Breast Health- 02

Anatomy of the Breast
Why Do My Breasts Hurt?
Breast Problems Overview
Diagnosing and Treating Breast Problems
Healthy Breasts for a Lifetime
Fibrocystic Breast Changes
Breast Calcification's
Breast Infection
Breast and Nipple Discharge
How Babies Change Your Breasts
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Fibrocystic Breast Changes

What Are Fibrocystic Breast Changes?

When you touch your breasts, do you notice that they feel lumpy or rope-like? Do they sometimes feel swollen or more tender to the touch, especially in the outer, upper parts? If so, you might have a very common condition doctors call “fibrocystic breast changes.”

This term refers to two naturally occurring conditions in your breasts: fibrous tissue and benign (non-cancerous) cysts.

“Fibrosis” means you have a lot of breast tissue that’s scar-like. It feels firm or rubbery. A cyst is a fluid-filled lump or sac that can move around in your breasts. If fluid builds up, it can stretch the surrounding tissue. It’s not harmful, but it can hurt.

Aside from a difference in the way your breast tissue feels, you might notice that:

• Changes are similar in both breasts
• Dark brown or green discharge leaks from your nipples
• Lumps change size during your menstrual cycle
• Pain or discomfort increases before your period

Is It Normal?

Yes. About half of women in their 20s to 50s will have fibrocystic breast changes. It’s rare after menopause, but it can happen if you’re having hormone therapy.

This means hormones like estrogen might play a part, since they affect breast tissue. But doctors aren’t exactly sure what causes these changes.

The condition used to be known as “fibrocystic breast disease.” But since it’s a normal part of life for many women -- and not really a disease -- medical professionals now call them “changes.”

Is It Cancer?

No. Fibrocystic breast changes aren’t harmful. And your chances of getting cancer don’t increase because you have them.

But it can make it tricky to feel for new lumps or changes in your breasts when you do self-exams. That’s why you really need to know what’s normal for your breasts. When you notice something different, have your doctor check it out right away.

How Is It Diagnosed?

Your doctor will first do a mammogram, or an ultrasound, if you’re younger. She might be able to evaluate your breasts from the shape, density, and other signs from the images.

If she needs more information to decide, she’ll do a biopsy. This means getting a sample of your breast tissue. It’s usually done in an office or clinic with a needle. Some women need surgery.

The biopsy will show if a lump is a cyst or solid. It’ll tell your doctor if the growth is cancerous.

What’s the Treatment?

You usually won’t need any -- unless your doctor finds it’s cancer. If it’s a cyst, your doctor can puncture and drain it. This can lessen pain and pressure, but the fluid can come back. Sometimes, cysts go away on their own.

Some women find relief if they avoid caffeine. This is found in coffee, tea, chocolate, and sodas. Studies haven’t proven a link, but if you have fibrocystic breasts, you might try cutting back to see if it helps.

Your doctor may also recommend minor lifestyle changes to help your symptoms, such as:

• Cut salt from your diet to help reduce breast swelling at the end of your menstrual cycle.
• Take a diuretic, a drug that helps drain fluid from your body.
• Ask your doctor before taking any vitamin or herb supplements said to help symptoms. They can have side effects.
• Some doctors treat severe cases with prescription hormones like birth control pills or tamoxifen, a medication most often used to treat breast cancer. These can have serious side effects, too.

Fibrocystic breast changes can be painful. Try these tips to ease discomfort:

• Avoid contact sports and activities that could impact your breasts
• Press heat or ice to painful areas
• Take an over-the-counter anti-inflammatory drug like ibuprofen
• Wear a good quality, supportive bra that fits well. Keep it on at night if needed.

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Breast Calcification's

Breast Calcifications

Breast calcifications are small calcium deposits that develop in a woman's breast tissue. They are very common and are usually benign (noncancerous). In some instances, certain types of breast calcifications may suggest early breast cancer.

There are two types of breast calcifications: macrocalcifications and microcalcifications.

