The presence of many nipple-areola complexes is called polythelia, and the formation of many breasts is called polymastia. It is most commonly seen in the axillary region. Failure to form the nipple and areola is called atelia, and failure to form the breast is called amastia. The condition where the breast does not fully develop and remains small is called hypomastia.

The congenital anomaly accompanied by the absence of pectoral muscles or other thoracic region muscles along with hypomastia or amastia, hand and arm anomalies, and costochondral junction anomalies has been defined as Poland Syndrome.

Developmental Disorders

During puberty, breasts may not grow evenly. Disorders of unknown cause are called idiopathic asymmetry. In these patients, either one breast is hypoplastic or the other may be overgrown. The excessive growth of one or both breasts after puberty was intended to be explained by hypersensitivity to the estrogen hormone at the tissue level. This type of breast growth is called Virginal hypertrophy. Sometimes it regresses on its own. For those who cannot regress, reduction surgery is performed after the age of 18. Breasts may grow excessively during pregnancy and lactation and may not shrink after this period. This disorder, called macromastia-gigantomastia, is corrected by reduction mammoplasty.

Gynecomastia

The enlargement of one or both breasts in men in the form of female breasts is called gynecomastia. Although it has not been fully determined, it has been suggested that there is an estrogen-androgen imbalance. The cause of gynecomastia seen in adult men should be investigated. Cortisone, cimetidine, narcotic drugs and substances, penicillamine, some antiepileptic drugs may cause kidney and liver failure and gynecomastia. Since unilateral or bilateral gynecomastia may occur in some testicular tumors, testicular examination and ultrasonographic examination should be performed.

Keeping in mind that breast cancer can also be seen in men in cases of unilateral breast enlargement, mammography and ultrasonography should be examined in this direction, and if necessary, fine needle or tru-cut biopsy should be performed. Gynecomastia that occurs during puberty usually regresses within 6-12 months. In patients who cannot regress, the enlarged gland should be removed surgically and/or by liposuction.

Breast Infections

Breast infections are frequently seen in lactating women. Bacteria entering the nipple cracks and milk ducts cause infection. It occurs 3-4 weeks after the start of lactation, with breast swelling, redness, pain and increased fever of the patient. They are treated with penicillin or cephalosporine. It is recommended to apply hot compress.

In cases of abscess formation, each abscess should be drained one by one. Additionally, broad-spectrum antibiotics should be administered, lactation should be stopped, and the breast should be emptied with special milking pumps.

Chronic breast infections: It occurs due to reasons such as tuberculosis, superficial and deep fungal infections, and syphilis.

Mondor Disease: It is the name given to thrombophlebitis of the superficial veins of the breast and chest wall. It may regress spontaneously within 2-6 weeks. Salicylates and anti-inflammatory drugs have a positive effect. Its relationship with breast cancer has not been determined.

Mastodynia (Mastalgia)

It means breast pain. Although the real cause is not well known, estrogen-progesterone balance disorder, prolactin excess or secretion rhythm disorder, ductus ectasia, and the presence of large tense-walled cysts are among the main reasons.

Two different types of pain have been defined: 1- Cyclic pains, 2- Non-cyclic pains. Cyclic pain is pain that usually gets worse in the two halves of the menstrual period and decreases or disappears with the start of menstruation. Noncyclic pains have nothing to do with the menstrual period. They are sharper and limited pains.

Fibrocystic Changes (FKD)

Fibrocystic change; It is a disease characterized by microscopic or large cysts (diameter larger than 3 mm), apocrine metaplasia, epithelial hyperplasia, adenosis and fibrosis. It is seen in women of productive age, between the ages of 25-50. In most patients, breast pain, breast swelling, and palpable masses, which begin in the premenstrual period and decrease with menstruation, are the main complaints.

Diagnosis is made by seeing well-circumscribed, thin-walled cysts on ultrasonography.

Nonproliferative and proliferative lesions detected in the breast are classified according to the degree of breast cancer risk they carry (Table 1). There is no definitive treatment for fibrocystic change. Patients can benefit from a caffeine-free diet, a diet that reduces saturated fats, and reduced stress factors.

Classification of Breast Tissues Without Carcinoma Detected According to Relative Invasive Breast Cancer Risk Based on Histological Examination (Table 1)

Low Risk (No risk)

Apocrine changes
Ductus ectasia
Mild epithelial hyperplasia (usual type)
Slightly increased risk (1.5-2 times)
Moderate or extensive epithelial hyperplasia (usual type)
sclerosing adenosis
Intraductal papilloma

Moderately Increased Risk (4-5 Times)

Atypical ductal hyperplasia (ADH)
Atypical lobular hyperplasia (ALH)
Mixed forms of ADH and ALH

High Risk (8-10 Times)

Ductal carcinoma in situ (DCIS)
Lobular carcinoma in situ (LCIS)