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Size, dimension and breast health

How does one know about the state of health of her breast?

Breast health begins with breast awareness, or a sense of what is normal for her breasts. To promote breast health, do regular breast self-examinations. With practice, one will discover how the breasts vary in sensitivity and texture at different times during menstrual cycle. One will also learn how breast health changes during various stages of life. The best time to do breast self-examination to detect a breast lump is during the first seven days after the menstrual periods are over. At this time of the menstrual cycle, the breasts are the softest and it is easiest to detect a small breast lump.

 

What are the changes which occur in the breasts during menstruation?

Many women experience in their breasts cyclical changes such as the swelling, pain, and tenderness just before menstruation. This is normal and occurs due to the influence of hormones- estrogen and progesterone.

 

How big should breasts be?

From a health perspective, there is no ideal breast size. Some of us are tall and some short. Similarly, some girls have large, medium, or small breasts.

 

If your mother and sisters have small breasts will you have small ones too?

There is some genetic component to breast size. However, breast sizes vary considerably within the same family. It is not uncommon within one family to see sisters or mother and daughters with very different breast sizes.

 

Is it normal to have different sized breasts?

Having different-sized breasts is perfectly normal. It's quite common for girls to have different-sized breasts or nipples, especially as they develop during puberty. Everyone's different, and no two women's breasts will look exactly the same. In fact, asymmetry — where one body part, like a foot or a hand, is a slightly different size or shape from its partner — is quite common in humans. In such cases supportive bras or special inserts that make their breasts appear more equal in size can be helpful.

 

What is to be done if one’s breasts are small and flat?

The breast is made up of glands and fatty tissue. Since it is the amount of fats that determines the size of the breast, one way of enlarging the breasts is by putting on more weight. This can be done by increasing one‘s intake of protein rich foods such as pulses- soyabean, rajma etc, eggs, milk, non-vegetarian items and healthy carbohydrates such chappatis, brown bread, rice, nuts etc. Exercise can enlarge the 'look' of the breasts, not by adding fat to breast tissue, but by enlarging the muscles beneath the breasts. There are no medicines for enlarging the size of the breasts. However, there are plastic surgery procedures for enhancing the size of the breasts.

 

Is there any medicine or exercise to decrease the size of the breasts?

No. There is no medicine or exercise to decrease the size of the breasts – they can be reduced in size only by surgery. If the size of the breasts is excessively large and giving rise to obvious cosmetic problems, discomfort or postural problems, then it is advisable to show a plastic surgeon.

 

How is Breast Self-Examination performed?

Breast Self-Examination includes five steps:

  • Step 1: Begin by looking at your breasts in the mirror with your shoulders straight and your arms on your hips. Here's what you should look for: (i)Breasts that are their usual size, shape, and color (ii) Breasts that are evenly shaped without visible distortion or swelling. If you see any of the following changes, bring them to your doctor's attention: (i) Dimpling, puckering, or bulging of the skin.(ii) A nipple that has changed position or an inverted nipple (pushed inward instead of sticking out). (iii) Redness, soreness, rash, or swelling.
  • Step 2: Now, raise your arms and look for the same changes.
  • Step 3: While you're at the mirror, gently squeeze each nipple between your finger and thumb and check for nipple discharge (this could be a milky or yellow fluid or blood).
  • Step 4: Next, feel your breasts while lying down, using your right hand to feel your left breast and then your left hand to feel your right breast. Use a firm, smooth touch with the first few fingers of your hand, keeping the fingers flat and together.
  • Step 5: Finally, feel your breasts while you are standing or sitting. Cover your entire breast, using the same hand movements described in Step 4.

 

 

Breast lump

What steps may be taken to detect early presence of a lump?

It is important that woman:

  • (i) Perform regular breast self-examinations (at least once a month – a few days after the periods are over).
  • (ii) Undergo mammogram.

 

What are the causes of breast lumps?

A breast lump is a growth of tissue that develops within your breast. A breast lump is often described as a mass, swelling, thickness or fullness. A breast lump can feel distinct and have definite borders, or it could feel more like a general area of thickened tissue in your breast. You may notice other breast changes accompanying a breast lump, such as skin redness, distension, dimpling or pitting; breast asymmetry; breast pain; nipple inversion; or unusual nipple discharge. There are many causes of breast lumps. Some of these causes are harmless, while others can be painful and/or dangerous. Causes of breast lumps include those due to hormonal changes, infections, injuries, non-cancerous growths, and cancer. Sometimes, a breast lump is a sign of breast cancer. That's why your doctor would promptly evaluate any breast lump you find. Fortunately, most breast lumps result from noncancerous (benign) conditions.

 

What are the causes of non-cancerous breast growths?

Non-cancerous breast growths include:

  • (i) Fibroadenoma.
  • (ii) Breast cysts.
  • (iii)Fibrocystic disease.

 

What are the common causes of breast lumps in adolescence?

