Breast Diseases Surgery

Breast tissue is a modified sweat gland located on the anterior chest wall, whose main function is to meet the nutritional needs of the baby. It shows some differences in men and women. The lobular cell groups that produce milk cannot develop in men, but the ductal structures and intermediate tissue structure, which can also be defined as milk ducts, are similar to those found in women.

Although breast cancer is the first thing that comes to mind when breast diseases are mentioned, breast tissue can also develop many benign diseases. This is also an indication that not every finding in the breast means the presence of cancer.

What May Be the Findings Encountered in Breast Diseases?

The breast tissue, which is prepared for a pregnancy that may occur in each menstrual cycle, goes back to square one when pregnancy does not occur. Therefore, it is significantly affected by cyclical hormonal changes. This may lead to recurring complaints or findings in the breast.

Pain in the breast, presence of a palpable mass, redness, discharge from the nipple in various colors, color changes in the breast skin and structural differences in the skin (redness, swelling and crusting), shape differences that do not exist in other breasts, shrinkage and dimples, swelling and lumps in the armpit, swelling in the arm and Edema may be seen as breast findings.

Mastitis (Inflammatory Diseases of the Breast)

Breastfeeding Mastitis (Puerperal Mastitis)

This condition, which can occur most frequently in the first months shortly after giving birth, is the most common infective condition of the breast. The most common cause is bacteria entering through cracks in the nipple that are damaged during breastfeeding. Patients may experience rapidly developing breast pain, redness, swelling and fever.

In this case, the first thing to do is not to interrupt breastfeeding or to empty the breast with the help of pumps, to support the emptying of the breast with warm compresses and massages; Following an absolute medical examination, appropriate antibiotics and painkillers are given to the baby and mother.

When deemed necessary, radiological and laboratory examinations may need to be performed. If left untreated, the infection may progress rapidly and turn into an abscess due to the effect of the milk present in the environment. If an abscess develops, draining the abscess with a needle or, in more advanced cases, by making a surgical incision is added to other treatments. In some patients, this condition may be recurrent during breastfeeding.

Although it is very rare, some infection-like tumors of the breast (inflammatory breast cancer) also cause a similar situation, so it is very important to consult a doctor.

Breast Abscesses

It usually occurs as a result of breastfeeding mastitis. In addition, it may also develop in periductal mastitis or granulomatous mastitis. In their treatment, it is essential to first evacuate them. Despite this, approaches specific to disease groups and additional treatments can be applied according to the physician's preference.

Rarely, diabetic patients with a sensitive immune system, those with chronic kidney failure, or those receiving immunosuppressant or tumor-related chemotherapy for any reason may develop infection and abscess in various areas of the breast. In these patients, appropriate antibiotics, surgical drainage in case of abscess, and biopsy in case of suspicion may be required.

Chronic Inflammatory Diseases of the Breast (Granulomatous Mastitis)

It is a special condition of mastitis that usually causes recurrent infection in the breast. While it may most commonly occur due to tuberculosis and similar chronic granulomatous infections, in some cases it may develop due to the immune system without an known cause (autoimmune). Recurrent mastitis in the breast may cause abscess formation and discharge from the skin, resulting in sores with drainage from one or more areas. Radiological examinations should also be performed during the diagnosis stage.

Since it is a disease that can be confused with breast cancer, the most definitive diagnosis can be made by biopsy in addition to these imaging methods. In its treatment, mild cases that can be observed and followed are monitored. During active periods, follow-up periods are kept short. In addition to classical mastitis and abscess treatment, long-term treatment may be required with appropriate medications ranging from immunosuppressants (such as antibiotics, steroids, immune drugs).

Depending on stable cases or post-treatment response, surgical removal of the area may be applied as a patient-specific treatment.

Periductal Mastitis

It is an infective condition that usually occurs in and around the nipple. It is not associated with breastfeeding. It occurs around the milk ducts. Most of the patients smoke. Its quality can be understood through medical examination and supporting imaging studies. Those with a mild course may regress with appropriate antibiotics.

If abscess formation is detected, drainage of the abscess should be added to the treatment. It is a disease that likes to recur. In cases that do not regress with treatments, recur, or whose imaging features raise suspicion of a tumor, it may be necessary to surgically remove the diseased channels around the nipple.

Pain in Breast

Breast pain is a problem that most women encounter at some point in their lives. While pain may sometimes be experienced only for a period of time, it may also appear as a constantly disturbing situation for some individuals. Cyclical hormonal changes in women of childbearing age can affect breast tissue variably depending on the individual.

