Breasts or boobs? (Part 2)

Breasts or Boobs? (Part 2)
Dr. Gregory Oyinloye

What are the problems to look out for?

Problems could arise from any tissue within the breasts and some of these are;

Breast pain (Mastodynia)
This is the most common problem of the breast. Like every other part of the body, breast pain is a major problem and may indicate something is wrong. This pain could be cyclic or non cyclical (relating to the menstrual cycle). As long as no lump is felt by the patient or health care professional and none is seen on imaging investigations, it should be considered, well not really abnormal.
Cyclical pain is due to filling of the glands with fluid before menstruation or ovulation. Pain may also be experienced in breastfeeding mother if the milk is not being used up as much as it’s being produced.

The commonest cause of non cyclic pain is poor support or bra fit. This is especially common in the greatly endowed but can also occur in small breasted individuals. When too tight, it tends to squeeze the breast, pressure causing soreness and poor blood supply to the areas in contact with the bra, especially in reinforced bras. These are the lower and outer edges. When too loose, the weight being born by the ligaments and the connective tissue in the upper edges are high, this is made worse by excessive movements while walking, working or even exercising.
Other causes of pain include mastitis which is an infective condition of the breast tissues, breast engorgement in breastfeeding women, breast cysts (not always), trauma, and nerve injury from surgery. Fat necrosis is usually a condition related to injury and may be painful, it involves dying fat tissue within the breast after some trauma.

Breast Lumps
These are growths within the breast tissue, they can be benign (non cancerous) or malignant(cancerous). Some lumps are so small and cannot be felt on the surface.

• The commonest non cancerous lump is a fibroadenoma, this originates from the supporting tissues and it is usually painless, occurs more often in young women within pubertal and early postpubertal years during active development. They are usually small but may grow into large lumps – giant fibroadenomas.

• Phyllodes tumors are large breast lumps which may be non cancerous to borderline cancerous and may transform or even re-grow after removal.

• Lymph nodes(pea-shaped glands that help fight harmful cells or infection) within the breast.

• Breast abscesses(pus collection)

• Lipomas(growths from fat cells)

• Cysts(fluid containing sacs) and galactceles (cyst containing breast milk).

• Lumps within the ducts are expectantly small but may also be felt on the surface these are usually papilomas(warts), and may cause blockage and accumulation of breast secretions.

• We can also have the breast feeling lumpy or stringy in a condition called fibrocystic disease. This requires no treatment, though the condition may be painful.

• Mondors disease is a cord like hardening underneath the breast skin and is usually due to the walls within a vein under the surface becoming hardened after an infection.

Cancerous breast lesions can also originate from any of the tissues within the breast and may seem similar to non cancerous ones. Some of the distinguishing features are:

• It may appear fixed to the chest or the skin(little or no mobility).

• They may be very hard.

• The skin above it may change (redden, crust or sore).

• Nipple may begin to discharge (clear, bloody or colour).

• Nipple may turn inwards.

• There may be puckering or dimpling of the skin.

•The armpit may also develop some swellings.

Some of these cancerous growths are confined to the originating tissue, while some may spread beyond the structure of origin.

Glandular cancers that remain confined are called lobar carcinoma in-situ. While those that break into surrounding tissue are called invasive lobar carcinoma. Similarly cancers within the ducts are called ductal carcinoma in-situ, when it spreads its called invasive ductal carcinoma. Other types are rare.

Breast enlargement and shrinking

Normal hormonal changes during puberty and pregnancy may cause breast enlargement to a variable degree. Some women go several cup sizes up during pregnancy and lactation while some may remain almost the same. The amount of milk produced is in the least affected by breast size. Rarely, a condition known as benign (non-cancerous) progressive enlargement/hypertrophy of the breast (this may be on one or both sides) develops. This makes the breast develop at a continuous and rapid rate and depending on the size, it could also be called macromastia or gigantomastia. These breasts could exceed 2kg in weight and can cause severe chest and back pain. It is usually caused by increased sensitivity to the hormones that cause breast growth and can occur during early adolescence, during pregnancy or breast feeding.
Male breasts may also enlarge and are usually non cancerous, due to fat deposit, hormonal changes or some medication. This is called gynecomastia.

Breast shrinking usually occurs with age- menopausal, excessive or sudden weight loss due to illness or diet changes, exercise and stress. Sudden and one sided reduction in size may also be a pointer to an ongoing condition such as breast cancer. Stoppage of hormonal therapy and contraceptives may also lead to breast shrinkage.