Benign Breast Problems

At Pune Breast Care, we diagnose and treat all  benign breast diseases.

Most benign conditions such as cysts, fibroadenomas or breast infections do not convert to cancer. 3 Common mistakes women make when dealing with these breast problems are:

1) Assume a condition to be benign without undergoing complete investigations.

2) Being  falsely reassured by 'false negative tests' that may incorrectly label a condition to be benign.

3)Attributing a recently noted new breast lump to a known old benign problem and delaying seeking attention

Each benign breast problem is unique and requires its own systematic diagnostic approach and treatment.

Mastalgia or Breast Pain

Mastalgia is a term that refers to painful breast and is broadly of 2 types.

Cyclical Mastalgia

 

This type of breast pain appears to vary with your menstrual cycle and usually affects both breasts. The upper, outer areas of the breast and commonly affected. The pain is usually worse in the few days before the period, improving thereafter.

Simple measures that may help cyclical mastalgia include:

 

  • Reduce consumption of caffeine in tea coffee and sodas.

  • Wear a comfortable, support  bra.

  • Apply warm or cool compresses when the breasts are painful.

  • Try vitamin E, evening primrose oil or GLA

 

If your mastalgia is severe and lifestyle limiting, you may be prescribed some additional medications.

 

Non-cyclical Mastlagia

 

This pain is usually localised to one specific part or parts of the breast and does not appear to vary with the menstrual cycle. This type of breast pain should be evaluated by a breast surgeon. Cysts and inflammation can cause this type of pain.  If your pain is associated with redness, fevers, skin changes, swelling or lump in the breast,  you should seek urgent attention.

Occasionally pain may arise from the rib cage or nerve root. Pain from Herpez Zoster or Shingles, or even a cardiac ailment can cause pain in the breast especially when felt on the left side.

Breast Pain FAQs

Is breast cancer painful?


Breast cancer most often presents as a painless breast lump. Women often ignore early signs of cancer as the lump does not hurt. Cancer can cause pain once it involves nerves in the area or may cause discomfort from stretching of surrounding tissues. You should not ignore a breast symptom such as swelling or a lump, because it isn't painful. Breast Pain, described here as 'cyclical mastalgia" is not a warning sign or risk factor for breast cancer.




What can I do about cyclical breast pain?


Simple measures you can take include Reduce consumption of caffeine in tea coffee and sodas. Wear a comfortable, support bra. Apply warm or cool compresses when the breasts are painful. Try vitamin E, evening primrose oil or GLA See a breast specialist for guidance if you have significant pain.




Why do women get breast pain around menopause?


Menstrual cycles may become irregular around menopause. Ovulation may not occur. The cyclial painful changes that occur in the breast can become exaggerated. Often these painful symptoms subside when menopause is complete. Women are advised to continue annual screening mammography after 40 years and discuss any unusual breast symptos with a breast surgeon.




How to prevent pain from mammograms?


If you are a healthy woman, going for regular screening mammography, plan your mammogram in the week after your period. The breast tissue is less tender and lumpy during this time. You can also taken an anti-inflammatory medicine half an hour before your test. Schedule your mammogram at a center that does a good number of mammograms, has experienced personnel and advanced diagnostic tehnology such as tomosynthesis to minimise need for repeated tests. Ask if they provide padding technology.




I have large breasts- will breast reduction help decrease pain?


Some women have breastst that are disproportionately large compared to their body frame. This condition is called macromastia. Due the weight of the large breasts, women often complain of upper back, neck and shoulder pain caused. This type of pain can be signifcantly improved by breast reduction surgery. You should consult a breast surgeon for these concerns.





 

Breast Feeding FAQs

How can I prevent breast infections and abscesses?


If you are breast feeding, breast feed and regular intervals. If the baby does not take a proper feed from one side, empty the breast manually or using a pump. This avoids stagnation of milk. Avoid cracked nipples as they act as pathways for bacteria to enter the breast tissue. Quit smoking and avoid tobacco as they increase risk of breast abscesses.




Can I continue to breastfeed if I have an infection?


Yes, Most of the time the bacteria causing a breast infection are already living in the baby's mouth. So you would not pass on the infection to the baby. If you are taking an antibioitic, verify if this antibiotic is safe for the baby if it enters breastmilk and watch for side effects such as diarrhea in the baby. If you have undergone surgical incision and drainage for the absvess, your surgeon will advise you when it is safe to resume breast feeding.