  • (i) Fibrocystic breasts: Fibrocystic breasts are composed of tissue that feels ropy, lumpy or bumpy in texture. More than half of women experience fibrocystic breast changes at some point in their lives. Although the breast changes categorized as "fibrocystic breasts" are normal, they can cause breast pain and tenderness. Symptoms are of breast lumps or areas of thickening with a monthly increase in breast pain or lumpiness from mid-cycle (ovulation) to just before period. Changes usually occur in both breasts. In some cases there may be a non-bloody nipple discharge.
  • (ii) Cysts: Breast cysts are fluid-filled sacs within breast. One can have one or many breast cysts. They're often described as smooth, easily movable, round or oval lumps with distinct edges. Cysts are the most common reason for breast lumps in teenagers. Breast cysts are common in women in their 30s and 40s. They often enlarge and become tender and painful just before the menstrual period and may seem to appear overnight. There will be a decrease in the lump size and resolution of other signs and symptoms after periods. If one has breast cysts, these usually disappear after menopause, unless one is taking hormone therapy. Cysts are rarely cancerous. Breast cysts do not require treatment unless a cyst is large and painful or otherwise uncomfortable. In that case, draining the fluid from a breast cyst can ease the symptoms. Having one or many simple breast cysts does not increase the risk of breast cancer.
  • (iii) Fibroadenomas: A fibroadenoma is a firm, smooth, rubbery or hard lump with a well-defined shape. They are solid, noncancerous tumors that often occur in women during their reproductive years. It moves easily under the skin when touched and is usually painless. Fibroadenomas are more common among women in their 20s and 30s. Fibroadenomas are one of the most common breast lumps in premenopausal women. They range in size from less than 1 cm to several centimetres in diameter, and can get bigger during pregnancy and breast-feeding. Treatment may include careful monitoring to detect changes in the size or feel of the fibroadenoma, or surgery to remove it.

 

Which women are more likely to develop fibrocystic breast condition?

Fibrocystic breast condition is said to primarily affect women age 30 and older.

 

What are the breast lumps that appear before the menses and subside after it?

Fibrocystic breasts and breast cysts tend to become prominent from the middle of the menstrual period to just before the periods. These are common conditions and can affect many women during some point of their lives. The increase in size and discomfort are related to cyclical hormonal changes that occur during the menstrual cycles. It is essential to confirm the condition with a surgeon so that other conditions are not missed.

 

How are breast lumps caused due to infection?

Infections of the breast are especially common in women who are breastfeeding. When the skin of the nipple is injured or cracked, such as occurs with nursing, bacteria can enter the wound and cause infections, resulting in the formation of an abscess (deep pocket of pus) or infection of the overlying skin resulting in redness.

 

How can a woman be certain that a lump is not cancer?

The only way to be certain that a lump is not cancerous is to have a tissue sampling (biopsy). There are several ways to do the biopsy. Sometimes, a fine needle aspiration (FNA) is done. FNA is like a blood test in that a needle is inserted and fluid is withdrawn. To determine the correct location to sample, the lump can either be felt, or if it cannot be felt, the FNA may be done during an ultrasound or mammogram. However, only a surgeon should decide if the test is required, and interpret the results of the test. Remember that a normal cytology or mammogram does not rule out a cancer.

 

 

Breast pain

What is the commonest cause of breast pain in non-breastfeeding women?

Fibrocystic breast disease is the commonest cause of painful breasts in non- breastfeeding women. Fibrocystic breasts are a benign condition which should not be confused with breast cancer.

 

Is it normal to have breast pain, especially during periods?

Breast pain is a common type of discomfort among women — affecting as many as seven in 10 women at some point in their lives. About 10 percent of women have moderate to severe breast pain more than five days a month. In some cases, severe breast pain lasts throughout the menstrual cycles. Postmenopausal women can experience breast pain, but the symptom occurs more frequently in younger, premenopausal women and perimenopausal women. The commonest cause of chronic breast pain is because of hormonal changes in the breast related to the menstrual cycles (fibrocystic disease). Breast pain of short duration (usually in a breast feeding woman) associated with fever can be because of infection. Breast pain alone rarely signifies breast cancer. Still, if one has unexplained breast pain that persists, or is associated with fever, or causes worry about breast cancer or otherwise disrupts her life, get checked by a doctor.

 

What is the significance of cyclic and non-cyclic breast pain?

Most cases of breast pain are classified as either cyclic (occurring periodically every month) or noncyclic. Each type of breast pain has distinct characteristics. Cyclic breast pain is usually clearly related to the menstrual cycle and is described as dull, heavy or aching; and is often accompanied by breast swelling or lumpiness. It usually affects both breasts, particularly the upper, outer portions and can radiate to the underarm. The pain intensifies during the two weeks leading up to the start of period, and then decreases afterwards. Usually affects premenopausal women in their 20s and 30s and perimenopausal women in their 40s.Noncyclic breast pain is unrelated to the menstrual cycle. The pain is described as tight, burning or sore, and it can be constant or intermittent. It usually affects one breast in a localized area, but may spread more diffusely across the breast. Usually affects postmenopausal women in their 40s and 50s.

