Cysts, which are fluid-filled sacs, form as a result of the enlargement of the milk duct glands in the breast. It is seen in one in every 14 women and is most common between the ages of 40-49. Generally, it constitutes 25 percent of breast masses. One fifth of the cysts are larger than 1 cm and half of them are more than one. Milk-filled cysts called galactoceles can be seen in breastfeeding mothers. While more than half of the simple cysts disappear in the first year, 12 percent can still be seen after 5 years. Simple cysts have smooth thin walls, while complex cysts are cysts that contain solid parts, have compartments, appear to have dense fluid content, and have irregular walls. Impalpable simple cysts on USG/MMG may cause pain, etc. If it does not cause any symptoms, it does not require follow-up. Cysts associated with menstruation can grow and shrink. The fluid in palpable or painful cysts can be drained with a syringe. This fluid can only be sent to pathology for analysis if it is bloody or if it has been drained from more than one recurring cyst. If the cyst does not recur and its contents are not bloody during the 3-month follow-up after this procedure, it is considered a benign or simple cyst. If the cyst content is bloody, the samples need to be sent to pathology because intracystic cancers may be seen. Therefore, in suspicious cases, such cysts are removed surgically. Similarly, the probability of cancer occurring in complex cysts containing solid structures is as high as 0.3 percent if the solid structure ratio is low and 23 percent if the solid structure ratio is high. It is necessary to perform biopsy and aspiration cytology from this solid component.
FIBROADENOMAS
It is the most common type of benign tumor in the breast in women. Generally, young women between the ages of 20-30 have a single menstrual period. It is seen more than once in 10-15 percent of patients. Two-thirds of fibroadenomas are simple fibroadenomas and do not increase the risk of breast cancer unless there are additional risk factors (such as family history). It has been observed that if there is complex fibroadenoma and a family history, the risk of breast cancer increases 3 times. In women over the age of 40, fibroadenomas must be removed if their growth rate is rapid (grows suddenly within a few weeks), if they are larger than 2 cm, and if there is a family history of breast cancer. Fast-growing giant fibroadenomas (larger than 5 cm) can be seen in teenage girls. These can also be removed surgically. It needs to be mixed. There is no need for mastectomy or plastic surgery in such patients. Very good cosmetic results are achieved in operations where only fibroadenoma is removed.
PHILLOIDES
It constitutes less than 1 percent of all breast tumors. Clinically, it is confused with giant fibroadenomas. It is pathologically distinguished from giant fibroadenomas by its clinical recurrence and spread to other organs. It is extremely difficult to distinguish fibroadenomas from phyllodes tumors on both ultrasound, mammography, and magnetic resonance imaging. A thick needle biopsy can be performed, but it may not be reliable. The exact distinction is made by pathological examination as a result of surgical removal of the entire mass.
The basic treatment of phyllodes is done by surgically removing the mass. If cosmetically sufficient tissue remains in the breast, 1-2 cm around it. Breast-conserving surgery can be performed while leaving clean tissue. Covering the entire breast, for example 20 cm. A tumor of this size can only be removed oncologically by removing the entire breast. Following breast removal, a prosthesis can be placed with plastic surgery in the same session. Phyllodes tumors do not spread to the armpit lymph nodes. Therefore, no intervention is made on the armpit lymph nodes. Local recurrences often occur in the breast and spread to the distant lung. Overall survival rates at 5 years are 91 percent for benign phyllodes and 82 percent for malignant phyllodes. Treatment of patients with benign phyllodes is completely surgical. Radiation therapy and chemotherapy (drug therapy) can be applied to the chest wall in only some of the malignant cases (high risk ones). In general, the role of these additional treatments after adequate surgical treatment is controversial.
INTRADUCTAL PAPILLOMA
Intraductal papillomas may originate from the milk ducts behind the nipple or are also seen in the outer regions of the breast. It is the most common cause of bloody nipple discharge seen behind the nipple and is seen between the ages of 30-50. They are generally seen as tumors smaller than 1 cm and 3-4 mm in size within the milk duct. Papillomas seen in the outer parts of the breast are seen less frequently with nipple discharge in younger patients. In intraductal papillomas that occur more than once and outside the breast, the nipple Compared to single intraductal papillomas seen in breast cancer, the risk of developing cancer in both breasts increases with or after it.
INFLAMMABLE DISEASES OF THE BREAST (MASTITIS)
Inflammatory diseases of the breast (mastitis) are seen between the ages of 18-50. If there is an abscess (pus), it needs to be drained urgently surgically. It can sometimes be difficult to distinguish clinically from breast cancer. In cases that do not respond to antibiotic treatment, a biopsy is required to rule out cancer in infections.
Breast inflammation (mastitis) may develop in 3-20 percent of breastfeeding mothers, most commonly in the first week after birth. Cracks, wounds, crusting and poor hygiene on the nipple cause microbe growth in the nipple. In such cases, if there is no treatment with antibiotics, mastitis develops in one third, but with antibiotics this rate can decrease to 5 percent. In such cases, continuing to breastfeed or draining the milk with the help of a pump reduces the formation of abscesses. If an abscess has developed due to inflammation in the breast, it must be drained with imaging guidance or surgically. In cases that cannot be intervened in time, serious septic conditions may occur. Breastfeeding mothers can use antibiotics such as penicillins, cephalosporins, clarithromycin, and erythromycin if they are allergic. Breastfeeding can be continued after the abscess is drained, reducing stasis and helping the infection regress. Milk accumulation in the breast exacerbates the inflammatory process in the breast and increases the recurrence of abscess. For this reason, if breastfeeding is not possible, the milk must be drained manually or with a pump.
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