The main function of the breasts is to produce milk at certain times. However, some special milestones and cyclical changes may occur aside from the lactation period. The first period, starting of sexual life, first pregnancy, lactation episodes and menstrual cycle have an essential role in the growth and maturation of breasts. Between menarche (first period) and postmenopause (after the last period), breasts undergo evolution (development) and then, involution (regression). The total duration of these processes (estrogen exposure), quality of life, stress factors, and maintaining a healthy lifestyle or not play important roles.
Diagnostic Methods for Breast Diseases
- Breast ultrasonography (USG)
- Mammography
- Magnetic resonance tomography of the breast (MRI)
Benign and malignant diseases of the breast are evaluated and treated by General Surgery. Commonly known fibrocystic changes are not diseases, but a variant of breast tissue. Among benign diseases and conditions of the breast are inflammatory, non-proliferative (no potential of uncontrollable growth), and proliferative (potential of uncontrollable growth) conditions.
Inflammatory diseases of the breast include lactational mastitis (inflammation of the breast during lactation and related to milk stasis), foreign body reactions, periductal mastitis (breast ductal ectasis), fat necrosis, and granulomatous mastitis.
Non-proliferative diseases include cysts, papillary apocrine changes, mild epithelial hyperplasia, non-sclerosing adenosis, and periductal fibrosis.
Proliferative Breast Diseases
Lesions without atypia (including normal cell types in the tissue):
- Sclerosing adenosis
- Apocrine metaplasia
- Epithelial metaplasia
- Radial scar
- Fibroadenoma
- Lipoma
- Hamartoma
- Adenoma (including lactating adenoma)
- Intraductal papilloma
- Diabetic fibrous mastopathy (a rare disease encountered in type 1 diabetic patients)
Lesions with atypia (including abnormal cell types in comparison to the normal tissue):
- Atypical hyperplasia
- Atypical ductal hyperplasia
- Atypical lobular hyperplasia
Procedures for benign breast diseases:
- Fine needle aspiration biopsy
- Tru-cut biopsy
- Surgical biopsies
Malignant Tumors of the Breasts:
Sarcoma and cancerous tumors are among the malignant tumors of the breasts. The most frequent is breast cancer. Cancer may be “invasive” (cancer that has spread from where it began in the breast to surrounding normal tissue) and "in situ”.
In situ cancer is considered as stage 0 (zero) breast cancer. If detected early (when the tumor is small), no additional treatment may be required aside from surgical treatment.
There are favorable results in invasive breast cancer in recent years. The basis for the treatment of breast cancer without metastasis is surgery.
The most common invasive types of breast cancer:
- Ductal cancer
- Lobular cancer
- Mixed ductal-lobular cancer
The surgical treatment for invasive breast cancer is divided into two groups: Organ (breast) conserving and radical approach.
Breast-Conserving Methods
- Tumorectomy or lumpectomy
- Sentinel lymph node biopsy with segmental mastectomy
- Oncoplastic breast surgery
Radical Methods
- Simple mastectomy
- Sentinel lymph node biopsy with simple mastectomy
- Modified radical mastectomy
Importance of screening methods in breast cancer:
Early diagnosis is quite important for the aforementioned tumors. Various diagnostic methods for the detection and successful treatment of breast disease in the early stage have been searched. The most favorable investigation combinations medically and economically are revealed. For breast cancer screening, mammography is warranted as of the age of 40 and if required, breast US may be performed all around the world. Mammography has a low diagnostic value due to dense breast tissue before the age of 40 and therefore, mammography is not generally recommended. However, breast cancer screening may be started at an early age with various screening methods (breast USG, breast MRI) if there is a breast cancer history in the family and the patients have severe risk factors.
Awareness is the most important factor in the early diagnosis of breast cancer. All women should perform self-examination on the 5th-7th day after menstruation every month. For postmenopausal women, self-examination on the same month of every day is warranted. Several features are controlled during this examination. Some important findings may include a change in general morphology and size of the breasts, skin retraction, color change, palpable mass, palpable mass under the armpit, or discharge from nipples. Some of these findings may be benign and of no importance, like one breast being bigger than the other one. If this finding has been always present, there is no problem. In case of other findings, visiting a doctor may be required just to be safe. For example, if there is blood-like discharge from the nipple. Bloody nipple discharge may be a symptom of a mostly benign tumor, known as papilloma, which should be removed. It is not a finding that necessarily indicates cancer.
The reason for self-examination of the breast is not to diagnose a disease, but it helps a woman to recognize her breast tissue and know the difference if there is something new. If there is something unusual, General Surgery should be consulted. Most of these lesions cause benign diseases, so you do not have to worry. If you are younger than forty, paying a visit to General Surgery will suffice.
All investigations performed on the breast when you have any complaints should be evaluated by General Surgery together with a physical examination of the breast.
Aside from standard follow-up and care after breast operations, rare dressings and drainage follow-up may be required. You should review these plans with your doctor.