Common Breast Symptoms
One of the most common issues associated with fibrocystic changes is breast pain, also known as mastalgia or mastodynia. This pain can be related to a woman’s menstrual cycle and will typically occur just prior to a menstrual period. However, this is not always the case. Sometimes, breast pain has no relation to a woman’s menstrual cycle. In either case, evaluation to rule out any specific masses or cysts is encouraged. Even if the pain is not related to a specific lesion, there may be several other explanations. Pulled chest wall muscles, pinched nerves, or costochondritis (inflammation of the cartilage in the ribcage) and scapulothoracic bursitis (another structural issue) may also cause pain.
Nipple discharge is another very common condition. Most women with nipple discharge are very concerned that they have cancer, but in fact, the majority of nipple discharge is what we refer to as “physiologic” – in other words, related to normal hormonal fluctuations. The discharge may be yellow, green, or brown. It may also be milky or creamy, especially in women who have had children. Sometimes milky discharge is related to elevations of a hormone called prolactin. Prolactin is normally produced during breast-feeding, but occasionally other factors can cause an elevation in prolactin and associated nipple discharge. One worrisome but rare cause of an elevated prolactin is a growth or tumor in the pituitary gland (a small gland in the brain that produces many of the body’s hormones). A patient who meets criteria for a physiologic nipple discharge can usually be given reassurance and does not need further work-up. In some situations, it may be prudent to get some limited diagnostic imaging. Usually, in the absence of a specific mass or abnormality on mammogram or ultrasound, no specific treatment for the discharge is indicated. Sometimes the discharge is clear or even bloody. This can indicate a growth within a milk duct. Often times the growths are benign, but due to the potential for cancer, anyone with bloody nipple discharge will be recommended to have a thoughtful work up to consider if the discharge might be caused by a cancer.
Cysts are fluid-filled sacs, more common in younger women. After menopause, cysts typically occur less frequently. Though most cysts are too small to feel, some are large enough to feel like lumps and can potentially cause breast pain. Often, these cysts require no treatment. If they are painful and interfering with breast exams, they could potentially be drained. This is something that can typically be taken care of in the office during your visit.
A New Breast Lump or Breast Mass
These always needs to be evaluated. Breast tissue is naturally lumpy and bumpy. We have a problem in that we tell women to their breasts and if they feel a lump, alert their provider and come in for an assessment. What we do not do is spend enough time helping patients understand what kinds of lumps of masses are truly worrisome. We do not spend enough time helping them to appreciate their normal underlying lumpy texture. We encourage breast self-awareness. Breast self-awareness is to know what is normal for you. It is knowing your underlying general pattern of lumpiness. We do not advocate trying to memorize every lump, undulation and nodule. Instead, think about how all of your breast lumps tend to be similar. Also look for symmetry between the two sides. Trust that if there is a change, you will pick up on it. If you notice a lump that is bigger than your normal pattern or that seems to be a change, do not hesitate to come in and have an evaluation either with your primary care provider or at our office. Remember, that negative imaging cannot clear a lump from being a breast cancer. Some breast cancers do not show up on mammogram and ultrasound. So if you have a new mass and the imaging is negative, you still need to see a breast surgeon.
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