Breast Concerns

What does this mean for you?

It is a benign or non-cancerous breast lump. They are commonly found in women between the ages of 17-35 although they may occur at any age. They have nothing to do with fibroids of the uterus (womb).

Signs and Symptoms

Fibroadenomas feel round and smooth and are generally quite mobile in the breast. They are not tender and do not change with the menstrual cycle. Fibroadenomas are made up of fibrous and glandular tissue. As fibroadenomas contain some breast tissue, they can enlarge with the passage of time, with pregnancy and when breastfeeding.

Diagnosis

Fibroadenomas can be quite easily seen on ultrasound and may also be seen on mammograms. Confirmation is required that the lump is a Fibroadenoma. This can be done by a needle biopsy.

Treatment

The majority if fibroadenomas are left with no further management. Some are removed especially if they are more then 3cm in size or increasing in size. A breast surgeon can advise you on this.

Operation

Benign breast lumps are best removed as day case procedures, under a general anaesthetic. We may also put local anaesthetic into the wound to minimise discomfort after surgery. The stitches are dissolvable. You are left with a small scar, which will fade in time. We send all excised lumps to be examined under a microscope by a pathologist. We will arrange to communicate these results to you.

Breast calcifications are small areas of calcium within the soft tissue of the breast. They cannot be felt and can only be detected on a mammogram. Calcifications are very common and, in most cases, are harmless.

Macro-calcifications

Macro-calcifications are coarse calcium deposits within the breast. They look like large white dots on a mammogram. They are found in approximately half of women over the age of 50 years and about 1 in 10 younger women. They may be caused by calcium deposits within a cyst or milk duct. They can be the result of previous injuries or inflammation. Macro-calcifications are harmless. They are not linked to cancer and do not need any treatment or monitoring.

Micro-calcifications

Micro-calcifications are tiny deposits of calcium within the breast tissue, appearing as fine white specks on a mammogram. Usually they are not due to cancer. Sometimes a group of micro-calcifications seen in one area (a cluster) may be a sign of pre-cancerous.

If your mammogram shows that there are calcifications, a Radiologist will determine if any further tests or investigations are required. These may include

• An Ultrasound scan
• A Biopsy

Nipple discharge is a common disorder and it is usually benign. Discharge can be clear, yellow, green, brown or bloody.

Most women do have small discharge and its normal.

The act of squeezing the nipple creates more discharge and it not recommended.

Some women are more prone to nipple discharge then others

• Women on birth control pills
• Some blood pressure medication
• Sedatives or anti-psychotic medication

Also, different life periods can cause nipple discharge

• Puberty
• Pregnancy
• New-born babies

The time to worry is when it is spontaneous, persistent and on one side.

Management

• Do not continue to express your breasts
• See your GP

Discharge that is from both breasts, from multiple ducts and is green, creamy, or brown is almost always benign. Unless it is persistent and causing embarrassment, it can usually be managed by you GP.

Single duct clear or blood-stained discharge is always taken seriously. In this case specialist assessment is required.

What could be the cause?

• Intraduct papilloma: fern like growth on the lining of the duct. It gets eroded and bleeds creating a bloody discharge. It is benign.
• Intraduct papillomatosis: Multiple little papilloma’s
• Intraductal carcinoma: in-situ-precancer that clogs up the duct like rust
• Cancer: cancers rarely cause nipple discharge. Only 4% of all spontaneous one-sided bloody nipple discharges are cancerous.

Serious or blood-stained discharge may require investigation with a smear, ultrasound, and mammogram.

If the discharge is persistent, exploration of the nipple duct will be carried out. This is a small surgical procedure carried out under general anaesthetic as a day case.

Gynaecomastia refers to the growth of breast tissue in males and in all ages. It commonly occurs in puberty and older age. It is seen on 30-60% of boys aged 10 to 16 years and usually requires no treatment as 80% resolve on its own within 2 years.

25% of older men aged 50 to 80 can also develop it for no apparent reason. Often it is related to medication they are on.

Investigations

Investigation are divided into 2 groups as is the disease.

Younger Age Group

• Exclusion of testicular tumours by examination
• Exclusion of drugs and alcohol use

Treatment

As the disease itself is self-limiting, little further needs to be done. Occasionally surgery is performed for cosmetic appearance.