Macrocalcifications look like large white dots on a mammogram (breast X-ray) and are often dispersed randomly within the breast. Macrocalcifications are common -- they are found in approximately half of women over age 50, and one in 10 women under age 50 -- and are considered noncancerous.

Microcalcifications are small calcium deposits that look like white specks on a mammogram. Microcalcifications are usually not a result of cancer. But if they appear in certain patterns and are clustered together, they may be a sign of precancerous cells or early breast cancer

How do I know if I have breast calcifications?

Breast calcifications do not cause symptoms, as they are too small to be felt during a routine breast exam. Usually, breast calcifications are first noticed on a mammogram.

What causes breast calcifications?

A number of factors can cause calcification in a woman's breast, including normal ageing, inflammation, and past trauma to the area. Calcium from your diet does not cause breast calcifications.

What happens if my doctor finds breast calcifications on my mammogram?

If you have macrocalcifications, no further testing or treatment is needed, because they are not harmful. If microcalcifications are seen on your mammogram, another mammogram may be performed to get a more detailed look at the area in question. The calcifications will be determined to be either "benign," "probably benign," or "suspicious."

How are breast calcifications treated?

''Benign'' calcifications are considered harmless. No further evaluation or treatment is needed.

''Probably benign'' calcifications have a less than 2% risk of being cancer. In other words, more than 98% of the time "probably benign" calcifications are not cancer. Typically, they will be monitored every six months for at least one year. After a year of follow-up, and assuming no new changes are found, your doctor will recommend you have a routine mammogram once a year.

''Suspicious'' calcifications may be benign or an early sign of cancer; therefore, your doctor may recommend you have a biopsy. During a biopsy, a small amount of breast tissue containing the calcification is removed and sent to a laboratory to be examined for cancer cells. If cancer is present, treatment may consist of surgery to remove the cancerous breast, radiation, and/or chemotherapy to kill any remaining cancer cells.

What happens during a breast biopsy?

Two types of biopsies are used to remove breast calcification tissue for further study, including stereotactic core needle biopsy and surgical biopsy.

Core needle biopsy: Under local anaesthesia (the area is numbed, but you are awake) a radiologist, using a thin, hollow needle and guided by a computer imaging device, will remove a small piece of tissue containing the suspicious calcifications.

Surgical biopsy: If tissue cannot be successfully removed using a core needle biopsy or the results are unclear, surgery may be needed to get a sample of the calcified breast tissue. A surgeon will perform the biopsy in an operating room under local or general anaesthesia. Prior to the surgical procedure, a radiologist may use X-rays to identify the calcified breast tissue and will then mark the tissue to be removed -- with either a thin wire or with dye. A surgeon will then cut the tissue sample so that it can be sent to a lab for analysis.

If you have breast calcifications, talk to your doctor about your concerns.

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Breast Infection

Breast Infection

How the Breast Is Built

The breast is composed of several glands and ducts that lead to the nipple and the surrounding colored area called the areola. The milk-carrying ducts extend from the nipple into the underlying breast tissue like the spokes of a wheel. Under the areola are lactiferous ducts. These fill with milk during lactation after a woman has a baby. When a girl reaches puberty, changing hormones cause the ducts to grow and cause fat deposits in the breast tissue to increase. The glands that produce milk (mammary glands) that are connected to the surface of the breast by the lactiferous ducts may extend to the armpit area.

Breast Infection Causes

Mastitis is an infection of the tissue of the breast that occurs most frequently during the time of breastfeeding. It can occur when bacteria, often from the baby's mouth, enter a milk duct through a crack in the nipple.

Breast infections most commonly occur one to three months after the delivery of a baby, but they can occur in women who have not recently delivered as well as in women after menopause. Other causes of infection include chronic mastitis and a rare form of cancer called inflammatory carcinoma.

In healthy women, mastitis is rare. However, women with diabetes, chronic illness, AIDS, or an impaired immune system may be more susceptible.

About 1%-3% of breastfeeding mothers develop mastitis. Engorgement and incomplete breast emptying can contribute to the problem and make the symptoms worse.

