BREAST DISEASES

Modern medicine can discover and treat most breast disease AND early diagnosis can be a guarantee for successful treatment. Be careful and try to discover any symptoms and changes in your breasts.

Breast Swelling with pain – “Mastodynia” or “Mastalgia”

Mastalgia is the medical term for breast pain or breast tenderness. The majority of mastalgia is cyclic, occurring shortly before or during menstruation. However, mastalgia can also occur at any time and unrelated to menstruation.

Hormonal fluctuations cause most cases of mastalgia during puberty, during or before menstruation, during the first three months of pregnancy, during breastfeeding, after childbirth when the breasts often swell as they fill with milk even in women not breastfeeding, and during perimenopause. Mastalgia during these times is normal and does not indicate a serious problem.

The term mastodynia describes painful breast tenderness and swelling which occurs in both breasts. The symptoms usually occur in the days preceding the menstrual period and can be extremely bothersome for some women. Although the exact reason for mastodynia is still unclear, it is known that female sex hormones are involved in its development. Mastodynia can be functional – i.e. painful but harmless, it can, however, also be a symptom of a breast alteration called “fibrocystic mastopathia”. Another common reason for mastodynia is a temporal lack of the luteal hormone Progesterone. Evidently, swelling in both breasts can always also be an early sign of pregnancy.

Breast Inflammation – “Mastitis”

Breast inflammation can develop during the lactational period (“Mastitis puerperalis”), but also during other times throughout a female´s life (“Mastitis non-puerperalis”). The latter mastitis is considerably less common and the underlying reasons are usually unknown. However, women who smoke, and women who suffer from diabetes are particularly prone to develop recurrent breast infections. Some benign breast diseases have been associated with mastitis, and malignant tumors can also cause prolonged breast infections. It is therefore always essential to rule out an underlying breast.

Breast milk production when a woman is not breastfeeding

Hyperprolactinemia, also known as galactorrhea, is inappropriate breast milk secretion. It generally occurs 3 to 6 months after the discontinuation of breast-feeding (usually after a first delivery). It may also follow an abortion or may develop in a female who hasn't been pregnant. Normal ovulation is a complex process that requires many things to happen properly and at the correct time with the proper hormone levels. Often subtle hormonal imbalances or ovulation abnormalities result in decreased fertility.  One hormone imbalance that can affect fertility is prolactin levels. Excessive prolactin levels in nonpregnant women is known as hyperprolactinemia.

Hyperprolactinemia can create several problems including:

• inadequate progesterone production during luteal phase after ovulation
• irregular ovulation and menstruation
• absence of menstruation
• galactorrhea (breast milk production in non-nursing woman) 

Mastopathia -  Fibrocystic breast

Mastopathis (Fibrocystic breast condition) include lumpiness, thickening and swelling, often associated with a woman's period. Mastopathia is a very common breast disease. It has been estimated that one out of five women has already consulted their physician because of mastopathic complaints. The reason for the fibro-cystic alterations of breast tissue that characterize this breast state is considered to be a relative lack of progestins. The local hormonal deficit results in an increased production of tissue and glandular structures which, in turn, lead to an expansion of ducts and liquid-containing cavities (small cysts). Many of the affected women complain about breast tenderness, pain, and an irregular, coarse structure of their breast tissue. This has also leaded to the fibrocystic breast disease. If such breast alterations are detected during a routine breast exam they do not need to be further evaluated in most cases because they are, in principle, benign. Some forms of mastopathia, however, have been associated with an elevated risk for malignant disease and thus need to be evaluated in regular periods by mammography and breast ultrasound. In case of an ambiguous mammography result a tissue biopsy should be attempted.

Breast Cysts

Breast Cysts are fluid-filled sacs that grow inside the breasts. These sacs form when normal milk glands in the breast get bigger. A woman can have a single cyst or many cysts at a time. Breast cysts range in size from smaller than a pea to larger than a ping pong ball.
Breast cysts are common, particularly in women age 40-60. Although larger cysts can sometimes be felt as "lumps," many cysts cannot be felt by physical examination. Cysts that cannot be felt may be found during a mammogram or ultrasound.
When a mammogram shows a possible cyst, a breast ultrasound is usually done. An ultrasound shows whether the lump is a fluid-filled cyst or a solid lump. It also shows whether a cyst is a "simple cyst" or "complex cyst." Breast ultrasound is the best way to identify and diagnose breast cysts because it is accurate 95 to 100% of the time.

