Breast disease: presentations and developmental anomalies
- Topic
Most breast complaints are benign, but a few signs, a new lump in an older woman, bloody discharge, skin retraction, must always be worked up.
What it is
Breast disease reaches the clinic as pain, a palpable mass, nipple discharge, skin or nipple changes, or an abnormality on a screening mammogram. Most of these turn out to be benign, but the chance of cancer rises with age and with certain signs. Developmental anomalies are mostly harmless: extra nipples or breast tissue along the milk line, accessory axillary tissue that responds to hormones and can even develop cancer, and congenital nipple inversion, which must be told apart from new, acquired inversion.
Key facts
- The ducts and lobules end in the terminal duct lobular unit, the origin of most benign and malignant epithelial lesions.
- Accessory breast tissue in the axilla enlarges in pregnancy and can give rise to the same diseases as the breast.
- Screening mammography finds cancers smaller and earlier than palpation.
Common presentations and their most likely causes
| Presentation | Most common cause | What raises concern |
|---|---|---|
| Cyclic pain | Hormonal change, fibrocystic change | A fixed focal area of pain with a mass |
| Mobile rubbery lump in a young woman | Fibroadenoma | Rapid growth (phyllodes tumour) |
| Hard irregular lump in an older woman | Invasive carcinoma | Skin dimpling, nipple retraction, axillary nodes |
| Bloody discharge from one duct | Intraductal papilloma | Older age, associated mass |
| Milky discharge from both breasts | Hyperprolactinaemia, drugs | Visual symptoms or headache (pituitary tumour) |
| Calcifications on mammography | Benign changes | Fine linear, branching, clustered calcifications (DCIS) |
| Red, swollen breast | Mastitis in lactation | No lactation, no fever, peau d'orange (inflammatory carcinoma) |
Clinical notes
- Any persistent lump in an adult is evaluated with imaging and, when indicated, needle biopsy (the triple assessment: examination, imaging and pathology).
- Breast changes in pregnancy and lactation make examination harder; a mass that persists should still be investigated.
Test yourself
Think of the answer, then tap the question to see it.
What is the most common cause of bloody discharge from a single nipple duct?
An intraductal papilloma, although carcinoma must be excluded.
Where can supernumerary nipples or breast tissue appear?
Anywhere along the embryonic milk line, from the axilla to the vulva.
Which mammographic calcifications are suspicious?
Fine, linear or branching clustered calcifications, which suggest DCIS with necrosis.
Elsewhere in DurgiPedia
- Breast: ducts, lobules and changes with life stage
- Skin, hair, nails and the mammary glands
- Clinical breast examination
- Prolactin and its control by dopamine
Connections
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Fibrocystic Breast Disease (StatPearls (NCBI Bookshelf), 2026); Breast Cancer Treatment (PDQ®)–Health Professional Version (National Cancer Institute, 2026).
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Representative model, for educational purposes only.