Chronic mastitis occurs in women who are not breastfeeding. In postmenopausal women, breast infections may be associated with chronic inflammation of the ducts below the nipple. Hormonal changes in the body can cause the milk ducts to become clogged with dead skin cells and debris. These clogged ducts make the breast more open to bacterial infection. Infection tends to come back after treatment with antibiotics.

Breast Infection Symptoms

Breast infections may cause pain, redness, and warmth of the breast along with the following symptoms:

• Tenderness and swelling
• Body aches
• Fatigue
• Breast engorgement
• Fever and chills
• Abscess: Sometimes a breast abscess can complicate mastitis. Noncancerous masses such as abscesses are more often tender and frequently feel mobile beneath the skin. The edge of the mass is usually regular and well defined. Indications that this more serious infection has occurred include the following:
  • Tender lump in the breast that does not get smaller after breastfeeding a newborn (If the abscess is deep in the breast, you may not be able to feel it.)
  • Pus draining from the nipple
  • Persistent fever and no improvement of symptoms within 48-72 hours of treatment

When to Seek Medical Care

Call your health care provider as soon as you feel any suspicious lump, whether you are breastfeeding or not. Call for an appointment if:

• You have any abnormal discharge from your nipples.
• Breast pain is making it difficult for you to function each day.
• You have prolonged, unexplained breast pain.
• You have any other associated symptoms such as redness, swelling, pain that interferes with breastfeeding, a mass or tender lump in the breast that does not disappear after breastfeeding.
• If you are breastfeeding, call your doctor if you develop any symptoms of breast infection so that treatment may be started promptly.

You may need to be evaluated in a hospital's emergency department if the breast pain is associated with other signs of an infection (such as a fever, swelling, or redness to the breast) and if your health care provider cannot see you promptly. The below symptoms require emergency treatment:

• A persistent high fever greater than 101.5°F
• Nausea or vomiting that is preventing you from taking the antibiotics as prescribed
• Pus draining from the breast
• Red streaks extending toward your arm or chest
• Dizziness, fainting, or confusion

Breast Infection Exams and Tests

The diagnosis of mastitis and a breast abscess can usually be made based on a physical exam.

• If it is unclear whether a mass is due to a fluid-filled abscess or to a solid mass such as a tumor, a test such as an ultrasound may be done. An ultrasound may also be helpful in distinguishing between simple mastitis and abscess or in diagnosing an abscess deep in the breast. This noninvasive test allows your doctor to directly visualize the abscess by placing an ultrasound probe over your breast. If an abscess is confirmed, aspiration or surgical drainage, and IV antibiotics, are often required.
• Cultures may be taken, either of breast milk or of material taken out of an abscess through a syringe, to determine the type of organism causing the infection. This information can help your doctor decide what kind of antibiotic to use.
• Nonbreastfeeding women with mastitis, or those who do not respond to treatment, may have a mammogram or breast biopsy. This is a precautionary measure because a rare type of breast cancer can produce symptoms of mastitis.

Breast Infection Treatment

Breast infections require treatment by a health care provider.

Breast Infection Home Remedies

After you see a doctor, try the following to help your breast infection heal.

• Pain medication: Take acetaminophen (Tylenol) or ibuprofen (such as Advil) for pain. These drugs are safe while breastfeeding and will not harm your baby. Your doctor may prescribe a prescription strength pain reliever if your pain is severe and not relieved with over-the-counter medication.
• In mild cases of mastitis, antibiotics may not be prescribed at all. If you are prescribed antibiotics, finishing the prescription even if you feel better in a few days is very important.
• Frequent feedings: Do not stop breastfeeding from the affected breast, even though it will be painful and you may be taking antibiotics. Frequent emptying of the breast prevents engorgement and clogged ducts that can only make mastitis worse.
  • If needed, use a breast pump to relieve pressure and completely empty the breast.
  • You can also breastfeed from the unaffected side and supplement with infant formula as needed.
  • The infection will not harm the baby because the germs that caused the infection probably came from the baby’s mouth in the first place.
  • Breastfeeding should be avoided in the infected breast when an abscess is present.
• Pain relief: A warm compress applied before and after feedings can often provide some relief. A warm bath may work as well.
  • If heat is ineffective, ice packs applied after feedings may provide some comfort and relief.
  • Avoid using ice packs just before breastfeeding because it can slow down milk flow.
  • Drink plenty of water -- at least 10 glasses a day. Eat well-balanced meals and add 500 extra calories a day while breastfeeding. Dehydration and poor nutrition can decrease milk supply and make you feel worse.