Older Age Group

• Exclusion of testicular tumors, liver problems, drugs
• Exclusion of breast malignancy by:
  • Clinic examination
  • Mammography
  • FNA (Fine needle Aspiration) or core biopsy

Treatment

This depends on the results of the investigation and would occasionally include surgery in the older age group to exclude malignancy.

Fibrocystic disease of the breast is a very common condition affecting women aged 35 to 50 years. It is thought to be due to increased sensitivity of breast tissue to hormone influences in the body.

Following menopause, the symptoms often disappear but if hormone replacement therapy is prescribed the symptoms can continue.

Symptoms:

Fibrocystic changes can affect one or both breasts and can be worse in some women prior to a period or not affected by the menstrual cycle at all. It covers a variety of symptoms including

• General lumpiness and breast thickening: This is often more noticeable prior to a period as the breast tissue reacts to hormonal changes. The area of breast tissue affected can also be more tender.
• Breast Pain: This can be worse prior to a period or not related to the menstrual cycle at all.
• Breast Cysts: Breast Cysts are fluid filled sacs which may be single, multiple, large, or small. They may cause discomfort and require drainage.
• Nipple Discharge: The discharge with fibrocystic disease can be white to brown to greenish to black. Blood stained discharge, if present, must be reported to your GP. A sample of the discharge should be sent to the laboratory for testing.

Summary

This is a non-cancerous condition and not a risk factor for cancer. It is important to get to know your breasts and notice how your breasts feel, especially following a period. If you notice a change in your breast appearance, or if you feel a lump, please see your GP.

Treatment

Cysts causing symptoms can be treated by inserting a needle into them to withdraw the fluid into a syringe. The cysts should collapse and then disappear. Smaller cysts may be left alone and often disappear. If the cyst returns following aspiration, please return to your GP or contact the Breast Clinic.

Breast pain or mastalgia is a very common condition experienced by 2 out of 3 women at some time in their life. Your breasts go through many changes that begin when you reach puberty and continue as you get older through menopause.

The breast tissue responds to the hormones produced by the ovaries and the pituitary gland.  There are 2 types of mastalgia - cyclical and non-cyclical.

Cyclical Mastalgia 

Mastalgia relates to the monthly period.  Typically breasts feel heavy, swollen and tender for several days before each period.  This is quite normal but sometimes the pain or tenderness can be severe and interfere with your normal activities.  Often all that is needed is reassurance from your Doctor that this is not due to cancer.  For some women though, the pain may be so severe that they require some sort of treatment.

Persistent or intermittent non-cyclical mastalgia

This is often described as a burning or drawing sensation.  By keeping a pain chart for 2 to 3 months it will enable your Doctor to determine which kind of breast pain you are suffering.

Hints to help you relieve breast pain

• Diary: Keep a record of your breast pain in relation to your menstrual cycle.
• Supportive Bra: Some women find it helpful to wear a properly fitted bra at all times even in bed. Wearing a bra at night is especially helpful if your breasts are heavy and painful.
• Pain relief: Simple pain relief – e.g. Paracetamol tablets 500mgs x 2 tablets four times a day may also help if your breasts are heavy and painful.
• Caffeine: Cutting down on caffeine in tea, coffee, coca cola and chocolate can help relieve breast pain.
• Nutrition: Symptoms of breast pain are made worse by being overweight.  If you are overweight, your GP will be able to help you plan a low fat reduction diet.
• Stress: Stress is known to effect breast pain. Learning to relax and take time out from busy schedules is helpful.
• Evening Oil of Primrose (Efamol) Capsules: Evening Oil of Primrose tablets are available without prescription from chemists, supermarkets and health food shops. These can be effective in relieving breast pain.  There are no obvious side effects but you will need to take the capsules for a few weeks before you will notice an improvement.  Try taking 3 grams for 3 months and if effective, reduce the dose after that.
• Voltaren Emugel: This is a non-steroidal anti-inflammatory cream that you can obtain from the chemist.  Try applying the cream and massage into the skin to the painful area of the breast.
• Danazol: This can be prescribed for severe breast pain.  It is a hormone treatment and it does have side effects.  It is not used as a first choice of treatment.