How can I prevent cracked nipples?


Avoidi harsh soaps that cause drying of the nipples. Y ou can use purified lanolin creams between feeds. Apply few drops of milk to the nipple and air dryi the nipples. You can also use nipple shields are measures that can be used to prevent cracked nipples.




Can breast cancer occur during pregnancy and breast feeding?


Yes. Pregancy associated breast cancer is a special type of cancer that can occur during pregnancy and in the first 2 years after pregnancy. Signs are often confused with expected changes associated with pregnancy, leading to late diagnosis. Breast Cancer during pregnancy should be managed in a cancer center with a breast surgeon, medical oncologist and obstetrician working in close co-ordination.




How is a breast abcess treated?


Once a pus collection develops in the breast, it usually will not respond to antibioitics along, and needs a draining procedure. This can be done one of two ways. A)Percutaneous Abscess Aspiration: Using ultrasound guidance, we can aspirate the abscess with a needle to remove the pus. This sample is also sent for culture to guide further antibiotic therapy. Multiple such aspirations may be required in some cases. B) Surgical Incision and Drainage: This procedure is usually done in the operating room under short general anaesthesia. Usually the incision is placed in a way that can allow the mother to continue breast-feeding after the surgery. Daily dressing changes may be needed after this procedure to allow complete wound healing.





Breast Feeding Problems

Breast Engorgement

Swollen painful Breasts are common 2-5 days after delivery. Massaging and emptying the breasts with each feed, using a breast pump, cool compresses and occasional pain reliever medications can be used to treat engorgement. If a certain area of the breast feels persistently firm or painful or the skin appears warm and red, you should seek urgent attention. Aggressive massage and heat application should be avoided.

 

Cracked Nipples

Cracked nipples are common during breastfeeding and can arise from poor latching and infant positioning, high intensity use of breast pump, trauma from baby’s teeth etc. These pose a risk for introducing infections into the breast. Avoiding soap to prevent drying, using purified lanolin creams, air drying the nipples, using nipple shields are measures that can be used to prevent cracked nipples.

 

Breast Infections

Mastitis or infection of breast tissue, is common during breastfeeding. Bacteria from the baby’s mouth infect breast tissue through cracked nipples. Poor latching and incomplete emptying of the breasts during feeds, increases this risk. Symptoms of mastitis can include fevers, redness, warmth and pain. This should be recognised and treated early to prevent abscess formation.

 

Breast Abscess  indicates a collection of pus on the breast. Once a pus collection develops in the breast, it rarely improves with antibiotics alone and often needs a drainage procedure. 

 

Recurrent Breast Abscesses

 

Idiopathic Granulomatous Mastitis (IGM)

IGM is a recurring inflammatory condition of the breast, often presenting as recurring mastitis, abscess, sinuses and fistulae.

The exact cause is unknown and is not due to bacterial infection. It is often seen in young women who have had a prior pregnancy and is believed to be an auto-immune condition. The condition is often misdiagnosed and treated with repeated surgery which leads to loss of breast volume, scarring and deformity of the breast.

Zuska’s Disease (ZD)

ZD is an inflammatory condition specifically affecting the nipple. It presents as abscesses sinuses and fistulae around the nipple. Smoking is a common risk factor for the condition. Changes in the lining of the nipple ducts cause plugging, thick yellow discharge  and infection around the nipple. The condition is not associated with pregnancy or breast feeding. It is treated with repeated courses of antibiotics and surgery for removal of sinuses and affected ducts.

 

Breast Tuberculosis (TB)

Tuberculosis of the Breast is a common condition in India. It causes “cold abscesses” that are typically not warm or painful. It can also present as sinus and fistulae of the breast that drain pus for prolonged periods of time. It can be diagnosed on core needle biopsy but more often than not is picked up after surgery. It needs to be distinguished from granulomatous mastitis as the two conditions are often confused with each-other. The condition does not respond to usual antibiotics and needs to be treated with anti-tubercular therapy for 6 months or more.

 

Recurrent Abscess FAQs

How can I prevent breast infections and abscesses?


