Frequently Asked Questions About Breasts
- Could I have fibroids in my breasts?
- What is fibrocystic breast disease and can it lead to cancer?
- What causes breast pain that is unrelated to breast cancer?
- Are lumpy breasts a sign of cancer?
- Should I perform a breast self-exam?
- Why do I feel more lumps in my breast around the time of my menstrual cycle?
- Is it safe to get breast implants?
- When is breast-reduction surgery necessary?
- Are underwire bras harmful?
A fibroid is a lump or growth in the uterus that is not cancerous. Fibroids can be as small as a pea to as large as a basketball. They are usually round and pinkish in color, and they can grow anywhere inside or on the uterus.
About 30 percent of women older than 30 years have fibroids, and they usually appear between the ages of 35 and 45. Some women are more likely to get fibroids, including black women, women who have never been pregnant and women who have a mother or sister with fibroids. The cause of fibroids is unknown.
You may be thinking of fibroadenomas. These usually solid, firm and round, noncancerous lumps can be found in the breasts during late teens and early 20s. They are usually painless, have clearly defined edges, and may feel rubbery.
Although the term is commonly used, fibrocystic disease is not a disease at all. Rather, the condition of generalized breast lumpiness is common in many women in their menstruating years, particularly in women aged 30 or older.
The cause is not known, but fluctuations in hormone levels can affect the symptoms.
Fibrocystic breasts typically have a dense and bumpy quality with areas of thickening and multiple fluid-filled areas (cysts). The bumpiness tends to be concentrated around the nipple and in the upper and outer areas of the breasts. Swelling, discomfort and tenderness can occur, especially just before menstrual periods, as hormonal changes cause a fluid buildup. Other symptoms can include either a sharp or aching pain, or a burning or itching sensation in the breasts.
Women with fibrocystic breasts do not have an above average risk of developing breast cancer. However, the texture of the breast tissue can make cancer harder to diagnose by physical examination or by mammogram. This condition usually disappears after menopause, except in some women who are taking hormone-replacement therapy.
There are multiple noncancerous breast conditions that may cause you to experience painful breasts at various times. Most women with breast pain have fibrocystic breast changes, a common condition discussed above.
Other causes of breast pain include:
Mastitis, most commonly seen after delivery with breast-feeding, is usually due to blockage and inflammation of a breast duct, trapping breast milk and allowing growth of bacteria leading to infection. The area is usually red, warm, tender and lumpy.
Abscess, a localized infection in the skin overlying the breast or deeper within the breast, is treated by surgical drainage with or without antibiotics.
Two other less common causes of breast pain are:
- Sclerosing adenosis, which is excessive growth of breast lobules, can be painful. It is usually associated with fibrocystic changes. These firm lumps usually require biopsy to exclude possible cancer.
- Mammary duct ectasia, seen more often in the menopausal years, is a blocked, dilated duct near the nipple. It can become inflamed and painful, with green to gray nipple discharge. When symptoms persist, surgical removal of the duct may be necessary.
While a lump or thickening in the breast or under the arm may be a sign of cancer, most breast lumps are harmless, the result of several factors during your reproductive life. Fibrocystic changes, also known as general lumpiness or benign breast disease, may become more noticeable during the middle-age years when breast tissue more often becomes fatty and soft.
Mastitis is commonly seen after delivery with breast-feeding, known as postpartum mastitis.
A cyst is a fluid-filled sac that can be too small to feel or can become larger than a walnut. In most cases it can be felt easily, but sometimes can be too small to feel. The exact cause of most cysts is not known. However, fluid retention just before the menstrual period can cause a cyst to swell and become tender or painful.
If you ever discover a new breast lump, you should always see your health-care provider for evaluation.
The official recommendation is that women do not need to perform formal monthly breast-self exams. However, women should continue to pay attention to any new lumps that they may feel during bathing or dressing.
Whatever the source, you should rely on a doctor's examination and medical diagnosis to determine the cause of breast lumps.
During the reproductive years your breasts may increase slightly in size or swell and become tender or sensitive just before your menstrual period. These symptoms typically disappear as menstrual bleeding winds down. If you are using hormones for birth control, the symptoms may vary on a monthly basis or persist from day to day until your body adjusts to the type of hormones you're using. Symptoms of tenderness or pain occasionally persist or become bothersome enough to warrant changing the amount or type of hormonal contraceptive you use, or you may opt for a non-hormonal method of birth control.
Undergoing any surgical procedure involves the risk of complications such as the effects of anesthesia, swelling, redness, bleeding and pain. In addition, there are potential complications specific to breast implants. These complications include: deflation, rupturing and the tightening of scar tissue formation around the implant. Feeling in the nipple and breast can increase or decrease after implant surgery. Infections are harder to treat when an implant is present than when the infection is in normal body tissue.
If you have breast implants, tell the X-ray personnel about them when you arrive for mammography, since having breast implants affects the way your mammogram will be performed and analyzed.
During mammography, a breast with implants must be compressed with special care to prevent the implants from rupturing. The breast also must be positioned differently for the X-ray. Deposits of calcium can be seen on mammograms and can be mistaken for possible cancer, resulting in additional surgery for biopsy and/or removal of the implant to distinguish the calcium deposits from cancer.
Published studies indicate that breast cancer is no more common in women with implants than those without implants.
The best way to determine the safety of implants is in consultation with your doctor and by monitoring the U.S. Food & Drug Adminstration's Web site, home of the most up-to-date recommendations.
Disproportionately large breasts can cause neck and shoulder pain as well as back pain. In addition, headaches, breast discomfort and skin irritation are more common. The weight of the breasts pushing down on a bra can result in grooves in the shoulder area. Women with larger breasts tend to exercise less, because of both physical discomfort and not having good choices for exercise clothing.
There are also emotional consequences that can be just as important as the physical issues. Feeling embarrassed frequently and dissatisfied with body image can alter a woman's psychological state.
The question of what determines medical necessity for breast-reduction surgery (mammoplasty) remains a thorny issue. Many insurance companies have set guidelines regarding payment for breast reduction. In general, the surgery will be covered when breast size is clearly out of proportion to body weight and height and has caused symptoms that cannot be relieved by other means.
If a woman with large breasts does not meet the criteria and is able to pay for the procedure herself, she may wish to first discuss this with her doctor before meeting with a plastic surgeon.
There have been rumors that underwire bras can increase the risk of breast cancer. However, there is no evidence that this is true.
But when shopping for a nursing bra, look for cups free of underwire. The wire acts similarly to a dam under the breast, preventing efficient emptying of the milk ducts. This can lead to plugged ducts and possible infection (mastitis).