Although most breast pains are a reflection of breast changes due to hormones, especially those that may affect daily life need treatment. Pain may generally increase during premenstrual periods, intense stress or seasonal changes.

The fibrocystic structure of the breast tissue may cause these individuals to feel pain more intensely. Pain is not a common condition in breast cancer. In cancer cases, pain is a finding that usually occurs in later stages.

Palpable Mass in the Breast

When a woman feels a lump in her breast, it is truly a frightening finding. However, benign breast masses occur much more frequently than cancer. In other words, not every mass or lump that is palpable in the breast is CANCER. However, since a mass is the most common finding of breast cancer, it must be evaluated by a physician and its diagnosis must be determined and its differential diagnosis must be made.

Breast Cysts

The word cyst means a fluid-filled sac. Breast cysts are one of the most common diagnoses in cases investigated as masses in the breast. Cysts are responsible for approximately one quarter of the cases in which a mass is detected in the breast. Most patients are in the middle age group, but they can be seen at any age, starting from adolescence.

They are mostly found in the form of cysts smaller than 1 cm. They can be detected in one or both breasts. It can often be accompanied by complaints of pain in the breast, or sometimes it may appear as a large, painless swelling.

Breast cysts usually do not require treatment. It is possible to make a complete diagnosis with ultrasonography. In cases that are large in size and disturb or worry the patient, the cyst can be drained, but the possibility of refilling with fluid is not small.

Fibroadenoma of the Breast

It is one of the most common benign breast lesions in patients presenting with a breast mass. It can occur in different ways starting from adolescence. It is most commonly seen in young women. It can occur in many different sizes in one or more breasts, in one or both breasts.

They are usually in the form of simple fibroadenomas and do not increase the risk of cancer in individuals who do not have any additional risk factors. Complex fibroadenomas pose an increased risk of cancer development in the presence of a family history. They usually do not require surgery and just need to be monitored.

If fibroadenomas tend to grow rapidly, exceed certain sizes, and if there is a familial tendency for breast cancer, tissue diagnosis must be obtained. This may require removal of the lesions.

They may appear as multiple masses that rarely grow rapidly during adolescence. In this case, there are many lesions in both breasts and they grow very quickly. In this case, fibroadenomas need to be removed surgically. The situation will calm down in older ages. Their removal usually does not cause significant deformation.

Phylloid Tumor of the Breast

They are solid lesions resembling fibroadenoma in the breast. They present as benign or, very rarely, malignant phyllodes tumors that tend to spread. Even when malignant, these are tumors that are not expected to be very aggressive. They can be detected in many different sizes.

It is not easy to distinguish between fibroadenoma and phyllodes tumor without removal and pathological examination, and the only way to understand whether it is benign or malignant is by removing the lesion in question and examining it pathologically.

While benign, benign phyllodes tumors only grow slowly and spread around, malignant phyllodes tumors can spread to more than one area and cause a mass effect (e.g. chest wall, skull, etc.). Unlike other breast cancers, it is not expected to spread to the armpit. Instead, removal with sufficiently clean surgical margins is usually sufficient. In large lesions, breast reshaping (reconstruction) may be performed. Prosthetics can also be used here.

If an aggressive course is detected in malignant cases, additional treatment methods (radiotherapy - chemotherapy) can be applied.

Nipple Discharge

Many patients who consult a physician complain about discharge from the nipple, especially when squeezing it. This situation worries patients about breast cancer. First of all, this condition occurs more frequently with increasing age or in women who have given birth or breast-fed a lot.

Since the breast tissue is a developed gland, the milk ducts cannot be expected to be filled with air and they are filled with secretion. However, expansion in these ducts may occur due to conditions that cause the breast to produce milk outside the breastfeeding period, inward growing buds called papillomas within the milk ducts, or, rarely, a condition in the milk ducts. In the presence of cancer, discharge may be observed.

It is important whether the nipple discharge occurs spontaneously or when the patient squeezes it. From a medical point of view, spontaneous spotting discharge is important. Discharge coming from both nipples or more than one duct usually causes less concern to physicians. Recurrent discharge from a single breast and single duct should be taken seriously.

Discharge of many different colors may come from the nipple. While discharges of white, yellow, green, gray color are generally considered good, the appearance of bloody, stagnant blood causes discomfort for the physician. Different imaging methods can be used to investigate the causes of discharge.

The most common causes of nipple discharge are enlargement of the milk ducts, cystic disease of the breast, intraductal papillomas and breast cancer. Intraductal papillomas, which can cause bloody nipple discharge, may increase the risk of breast cancer. Breast cancer is detected in one in 7-8 of the patients with bloody nipple discharge.