Medications for Mastitis

For simple mastitis without an abscess, oral antibiotics are prescribed. Cephalexin (Keflex) and dicloxacillin (Dycill) are two of the most common antibiotics chosen, but a number of others are available. The antibiotic prescribed will depend on your specific situation, your doctor’s preference, and any drug allergies you may have. This medicine is safe to use while breastfeeding and will not harm the baby.

Chronic mastitis in nonbreastfeeding women can be complicated. Recurrent episodes of mastitis are common. Occasionally, this type of infection responds poorly to antibiotics. Therefore, close follow-up with your doctor is mandatory.

If the infection worsens in spite of oral antibiotics or if you have a deep abscess requiring surgical treatment, you may be admitted to the hospital for IV antibiotics.

Surgery for an Abscess

If an abscess is present, it must be drained. After injection of a local anesthetic, the doctor may drain an abscess near the surface of the skin either by aspiration with a needle and syringe or by using a small incision. This can be done in the doctor’s office or emergency department.

If the abscess is deep in the breast, however, it may require surgical drainage in the operating room. This procedure is usually done under general anesthesia to minimize pain and completely drain the abscess. Antibiotics and heat on the area are also used to treat abscesses.

Next Steps

Mastitis does not cause cancer, but cancer can mimic mastitis in appearance. If a breast infection is slow to go away, your health care provider may recommend a mammogram or other tests to rule out cancer.

Follow-Up Care After a Breast Infection

If you have a breast infection, you may be seen for a recheck in 24-48 hours.

• Take all antibiotics as prescribed.
• Take your temperature three times a day for the first 48 hours after treatment begins. Watch for fever.
• Call your doctor if you develop a high fever, vomiting, or increasing redness, swelling, or pain in the breast.
• Follow up with your doctor in one to two weeks to make sure that the infection has gone away. If the infection spreads or an abscess develops, you may require IV antibiotics or surgical treatment.

Mastitis Prevention

Sometimes mastitis is unavoidable. Some women are more susceptible than others, especially those who are breastfeeding for the first time. In general, good habits to prevent mastitis include the following:

• Breastfeed equally from both breasts.
• Empty breasts completely to prevent engorgement and blocked ducts.
• Use good breastfeeding techniques to prevent sore, cracked nipples.
• Avoid dehydration by drinking plenty of fluids.
• Practice careful hygiene: Handwashing, cleaning the nipples, keeping your baby clean.

Outlook for Breast Infections

When treated promptly, the majority of breast infections go away quickly and without serious complications. Most women can and should continue to breastfeed despite an episode of uncomplicated mastitis. With proper treatment, symptoms should begin to resolve within one to two days.

A breast abscess may require surgical drainage, IV antibiotics, and a short hospital stay. A small incision is made and usually heals quite well. Prognosis for complete recovery is also good.

Postmenopausal women with breast abscesses have a high rate of return after simple drainage and frequently need to follow up with a surgeon for more definitive treatment. Chronic infection can result if an abscess is not completely drained, and this can result in a poor cosmetic outcome.

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Breast and Nipple Discharge

Breast and Nipple Discharge: What It Could Mean

For women who aren't breastfeeding, the sight of nipple discharge can be alarming. But if you notice discharge from your nipple, there's no reason to panic. While nipple discharge can be serious, in most cases, it's either normal or due to a minor condition.

Still, if you are not nursing, you should contact your health careprovider any time you notice breast discharge. Based upon your symptoms and the results of diagnostic tests, your doctor will decide on the best course of treatment.

What is normal and what is abnormal nipple discharge?