Breast Fibro-adenoma

Breast Fibro-adenomas are solid, round, rubbery lumps that move easily when pushed, occurring most in younger women. Breast Fibro-adenomas are benign tumors of the breast. They are fairly common and usually develop in younger women. Almost every third woman in her fertile years is affected by one or more fibro-adenomas. Breast Fibro-adenomas consist of proliferating connective tissue that edge out neighboring glands and that can grow to a size of several centimeters. Smaller breast fibro-adenomas do not cause symptoms and are usually detected during routine ultrasound examinations. Larger tumors can be easily palpated and are usually well delineated and re-locatable. The tumors are identifiable by ultrasound and if their shape and texture are clearly benign, can be followed by regular ultrasound examination. If the dignity of the breast fibro-adenoma is doubtful, a histological diagnosis by core-biopsy is warranted. Larger fibro-adenomas and fibro-adenomas which grow fast should be removed.

Breast Lipoma

Breast Lipoma is a benign tumor which develops out of fatty tissue. Breast Lipomas are common benign tumors which can develop in arms, legs, but also in the breast. They are usually visible directly below the skin and can easily be dislocated with digital pressure. They appear soft or plump. They usually do not cause symptoms but can become painful if they displace and thereby irritate adjacent nerves. Since lipomas are benign tumors, they need not be removed unless they cause discomfort or if their dignity is unclear.

Breast Intraductal Papilloma

Breast Intraductal papillomas - growths similar to warts near the nipple. Breast Papilloma is a cauliflower-like proliferation of cells which usually layer ductal glands. They are a common reason for nipple secretion from a non-lactating breast. Depending on its composition, the liquid can be whitish, brownish, or bloody. Unfortunately, papillomas can sometimes transform into malignant tissues and it is thus customary to search nipple secretions for malignant cells. Another possibility to discover and to localize papillomas is the so called galactorgraphy, a technique that allows delineating the whole breast duct system by radio-contrast imaging. This method enables the surgeon to precisely remove suspicious tissues. It should be noted that not all secretions from breast nipples are caused by papillomas. Especially when both nipples secrete, the underlying cause is often enough a hormonal dys-balance. A simple blood test can help to differentiate between the two diseases.

Blocked or clogged milk ducts

Clogged or plugged milk ducts are just what they sound like — ducts that have become blocked, inflamed, and sore. The first sign of a plugged duct may be a small, hard lump that's sore to the touch, or a very tender spot in your breast. Some women also notice redness on their breast. You might also feel achy, run down, and feverish, which could be a sign that your clogged duct has become infected.
Ducts become plugged when milk fails to drain completely. This can happen because of a poorly fitted nursing bra, incomplete or skipped feedings, an inadequate pump, an illness such as a cold, stress brought on by the holidays or work, or simply out of the blue. Left untreated, a plugged duct can evolve into a full-blown breast infection known as mastitis, so don't ignore the symptoms.

Breast Injury

Breast Injury is a direct blow to the breast, usually by a blunt object; Bruising of skin and underlying tissues of the breast or nipple. Contusions cause bleeding from ruptured small capillaries that allow blood to infiltrate fatty tissue, muscles, tendons, nerves or other soft tissue. Most common signs and symptoms of the Breast injury include:

• Local swelling of the breast-either superficial or deep;
• Pain in the breast or nipple;
• Feeling of firmness when pressure is exerted on the injury area;
• Tenseness;
• Discoloration under the skin, beginning with redness and progressing to the characteristic "black and blue" bruise; and
• Hard, tender ring surrounding the nipple.

During Breast injury the following is recommended:

• Ice massage. Massage firmly over the injured area in a circle about the size of a softball. Do this for 15 minutes at a time, 3 or 4 times a day, and before workouts or competition.
• After 48 hours, apply heat instead of ice if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments or ointments.
• Take whirlpool treatments, if available.
• Protect the injured area, with pads or an elasticized-bandage wrap between treatments.

Breast Cancer - see on next page