 

What if there is breast pain, redness, and fever in a breast-feeding woman?

Infection of the breast tissue (mastitis / breast abscess) causes pain, swelling and redness of the breast. This most commonly affects women who are breast-feeding, although in rare circumstances this condition can occur in a woman who is not breast feeding. Often, mastitis occurs within the first six weeks after birth (postpartum), but it can happen later during breast-feeding. The condition can leave feel exhausted and rundown, making it difficult to care for baby. A doctor should be consulted. Sometimes mastitis leads a mother mistakenly to wean her baby before she intends to. But she should continue breast-feeding while she has mastitis but consult a doctor / surgeon immediately.

 

When to see a doctor if a woman has breast pain?

She should consult doctor if the

  • breast pain persists for more than a couple of weeks,
  • the breast pain seems to be getting worse over time,
  • she is breast feeding,
  • there is associated fever and redness over the breast,
  • the breast pain interferes with daily activities.

  • Also see the doctor for evaluation if the pain in one particular area within breast. Although it's not a common symptom of breast cancer, breast pain does occur in about 2 to 7 percent of women with breast cancer.

     

What are the symptoms of infection in the breast?

With breast infection, signs and symptoms can appear suddenly and may include: breast tenderness or warmth to the touch, general malaise or feeling ill, swelling of the breast, pain or a burning sensation continuously or while breast-feeding, skin redness, and fever of 101 F (38.3 C) or greater. Although breast infection usually occurs in the first several weeks of nursing, it can happen any time during breast-feeding. Breast infection tends to affect only one breast — not both breasts. A doctor / surgeon should be consulted immediately, as this condition requires immediate treatment with antibiotics. If delayed, it will form pus (abscess) and may require surgery.

 

 

Nipple discahrge

Is it normal for there to be discharge coming out of the breasts?

Normally no discharge takes place through the breast. If the discharge is bloody or pus-like, it may indicate one of the rare serious conditions like an infection or tumor. For this, it is necessary that a doctor be consulted.

 

When should one see a doctor for nipple discharge?

Most often, nipple discharge stems from a non-cancerous (benign) condition. However, breast cancer is a possibility, especially if in women over age 40, or have a lump in breast, or the discharge is persistent, or contains blood, or if only one breast is affected. It is necessary that a surgeon is consulted. Nipple discharge in a man under any circumstances is problematic and should always be investigated.

 

What are the causes of ulcer and itching over the nipple?

A condition called eczema of the nipple can cause a superficial ulcer and itching over the areola. However, this tends to involve both sides and usually involves only the areola but spares the nipple. Less commonly, an underlying cancer can cause ulceration of the nipple and areola – this usually involves only one side and may involve both the nipple as well as the areola. Any such problem must be immediately shown to a surgeon

 

 

Breast cancer

How does a cancer lump present like?

A cancer lump in its early stages can present just like a benign (non-cancerous) lump. A cancer lump tends to progressively increase in size, and is usually painless. Additional features that can be seen in a cancer lump (in later stages) are distortion or swelling of the breast, redness, thickening, dimpling or bulging of the skin, recent change in position or inversion of the nipple (nipple pushed inwards), one sided nipple discharge, bloody nipple discharge, or lumps in the armpit. Therefore, any breast lump in a woman should be shown to a surgeon; although the chance of it being cancer is more after the age of 40

 

Can teenage girls get breast cancer?

Yes, however, breast cancer is rare during adolescence. On the other hand, breast lumps which are not cancerous are common at this time of life.

 

When to seek medical advice for lump in the breast?

Normal breast tissue in healthy women often feels lumpy or nodular. If you detect the presence of any new breast lump, or if a previously evaluated benign breast lump seems to have grown or otherwise changed, make an early appointment with your doctor to get it checked out. Also, any recent appearance of breast pain, distortion or swelling of one breast, redness, thickening, dimpling or bulging of the skin, recent change in position or inversion (nipple pushed inwards) of the nipple, one sided nipple discharge, bloody nipple discharge, or lumps in the armpit should mean an early surgical consultation.

 

What are the risk factors for breast cancer?

A risk factor is something that may increase the chance of developing a disease. Studies have found the following risk factors for breast cancer:
(i) Breast cancer is common in older women and is more common after 60 years of age.
(ii) A woman who had breast cancer in one breast has an increased risk of getting cancer in her other breast.
(iii)A woman's risk of breast cancer is higher if her mother, sister, or daughter had breast cancer.
(iv)Women who had their first menstrual period before age 12 are at an increased risk.
(v) Women who never had children.
(vi) Women who are physically inactive throughout life.
(vii)Overweight and consumption of high fat diet.

 

What is mammogram?

Mammogram is like a chest x-ray. It can often show a breast lump before it can be felt.

 

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