Breast problems are very common as breast tissue responds to hormone fluctuations, particularly to changes in prolactin and estrogen levels. Below is a list with a common breast problems (data pooled from Ref. 3 and 7) and links for more detailed information.
List of breast problems
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breast cancer : mammography and breast self examination will often detect this early
breast cysts : can be solitary or on both breasts
breast implants : problematic for some (silicone implants)
breast infection : breast abscess common in lactating women who breast feed
breast pain : often due to fibrocystic disease
Breast self examination (BSE) : if done monthly, will complement breast cancer prevention
fibrocystic breast : painful, lumpy breasts, often premenstrually aggravated
lactating breast : normal after childbirth; in other cases can be a sign of a prolactin secreting pituitary tumor
large breasts : pendulous, large breasts often need reduction mammoplasty
lump in breast : breast lumps are common, can be benign or malignant
nipple discharge : on one breast only: suspect tumor; on both breasts: hormone dysbalance
nipple retraction : sign of advanced breast cancer
orange skin (=peau d’orange) : sign of advanced breast cancer
palpable mass : could be benign or malignant, needs urgent work-up through physician
vague breasts thickening (=breast nodularity) : common symptom, cyclical changes with hormones, no pathology found
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Breast Cancer Information
This has been dealt with in a separate breast cancer chapter page.
Breast Infection
Breast infections are rare except in the period after the birth of a child. With breast feeding the baby the sucking newborn often causes skin cracks of the nipples, which can lead to nipple infections.
Skin flora and mouth flora from the newborn can subsequently enter under mother’s skin layer of the nipple and breast skin causing various tissue infections. The most common ones are skin yeast infections and breast abscesses.
Treatment:
Superficial yeast infections usually responds to topical antifungals. A breast abscess often will need incision and drainage by the physician followed by antibiotic therapy.
Breast Cysts
Cysts in breasts are common. They are often felt during a breast self examination. They can occur cyclically and are then usually part of fibrocystic disease. Ultrasound examination shows that they are filled with fluid, even if they may feel solid. Fine needle aspiration often stops the pain and has the advantage that a fluid sample for cell testing can be examined by a pathologist to rule out cancer. However, most of the time they are harmless (=benign).
Nipple Retraction
A retracting nipple is usually an ominous sign of invasive breast cancer. The physician should be consulted immediately.
Orange Skin (=Peau D’Orange)
Peau d’orange in French simply means “orange skin”. This can be part of the signs and symptoms of invasive breast cancer that invades the skin from underneath giving the skin of the breast an irregular surface instead of the normal smooth surface. The skin surface feels similar to that of an orange, hence the name coined originally be French physicians, but used by doctors all over the world.
Palpable Mass
To feel a breast mass in a woman’s breast is abnormal, but is one of the important signs of breast cancer.
Vague Breast Thickening (= Breast Nodularity)
This is a normal finding as a woman’s breast that is made up of 15 to 25 subunits (called “lobules”)and they have a lumpy feel about them when examined through the layer of subcutaneous fat that surrounds them. By doing breast self examinations regularly just following the menstrual period a woman will get used to this normal structure. The breasts feel most nodular just prior to the periods (premenstrually) and breast self examination should be avoided then to avoid unnecessary anxiety. The best time for breast self-examination is right after the period.
References:
1. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 235.
2. B. Sears: “Zone perfect meals in minutes”. Regan Books, Harper Collins, 1997.
3. Ryan: Kistner’s Gynecology & Women’s Health, 7th ed.,1999 Mosby, Inc.
4. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 245.
5. AB Diekman et al. Am J Reprod Immunol 2000 Mar; 43(3): 134-143.
6. V Damianova et al. Akush Ginekol (Sofia) 1999; 38(2): 31-33.
7. Townsend: Sabiston Textbook of Surgery,16th ed.,2001, W. B. Saunders Company
8. Cotran: Robbins Pathologic Basis of Disease, 6th ed., 1999 W. B. Saunders Company
9. Rakel: Conn’s Current Therapy 2001, 53rd ed., W. B. Saunders Co.
10. Ruddy: Kelley’s Textbook of Rheumatology, 6th ed.,2001 W. B. Saunders Company
11. EC Janowsky et al. N Engl J Med Mar-2000; 342(11): 781-790.
12. Wilson: Williams Textbook of Endocrinology, 9th ed.,1998 W. B. Saunders Company
13. KS Pena et al. Am Fam Physician 2001; 63(9): 1763-1770.
14. LM Apantaku Am Fam Physician Aug 2000; 62(3): 596-602.
15. Noble: Textbook of Primary Care Medicine, 3rd ed., 2001 Mosby, Inc.
16. Goroll: Primary Care Medicine, 4th ed.,2000 Lippincott Williams & Wilkins
17. St. Paul’s Hosp. Contin. Educ. Conf. Nov. 2001,Vancouver/BC
18. Gabbe: Obstetrics – Normal and Problem Pregnancies, 3rd ed., 1996 Churchill Livingstone, Inc.
19. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 251.
20. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 250.
21. Ignaz P Semmelweiss: “Die Aetiologie, der Begriff und die Prophylaxis des Kindbettfiebers” (“Etiology, the Understanding and Prophylaxis of Childbed Fever”). Vienna (Austria), 1861.
22. Rosen: Emergency Medicine: Concepts and Clinical Practice, 4th ed., 1998 Mosby-Year Book, Inc.
23. Mandell: Principles and Practice of Infectious Diseases, 5th ed., 2000 Churchill Livingstone, Inc.
24. Horner NK et al. J Am Diet Assoc Nov-2000; 100(11): 1368-1380.
