Feminity in difficult times

Most breast alterations are benign in nature and do not actually classify as disease. They are often detected during a breast self-exam or during mammography screening, and do not have to be treated in the absence of symptoms. We do, however, now know that women who suffer from specific forms of benign breast disease, also harbour a significantly elevated breast cancer risk. In addition, even with the most advanced breast analysis equipment that is available today, it is not always possible to confirm that a newly detected breast lesion is indeed benign. It is therefore imperative that newly diagnoses breast alterations are to be clarified. Even if three out of four lesions are of benign nature, it is of critical importance to identify those who represent a malignant tumor..

Painful Breast Swelling (»Mastodynia«)

The term mastodynia describes painful breast tenderness and swelling which occurs in both breasts. The symptoms usually occur in the days preceding the menstrual period and can be extremely bothersome for some women. Although the exact reason for mastodynia is still unclear, it is known that female sex hormones are involved in its development. Mastodynia can be functional – i.e. painful but harmless, it can, however, also be a symptom of a breast alteration called »fibrocystic mastopathia«. Another common reason for mastodynia is a temporal lack of the luteal hormone Progesterone. Evidently, swelling in both breasts can always also be an early sign of pregnancy.

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Breast Inflammation (»Mastitis«)

Breast inflammation can develop during the lactational period (»Mastitis puerperalis«), but also during other times throughout a female´s life (»Mastitis non-puerperalis«). The latter mastitis is considerably less common and the underlying reasons are usually unknown. However, women who smoke, and women who suffer from diabetes are particularly prone to develop recurrent breast infections. Some benign breast diseases have been associated with mastitis, and malignant tumors can also cause prolonged breast infections. It is therefore always essential to rule out an underlying breast.

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Fibrous-cystic Mastopathia

Mastopathia is a very common breast disease. It has been estimated that one out of five women have already consulted their physician because of mastopathic complaints. The reason for the fibro-cystic alterations of breast tissue that characterize this breast state is considered to be a relative lack of progestins The local hormonal deficit results in an increased production of tissue and glandular structures which, in turn, lead to an expansion of ducts and liquid-containing cavities (»cysts«). Many of the affected women complain about breast tenderness, pain, and an irregular, coarse structure of their breast tissue. This has also lead to the »fibrocystic breast disease«. If such breast alterations are detected during a routine breast exam they do not need to be further evaluated in most cases because they are, in principle, benign. Some forms of mastopathia, however, have been associated with an elevated risk for malignant disease and thus need to be evaluated in regular periods by mammography and breast ultrasound. In case of an ambiguous mammography result a tissue biopsy should be attempted.

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Fibroadenomas are benign tumors of the breast. They are fairly common and usually develop in younger women. Almost every third woman in her fertile years is affected by one or more fibroadenomas. Fibroadenomas consist of proliferating connective tissue that edge out neighbouring glands and that can grow to a size of several centimetres. Smaller fibroadenomas do not cause symptoms and are usually detected during routine ultrasound examinations. Larger tumors can be easily palpated and are usually well delineated and relocatable. The tumors are identifiable by ultrasound and if their shape and texture are clearly benign, can be followed by regular ultrasound examination. If the dignity of a fibroadenoma is doubtful, a histological diagnosis by core-biopsy is warranted. Larger fibroadenomas and fibroadenomas which grow fast should be removed.

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A lipoma is a benign tumor which develops out of fatty tissue. Lipomas are common benign tumors which can develop in arms, legs, but also in the breast. They are usually visible directly below the skin and can easily be dislocated with digital pressure. They appear soft or plump. They usually do not cause symptoms but can become painful if they displace and thereby irritate adjacent nerves. Since lipomas are benign tumors, they need not be removed unless they cause discomfort or if their dignity is unclear.

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Intraductal Papilloma

A papilloma is a cauliflower-like proliferation of cells which usually layer ductal glands. They are a common reason for nipple secretion from a non-lactating breast. Depending on its composition, the liquid can be whitish, brownish, or bloody. Unfortunately, papillomas can sometimes transform into malignant tissues and it is thus customary to search nipple secretions for malignant cells. Another possibility to discover and to localize papillomas is the so called galactorgraphy, a technique that allows to delineate the whole breast duct system by radiocontrast imaging. This method enables the surgeon to precisely remove suspicious tissues. It should be noted that not all secretions from breast nipples are caused by papillomas. Especially when both nipples secrete, the underlying cause is often enough a hormonal dysbalance. A simple blood test can help to differentiate between the two diseases.

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