recurrences within the breast.
Galactocele is a rare condition that occurs during or after the breastfeeding period. It is characterized by the accumulation of milk in a cystic structure.
Adenosis is a benign condition that occurs due to the proliferation of milk-producing structures/ducts in the breast tissue. It can occur anywhere in the breast and is palpable as nodules with unclear boundaries. As the lesion ages, fibrosis develops. Biopsy is performed for a definitive diagnosis.
Gynecomastia is the enlargement of the male breast, which can occur due to various factors. Physiologically, gynecomastia can be seen in the neonatal period, during adolescence, and in old age. Pathological gynecomastia may be associated with many chronic diseases, medications, and tumors. However, in general, gynecomastia does not increase the risk of male breast cancer. Most patients seek medical attention primarily for aesthetic concerns.
The development of gynecomastia involves an excess of the estrogen hormone, androgen deficiency, and the influence of certain medications. In children under the age of 10, gynecomastia with or without signs of early puberty necessitates endocrine evaluation for potential tumors. Gynecomastia occurring during adolescence is not typically treated, as it tends to resolve on its own within 2-3 years and is usually unilateral. Surgical intervention may be considered if it becomes severe, does not regress within the expected timeframe, or causes psychological distress.
Gynecomastia observed in old age is usually bilateral. Treatment is required in cases where gynecomastia leads to severe pain, tenderness, and significant disruption of social life. Medical treatment can be used, and if cancer is ruled out, surgical methods such as subcutaneous mastectomy can be employed for cosmetic reasons.
Surgical procedures like liposuction can be considered if gynecomastia is not associated with cancer. Gynecomastia is not a lesion that leads to breast cancer.
Mondor's Disease is a condition characterized by clotting in the superficial veins of the breast and the resulting inflammation. Local trauma and strenuous movements are often considered responsible for its development. At the onset of the condition, localized pain and tenderness in the breast are typically present. The pain diminishes within 3-4 weeks, and the lesion completely disappears within 5-6 weeks. In general, it does not usually require treatment.
Granulomatous mastitis is frequently observed in developing countries and in individuals with suppressed immunity. It may be associated with past infections and trauma. Imaging methods can often be confused with cancer. Recurrent abscesses may occur despite antibiotic treatment.
Distinguishing it from cancer through imaging methods is quite challenging. A biopsy is always necessary for a definitive diagnosis. Patients with small lesions can be monitored. If multiple foci are present, immunosuppressive medications can be used. If they respond to immunosuppressive drugs, surgical removal is an option. Besides granulomatous mastitis due to infection, it can also be caused by infectious sources like tuberculosis, sarcoidosis, typhoid, fungal infections, and others.
Idiopathic lobular granulomatous mastitis is common in young, reproductive-age patients. This type of granulomatous mastitis, which is not associated with other infectious sources, should be ruled out. The cause is often unknown.
Lesions that lead to breast lumps, abscesses, and recurrent discharge can be observed. Consequently, recurrent mastitis, abscesses, and nipple distortion can occur. Differential diagnosis with breast cancer is essential. Treatment involves total excision that encompasses the areas with lumps and sinus openings that produce discharge.
Breast examination Turkey, whether through ultrasound or mammography, does not prevent the development of cancer in a patient. However, regular monitoring and treatment methods can lead to the early diagnosis and treatment of potential breast cancer. Patients should see a doctor once a year. Therefore, every woman has the opportunity to self-examine her breasts regularly, approximately 12 times a year (you can find detailed information in the relevant section).
The goal of self-breast examination is not for the patient to diagnose herself but rather to detect any abnormalities before the routine checkup and share them with the doctor without waiting for the annual examination. When done regularly, self-examination increases patients' awareness and makes it easier for them to understand the seriousness of the disease. There are certain changes in the breast that can cause concern for the patient.
Nipple retractions that are present from birth do not pose a pathological concern. However, a newly developed nipple retraction should be evaluated for potential cancer. No woman's breasts are perfectly symmetrical. This asymmetry can be visibly noticeable, but it is often not noticeable. In such cases, it does not indicate pathology. However, it is known to cause aesthetic concerns among patients.
Breast examinations should be carried out at least once a year and on a regular basis. Many patients believe that undergoing a mammogram is sufficient and is evaluated by various medical specialties. However, the monitoring, treatment, and surgery for breast diseases are typically performed by the general surgery department. Examination, ultrasound, and mammography, when performed together, form a comprehensive approach. They complement each other. If necessary, advanced tests like breast MRI can be conducted.
One concerning aspect for patients is the exposure to X-rays during mammography. However, routine mammography during checkups has been reported not to increase the risk of cancer. Patients often perceive mammography as a painful procedure, but it is a very brief examination. Additionally, pain thresholds vary from patient to patient, so the level of discomfort is described differently by each individual, but the pain they experience is generally considered tolerable.
It is known that approximately 1 in 8 women in the world has breast cancer, underscoring the importance of regular breast examinations.
With the current available treatment methods, breast diseases and breast cancer can be effectively managed. The goal of all these examinations is to achieve early diagnosis, providing the patient with more effective and less invasive medical and surgical interventions.
We are committed to being with you during your treatment process for general surgery diseases with accurate diagnosis and effective treatment methods. Here, you can read the real experiences of my patients who share their health journey with me. Their sincere comments can be a guide for you as well.
Prof. Dr. Sezai AydınGeneral Surgery Turkey
PROF. DR. SEZAI AYDIN