Bloody nipple discharge is never normal. Other signs of abnormality include nipple discharge from only one breast and discharge that occurs spontaneously without anything touching, stimulating, or irritating your breast.

Color isn't usually helpful in deciding if the discharge is normal or abnormal. Both abnormal and normal nipple discharge can be clear, yellow, white, or green in color.

Normal nipple discharge more commonly occurs in both nipples and is often released when the nipples are compressed or squeezed. Some women who are concerned about breast secretions may actually cause it to worsen. They do this by repeatedly squeezing their nipples to check for nipple discharge. In these instances, leaving the nipples alone for a while may help the condition to improve.

Based on your medical evaluation, your doctor will determine whether your nipple discharge is normal (physiologic) or abnormal (pathologic). Even if your doctor determines your breast discharge is abnormal, keep in mind that most pathological conditions that cause nipple discharge are not serious and are easily treated.

What might cause normal nipple discharge?

Some causes of normal nipple discharge include:

• Pregnancy. In the early stages of pregnancy, some women notice clear breast discharge coming from their nipples. In the later stages of pregnancy, this discharge may take on a watery, milky appearance.
• Stopping breastfeeding. Even after you have stopped nursing your baby, you may notice that a milk-like breast discharge persists for a while.
• Stimulation. Nipples may secrete fluid when they are stimulated or squeezed. Normal nipple discharge may also occur when your nipples are repeatedly chafed by your bra or during vigorous physical exercise, such as jogging.

What causes abnormal nipple discharge and can it be noncancerous?

A number of noncancerous conditions can cause nipple discharge.

If your initial medical evaluation indicates the discharge is abnormal, your doctor may ask for more tests. The tests will help determine the underlying condition that's causing the problem and may include one or more of the following:

• Laboratory analysis of the discharge
• Blood tests
• Mammogram and/or ultrasound of one or both breasts
• A brain scan
• Surgical excision and analysis of one or more ducts in your nipple

Possible causes of abnormal discharge include:

• Fibrocystic breast changes. Fibrocystic refers to the presence or development of fibrous tissue and cysts. Fibrocystic changes in your breasts may cause lumps or thickenings in your breast tissue. They do not indicate, though, the presence of cancer. In addition to causing pain and itching, fibrocystic breast changes can, at times, cause secretion of clear, white, yellow, or green nipple discharge.
• Galactorrhea. It might sound scary. But galactorrhea simply describes a condition in which a woman's breast secretes milk or a milky nipple discharge even though she is not breastfeeding. Galactorrhea is not a disease and has many possible causes. These include:
  • Pituitary gland tumours
  • Certain medications, including some hormones and psychotropic drugs
  • Some herbs, such as anise and fennel
  • Hypothyroidism
  • Illegal drugs, including marijuana
• Infection. Nipple discharge that contains pus may indicate an infection in your breast. This is also known as mastitis. Mastitis is usually seen in women who are breastfeeding. But it can develop in women who are not lactating. If you have an infection or abscess in your breast, you may also notice that your breast is sore, red, or warm to the touch.
• Mammary duct ectasia. This is the second most common cause of abnormal nipple discharge. It is typically seen in women who are approaching menopause. This condition results in inflammation and possible blockage of ducts located underneath the nipple. When this occurs, an infection may develop that results in thick, greenish nipple discharge.
• Intraductal papilloma. These are noncancerous growths in the ducts of the breast. They are the most common reason women experience abnormal nipple discharge. When they become inflamed, intraductal papillomas may result in nipple discharge that contains blood or is sticky in texture.

What is the connection between nipple discharge and breast cancer?

Most nipple discharge is either normal or caused by a benign medical condition. There are instances, though, when discharge from the breast may be a symptom of some forms of breast cancer. This likelihood is greater if your nipple discharge is accompanied by a lump or mass within the breast or if you have had an abnormal mammogram.

One form of breast cancer that may cause breast discharge is intraductal carcinoma. This cancer develops within the ducts of the breast located beneath the nipple.

