Family Medicine North  
Breast Health

Although women are increasingly aware of breast cancer, other conditions also can affect the breast. These conditions include infections, injuries, and lesions (lumps). Breast conditions are influenced by gender, heredity (family history), hormones, and sometimes by medication.

About 80 percent of breast lumps are benign (not cancer), yet it is natural for women to be concerned about them. A lump that is benign is highly unlikely to become cancer.

If you notice a lump in your breast, tell your doctor or other health care professional about it. Lumps are generally detected by your own self-examination, x-ray of the breasts (mammography), or physical examination of the breasts by your doctor or other health care professional.

Normal breasts
The developed breasts are made of fatty tissue containing mammary glands. These glands are capable of lactation – producing colostrums (a protein-rich fluid in late pregnancy) and milk after childbirth. The glands empty into a system of ducts that lead to the nipple.

The dark pigmented area around the nipple is called the areola. It also contains small glands that produce secretions to lubricate the nipple. The breast tissue extends into the armpit where lymph nodes are present. Lymph nodes are small organs that are important in fighting infection.

The breast tissue can also undergo changes throughout your life. These include:

  • Puberty: During puberty (ages 11 to 14 years), a girl’s breasts begin to develop. At that time, a lump may be noted under one or both nipples. At this age, even boys may have these lumps. Within six months to one year, these lumps usually go away without treatment.
  • Menstrual Period: You may notice swelling, tenderness, or soreness in your breasts before and sometimes during your menstrual period. These changes are caused by extra fluid collecting in the breast tissue. Other changes which may be related to the menstrual cycle are called fibrocystic changes. The breasts may feel generally lumpy, ropy, or granular. This lumpiness is most likely benign.
  • Pregnancy: During pregnancy, you may notice your breasts changing. They may become larger, feel warm, and become more sensitive. The nipples may turn a darker color. Late in pregnancy, the breasts secrete colostrums from the nipples. At this time, it is important to wear a comfortable bra which supports the breasts. The nipples should be kept clean and dry to avoid irritation. When pregnant, you may want to discuss with your doctor or health care professional whether you plan to breast feed your baby. If you do, you may want to learn more about lactation.
  • Lactation: During late pregnancy and after childbirth, the breasts change to prepare for breast feeding the baby. In the first three days after the birth of the baby, the breasts produce colostrums. After that, your breasts begin producing regular breast milk. A lot of milk may be produced, more than the baby needs, which might make your breasts feel hard and uncomfortable. However, in several weeks the amount of milk produced will adjust to what the baby needs. To take care of your breasts during lactation, wear a supportive bra and bathe or shower daily. Take care of your nipples by keeping them clean and dry. Nursing pads or folded squares of absorbent white cloth can be inserted into the bra over the nipples. These pads can be changed as often as needed to keep the nipples dry. If you have fever in the first week following childbirth, you should call your doctor.
  • Menopause: After going through menopause (the change of life), you should examine your breasts once a month on a certain day, such as the first day of every month. By examining your breasts regularly, you can become familiar with what they feel like and notice any changes in them.

Hormones and medications
The breasts can be affected by hormones made within the body and by certain medications.

Hormones are produced in the body by the endocrine glands. Some of these hormones regular the menstrual cycle and also create changes in the breasts during different times in the cycle.

Many women have breast discomfort before their menstrual period because of changes caused by hormones. If a woman has cysts in her breasts, she may notice that they temporarily become larger just before she has her period.

Another source of hormones is from oral contraceptives (birth control medication). Taking oral contraceptives can cause a feeling of fullness in the breasts in some women. If a woman is having breast discomfort, she may wish to discuss her birth control medication with her doctor.

Certain medications can also affect the breasts. If you notice changes in your breasts, make a list of all medications you are taking. Include in your list:

  • prescription medications
  • over-the-counter medications
  • medications prescribed by another doctor

Knowing what medications you are taking will help your doctor determine the cause of these breast changes.

If you notice changes in your breasts and have made an appointment with your doctor, prepare a list of questions to ask. Your doctor will need to know:

  • if a family member has had breast problems
  • your age
  • how long you have had this breast condition
  • does the breast condition change when you are breast feeding, during your menstrual cycle, or during menopause
  • does your breast or lump in your breast change size
  • how quickly these changes are occurring
  • if you have an discharge from your nipples

Beast problems

  • Galactorrhea is the continued flow of milk from the breasts at times other then when you are breast feeding a baby and after weaning. Galactorrhea can happen in women who have never had a baby and even men. Hormone problems may be the cause of glactorrhea. Certain medications also can cause galactorrhea in both women and men. It usually stops when the medication is stopped. If you have been breast feeding but have stopped, your breasts may still produce milk. If this happens, you may wish to talk with your doctor because galactorrhea could indicate changes in other parts of your body. Your doctor may order tests to find the reason for the continued milk production.
  • Mastitis is an infection in one or both breasts. It is caused by bacteria entering the breast through the nipple. Symptoms of the infection are fever, nausea, loss of appetite, tiredness, redness or soreness of the breast, or blood-tinged discharge from the nipple. Slight bleeding from the nipple may be noticed and several lumps may be felt. The breast may be painful, tender, and red. It mastitis is not treated, a large, hard lump may form and later become an abscess. Fever and chills may occur. If you notice any symptoms of mastitis, call your doctor immediately.
  • Injuries. The breast may be injured if they receive a direct, sharp blow. They may become bruised. Later, in the place where the bruise was, a lump may form. This lump is called fat necrosis and is made up of damaged fat tissue. The lump usually goes away after some time.
  • Nipple fissure is another injury. Another some pain in the nipples is common during the first days of breast feeding, it should stop as the milk begins to flow. If the pain continues and a fissure (crack or split) develops in the nipple, the milk may not flow to feed the baby. A fissure can be cause by the baby’s sucking on the same breast too long, by damp clothing over the breast, or by the breast being too full for the baby to nurse comfortably. The breast with a nipple fissure should be rested for one to two days, and should be emptied by a breast pump or by hand. The baby can nurse from the other breast for those two days and return to the first breast when it has healed.

Breast self-examination
Most lumps in the breast are found by women themselves. Therefore, it is important for you to examine your breasts each month. This teaches you what your breasts feel like. You will be able to notice any changes in your breasts since the last time you checked. The best time to examine your breasts is 7 to 10 days after the start of your menstrual period, when your breasts are not swollen and tender. If you are past menopause, pick a regular day, such as the first day of the month to examine your breasts.

What to look for:

  • lumps in the breast
  • swelling of the breast
  • dimpling or puckering of the skin
  • redness or soreness of the skin
  • glactorrhea (continued flow of milk)
  • change in the shape of the nipple
  • crust on the nipple
  • sudden inversion of the nipple (nipple drawn inward)
  • nipple discharge or bleeding

Most of these symptoms suggest that something is wrong – but may be easily treated. Therefore, you should see your doctor or other health care professional if you have any of these symptoms.

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