Breast mass

• Disease description (causes and symptoms)

  • Definition summary: A general term for all masses that develop in the breast (including benign and malignant masses). The prevalence of breast tumors among adult women in Korea is approximately 20%, and about 90% of these are benign lesions (such as fibroadenomas, cysts, intraductal papillomas, and phyllodes tumors).
  • Causes and pathophysiology (briefly):
    • Benign lesions: Fibroadenomas (common in the 20s–30s), fibrocystic cysts (common in the 35s–50s), intraductal papillomas (nipple discharge), phyllodes tumors (grow rapidly and may be locally invasive), and others are caused by tissue proliferation or cystic changes.
    • Malignant lesions (breast cancer): Tumors develop due to abnormal proliferation of the mammary gland epithelium. Risk factors include genetic predisposition (such as BRCA mutations), hormone exposure (early menarche, late menopause, not breastfeeding, and low parity), a Western-style high-fat, high-calorie diet, and family history.
  • Main symptoms:
    • Usually a painless, firm lump (the most common symptom)
    • Nipple discharge (clear/bloody), skin dimpling or wrinkling, asymmetry in breast size, localized pain (common with cysts or inflammation), enlarged axillary lymph nodes, and others
  • Diagnostic approach (summary): Self-examination → clinical examination → mammography and breast ultrasound → if necessary, fine-needle aspiration and tissue biopsy (core biopsy) for definitive diagnosis

• Treatment methods

  • Principles according to diagnosis
    • Benign findings (if small and asymptomatic): Observation with regular imaging follow-up may be appropriate
    • If there is pain, an increase in size, symptoms, or suspicious findings: Excision or drainage (aspiration in the case of a cyst)
    • If atypical proliferation or malignant findings are identified on biopsy: Appropriate surgical excision and additional treatment
  • Surgical treatment
    • Partial mastectomy (breast-conserving surgery/local excision, lumpectomy) — common for early breast cancer
    • Total mastectomy (removal of the entire breast) — for extensive or multiple lesions, or when chosen by the patient
    • Phyllodes tumors: Wide excision with an adequate margin is recommended (due to the risk of recurrence and malignant transformation)
    • Sentinel lymph node biopsy or axillary lymph node dissection is performed when necessary
  • Nonsurgical and adjuvant treatments
    • In the case of breast cancer: Radiation therapy (standard after breast-conserving surgery), chemotherapy (depending on tumor stage and molecular phenotype), hormone therapy (for ER/PR-positive disease: tamoxifen and aromatase inhibitors), and targeted therapy (such as trastuzumab for HER2-positive disease)
    • Benign cysts: Aspiration (temporary relief); excision may be considered if they recur
    • Intraductal papillomas: Surgical removal for definitive diagnosis and treatment
  • Drug treatment (summary)
    • Anti-hormonal drugs (as adjuvant treatment for breast cancer), targeted therapy, and anticancer drugs — used under the judgment of a specialist
  • Lifestyle management and precautions
    • If suspicious symptoms are found, prompt consultation with a specialist is recommended
    • After surgery, wound care and infection prevention; when lymph nodes have been removed, prevention of lymphedema (upper-limb exercises, weight management, and infection prevention)
    • Regular screening (self-examination and imaging tests) is recommended
  • Risk of complications
    • Postoperative infection, bleeding, wound scarring, changes in breast shape, lymphedema (after axillary lymph node dissection), and recurrence (with some phyllodes tumors and malignant tumors)

• Checklist before an outpatient visit (including sample questions)

  • Items/materials to prepare
    • A list of current medications (including hormone medications) and allergies
    • Past medical history, surgical history, and family history (especially breast or ovarian cancer)
    • Results of previous breast imaging (mammography/ultrasound/biopsy), including films/reports if possible
    • A record of when symptoms began and how they have changed (changes in lump size, presence or absence of pain, color and amount of nipple discharge, etc.)
    • Menstrual, childbirth, and breastfeeding history (including age at menarche and menopause)
  • Photos/notes to show the doctor during the outpatient visit
    • Photos of breast skin changes (dimpling or redness) or discharge, and notes marking the location of the lump when felt by palpation
  • Examples of basic questions to ask during an outpatient visit (items the patient can present to the doctor first)
    • “How likely is it that this lump is malignant?”
    • “Is a biopsy (or aspiration) necessary? What does the procedure involve, and what are the risks?”
    • “Is it okay to observe it without surgery? How often should follow-up be performed?”

• Examples of general questions to ask the doctor

  • What are the side effects, advantages, and disadvantages of this medication (or treatment)?
  • How is the possibility of malignancy (or the stage and prognosis) of the lesion evaluated?
  • What are the expected recurrence rates and complications for each treatment option?
  • What will the breast shape (cosmetic appearance) and recovery period be like after surgery?
  • Hereditary risk is suspected; am I a candidate for genetic testing (e.g., BRCA)?

• Examples of disease-specific questions

  • Does this lump appear benign on imaging (e.g., a simple cyst or fibroadenoma), or is a biopsy absolutely necessary?
  • If surgery is necessary, is breast conservation possible? If total mastectomy is required, what reconstruction (breast restoration) options are available?

(Note: This document is intended to provide general information. Please discuss individual diagnosis and treatment decisions with your treating doctor based on clinical examination and test results.)