If you are breast feeding, breast feed and regular intervals. If the baby does not take a proper feed from one side, empty the breast manually or using a pump. This avoids stagnation of milk. Avoid cracked nipples as they act as pathways for bacteria to enter the breast tissue. Quit smoking and avoid tobacco as they increase risk of breast abscesses.




Can I continue to breastfeed if I have an infection?


Yes, Most of the time the bacteria causing a breast infection are already living in the baby's mouth. So you would not pass on the infection to the baby. If you are taking an antibioitic, verify if this antibiotic is safe for the baby if it enters breastmilk and watch for side effects such as diarrhea in the baby. If you have undergone surgical incision and drainage for the absvess, your surgeon will advise you when it is safe to resume breast feeding.




How can I prevent cracked nipples?


Avoidi harsh soaps that cause drying of the nipples. Y ou can use purified lanolin creams between feeds. Apply few drops of milk to the nipple and air dryi the nipples. You can also use nipple shields are measures that can be used to prevent cracked nipples.




Can breast cancer occur during pregnancy and breast feeding?


Yes. Pregancy associated breast cancer is a special type of cancer that can occur during pregnancy and in the first 2 years after pregnancy. Signs are often confused with expected changes associated with pregnancy, leading to late diagnosis. Breast Cancer during pregnancy should be managed in a cancer center with a breast surgeon, medical oncologist and obstetrician working in close co-ordination.




How is a breast abcess treated?


Once a pus collection develops in the breast, it usually will not respond to antibioitics along, and needs a draining procedure. This can be done one of two ways. A)Percutaneous Abscess Aspiration: Using ultrasound guidance, we can aspirate the abscess with a needle to remove the pus. This sample is also sent for culture to guide further antibiotic therapy. Multiple such aspirations may be required in some cases. B) Surgical Incision and Drainage: This procedure is usually done in the operating room under short general anaesthesia. Usually the incision is placed in a way that can allow the mother to continue breast-feeding after the surgery. Daily dressing changes may be needed after this procedure to allow complete wound healing.





Nipple Discharge FAQs

Is it normal to get some sticky fluid from the nipple?


A small amount of sticky whitish or green- brown discharge from the nipple that is seen when your press or stimulate the nipples, is normal. Just like skin cells are shed from time to time, dead cells lining the ducts are shed and get liquified, collecting in chambers behind the nipple. When you press around the nipple, this fluid comes out. If your breast discharge is new or unusual, you should see a breast specialist.




When is nipple discharge abnormal?


If discharge is bloody or clear watery, it may be a sign or a growth in the ducts thats bleeding or secreting fluid. Such discahrge usually affects onebreast or only one particular duct opening. If you notice that without any stimulation, your bra on one side is wet, or shows blood spots, that imay be cause for concern. If you are not pregnant or breast feeding, but have milky discahrge, this is abnormal as well.




What causes Galactorrhea or abnormal milk discharge?


Certain medications that increase prolactin levels can cause galactorrhea. These include some antacids, antidepressants, antipsychotics, anti-hypertensive and estrogen containing drugs. Abnormalities in thyroid and other hormones can also cause galactorrhea. Rarely galactorrhea may be caused by a tumor in the pituitary gland. A breast surgeon can do a hormonal workup and advise you to see an endocrine specialist if needed.




I have nipple discharge but why is my mammography/ ultrasound normal?


Certain conditions like intraductal papillomas and ductal carcinoma in-situ are microscopic, cell level changes in the duct lining. They often do not cause a mass or calcifications, so mammograms and ultrasounds may be normal. If you have abnormal discharge you should see a breast surgeon even if your imaging is normal.




Why does an papilloma need surgery?


Sometimes a papilloma is associated with atypia or DCIS (ductal carcinoma insitu) and hence a complete removal of the papilloma and involved duct is advised. The surgery can usually be done as a short-stay or day-care procedure and the scar around the areola usually becomes invisible in a few months.





Nipple Discharge

 

   Galactorrhea

Milky discharge from the nipple in a woman who is not pregnant or breast feeding is called galactorrhea. It is often caused by hormonal or endocrine problems, rather than intrinsic problems of the breast itself. Common medicines  can cause galactorrhea. These include some antacids, antidepressants, antipsychotics, anti-hypertensive and estrogen containing drugs. A blood levels of Prolactin and Thyroid hormones is often advised. Rarely galactorrhea may be caused by a tumor in the pituitary gland and hence a complete workup should be done by seeing a breast specialist.