Another rare form of breast cancer that may result in nipple discharge is Paget's disease. This condition develops in the ducts of the breast and then moves to the nipple. It may cause the nipple and the surrounding areola to bleed or ooze. Paget's disease usually occurs with another form of breast cancer.

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How Babies Change Your Breasts

How Babies Change Your Breasts

When you’re going to have a baby, you expect your body to go through some pretty big changes. You know that your belly will grow bigger, your hair should look shinier, and your skin may even have that much-talked-about “pregnancy glow.”

But that’s not all. You may be surprised to know that your breasts will go through many changes, too, even beyond after your little one arrives.

Early Signs

Many women find that their breasts feel sensitive very early in pregnancy. (For some women, this is the first hint that they're pregnant.) If your breasts tingle or feel tender to the touch, that’s normal. It’s a common side effect from all of the extra hormones running through your body. If you notice any lumps at any point, though, tell your doctor so you can find out what it is.

Color Changes

The hormones in your system may change the way your breasts look while you’re pregnant. Many women find that the areola -- the area around the nipple -- gets darker during pregnancy. This is normal. The colour may or may not lighten after you give birth.

You may notice new blue veins just beneath the surface of your breast skin. This, too, is normal. It happens because the body boosts its blood supply to your breasts when you’re pregnant.

Let your doctor know about other skin changes.

New Size

You’ll probably want to buy some new bras, because your breasts may go up a size or two while you’re pregnant. It might happen during the first trimester, as your body builds up fat stores, or later, as your body prepares for breastfeeding.

If you need new bras, try pregnancy or maternity bras, which offer soft comfort and support, often without wires. You can even wear them to sleep at night.

Stretch Marks

Your growing belly isn’t the only place where you may get stretch marks. They may appear on your breasts as they grow larger.

The growing may make your skin itch, too. Moisturizer or lotion may soothe the itching, but there’s no product that can make stretch marks disappear. They should fade, though, after your baby is born.

Pre-Baby Leaking

Toward the very end of pregnancy, some women begin to leak pale yellow liquid from their breasts. The liquid is called colostrum, and it’s what your breasts make to nourish your baby until he’s 2 or 3 days old. (That’s when your breast milk comes in.)

If you leak, breast pads can keep your shirt from getting wet. Tell your doctor if you have any other type of discharge from your nipples, in case it’s not normal.

Engorged Breasts

When your newborn is a few days old, your breasts will start to make milk. When this happens, your breasts may swell with so much milk, it can feel pain. (This is called engorgement.)

Once your baby eats some milk, it eases the pain and swelling, until you make more milk. It may take your body a few days to figure out how much to make, based on how much your baby eats before you get some relief from this cycle. To curb some of the pain of engorgement, put warm, wet washcloths or chilled cabbage leaves on your breasts.

Let-Down Tingling

It’s normal to feel a tingle in your breasts when you’re about to feed your baby. This is your body’s response to cues that it’s time for your baby to eat. A rush of milk fills your breasts, and the flow can make them tingle. Over time, the strong tingling feeling should feel much less intense.

Nipple Pain

Breastfeeding is natural, but it takes time for both Mom and Baby to figure things out. If your little one doesn’t latch on right, he may make your nipples sore when he eats.

You can soothe pain with nipple cream or rub breast milk over your nipples after your baby eats, then let it air-dry. If the pain doesn’t stop, ask your paediatrician for help with your technique. Or see a lactation consultant, who teaches moms and babies how to breastfeed correctly.

Post-Baby Leaking

You may leak milk when your breasts are engorged or between feedings. Sometimes, when your baby latches onto one breast, your other one may leak milk. This is all normal, and it should happen less often the longer your nurse your baby. If you leak, you may want to wear breast pads daily, to prevent milk stains on your shirt.

Mastitis

Sometimes, a milk duct can get clogged, which can lead to an infection that doctors call mastitis. Signs include a fever, soreness, and red streaks on your breast. The area above the clogged duct may feel hot to the touch.

Call your doctor if you think you have mastitis. She can check to see what the problem is and whether you’ll need to take antibiotics to get better.