 

Intraductal  Papilloma

A papilloma often presents as abnormal nipple discharge. Discharge is often seen coming from a single milk duct and is usually  bloody or watery. Papilloma can be single of multiple wart-like growths arising from the lining of the ducts. They do not usually present as a lump or swelling and are often missed on mammography and ultrasound. Treatment of a papilloma involves removal of the involved duct system for complete pathological evaluation and treatment.Sometimes a papilloma is associated with atypia or DCIS (ductal carcinoma insitu) and hence a complete removal of the papilloma and involved duct is advised.

Duct Ectasia

Duct ectasia is caused by thickening of the walls of the milk duct. The milk ducts get plugged and widen. These findings are commonly noted on ultrasound especially in the elderly and often do not need surgery or other treatment. In some patients, especially diabetics and smokers, the condition can cause repeated infections or ‘chronic periductal mastitis’.

 

Breast Lumps

Breast Cysts

 

Breast Cysts are fluid-filled sacs and are not growths or tumours. They do not increase your risk of breast cancer. They can be seen at any age but are more common in young women. ‘Simple cysts’ usually do not need any treatment, unless they are large and cause symptoms. These can be treated by aspiration with a needle.

 

‘Complex cysts’ or  'complicated cysts' have "debris" or a "thick wall" or a solid component associated with them. These cysts are usually aspirated with a small needle to remove the fluid. This fluid can be tested with cytology if it appears bloody. Rarely a  type of breast tumor called ‘encysted papillary carcinoma’ can present as a complex cyst.

Fibroadenomas

 

Fibroadenoma is a commonly found benign or non-cancerous growth. Fibroadenomas are often multiple. They are usually diagnosed with an ultrasound a confirmatory needle biopsy. Not all fibroadenomas needed treatment. Usually once they are larger than 2-3 cm they tend to cause pain and discomfort and can be surgically removed. The surgery can usually be done as a short-stay or day-care procedure. The scar is hidden around the areola or the fold below the breast so that it  becomes invisible in a few months.

Fibroadenomas that grow rapidly or recur in the same area after surgery can in-fact be a different type of breast tumor called “Phyllodes tumor”. These should be treated by a breast surgeon who has expertise treatment of the condition.

Breast Lump FAQs

Is it normal to get some sticky fluid from the nipple?


A small amount of sticky whitish or green- brown discharge from the nipple that is seen when your press or stimulate the nipples, is normal. Just like skin cells are shed from time to time, dead cells lining the ducts are shed and get liquified, collecting in chambers behind the nipple. When you press around the nipple, this fluid comes out. If your breast discharge is new or unusual, you should see a breast specialist.




When is nipple discharge abnormal?


If discharge is bloody or clear watery, it may be a sign or a growth in the ducts thats bleeding or secreting fluid. Such discahrge usually affects onebreast or only one particular duct opening. If you notice that without any stimulation, your bra on one side is wet, or shows blood spots, that imay be cause for concern. If you are not pregnant or breast feeding, but have milky discahrge, this is abnormal as well.




What causes Galactorrhea or abnormal milk discharge?


Certain medications that increase prolactin levels can cause galactorrhea. These include some antacids, antidepressants, antipsychotics, anti-hypertensive and estrogen containing drugs. Abnormalities in thyroid and other hormones can also cause galactorrhea. Rarely galactorrhea may be caused by a tumor in the pituitary gland. A breast surgeon can do a hormonal workup and advise you to see an endocrine specialist if needed.




I have nipple discharge but why is my mammography/ ultrasound normal?


Certain conditions like intraductal papillomas and ductal carcinoma in-situ are microscopic, cell level changes in the duct lining. They often do not cause a mass or calcifications, so mammograms and ultrasounds may be normal. If you have abnormal discharge you should see a breast surgeon even if your imaging is normal.




Why does an papilloma need surgery?


Sometimes a papilloma is associated with atypia or DCIS (ductal carcinoma insitu) and hence a complete removal of the papilloma and involved duct is advised. The surgery can usually be done as a short-stay or day-care procedure and the scar around the areola usually becomes invisible in a few months.





 
 

Copyright 2020. All rights reserved by Dr. Pranjali Gadgil

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