Breast Symptoms

Understanding the wide range of possible breast symptoms and their potential implications is crucial. Not all symptoms indicate cancer, but they do require attention if they persist, change, or are accompanied by other signs. Early consultation with a doctor ensures that necessary tests can be performed and appropriate measures can be taken to address any underlying conditions.


Common Breast Symptoms

  • Breast Lumps
  • Breast Pain
  • Breast Shape Changes
  • Nipple Discharge
  • Skin changes
  • Axillary lump


Breast Lumps

Types and Characteristics of Breast Lumps

  • Cysts: Fluid-filled sacs that can feel smooth and moveable under the skin. They may fluctuate in size and tenderness throughout the menstrual cycle.
  • Fibroadenomas: Solid, benign tumours that are generally round, smooth, firm, and moveable. Commonly found in younger women.
  • Inflammatory Lumps: These are caused by infections or inflammations, such as mastitis, and present as painful, swollen, red areas on the breast, particularly in breastfeeding women.
  • Malignant Tumours: Cancerous lumps are more likely to be hard, irregularly shaped, and firmly fixed within the breast tissue.


Causes of Breast Lumps

  • Hormonal Fluctuations: Common in conditions like fibrocystic breast changes, affecting the texture and feel of the breasts.
  • Infections: Leading to abscesses or mastitis, especially during breastfeeding.
  • Benign Growths: Such as cysts and fibroadenomas.
  • Cancer: Although many lumps are benign, persistent or unusual lumps must be evaluated for breast cancer.


When to See a Doctor?

  • Any new lump should be evaluated, especially if it does not vary with your menstrual cycle.
  • Lumps that are hard, unmovable, or associated with other changes such as skin dimpling or nipple retraction.
  • Persistent or worsening lumps, even if previously evaluated.


Breast Pain (Mastalgia)

Types and Patterns of Breast Pain

  • Cyclic Mastalgia: The most common type, linked to menstrual cycles and often resolving after menopause. Pain may be described as heavy, dull, and achy, usually affecting both breasts.
  • Non-Cyclic Mastalgia: Unrelated to menstrual cycles, it can be continuous or sporadic and may affect one specific breast area. Causes include trauma, muscular strain, or hormonal imbalances.
  • Extramammary Pain: Pain that originates outside the breast (such as the chest wall) but is felt in the breast.


Causes of Breast Pain

  • Hormonal Changes: Particularly oestrogen and progesterone fluctuations during menstrual cycles, pregnancy, or menopause.
  • Medications: Some hormonal therapies, antidepressants, and cardiovascular drugs can induce or exacerbate breast pain.
  • Breast Size: Larger breast size can cause pain due to excess weight, leading to strain on the back and chest wall.
  • Breast Cysts: Fluid-filled sacs that can cause tenderness and sharp pains.


When to See a Doctor?

  • Severe or unusual breast pain that disrupts daily activities.
  • Pain that persists throughout the month and does not appear linked to the menstrual cycle.
  • Accompanying symptoms such as a lump, nipple discharge, or infection signs.


Diagnostic Approaches for Breast Pain

  • Clinical Examination: Essential to evaluate any breast lumps or persistent pain.
  • Mammography or Ultrasound: These imaging techniques help differentiate between cystic and solid masses and detect any abnormal changes within the breast.
  • MRI: Sometimes used when other imaging results are inconclusive.
  • Biopsy: A definitive way to determine the nature of a lump, distinguishing benign from malignant tissues.


Breast Shape Changes

Types of Breast Shape Changes and Their Significance

  • Size Changes: One breast may become larger or smaller compared to the other. While slight asymmetry is normal, sudden changes are not.
  • Contour Changes: Any new dimpling, puckering, or skin bulging.
  • Changes in Consistency: Areas of the breast becoming unusually firm or having an uneven texture.


Potential Causes of Breast Shape Changes

  • Hormonal Fluctuations: Common during menstruation, pregnancy, or menopause.
  • Breast Infections: Mastitis or abscesses can cause localised swelling and shape changes.
  • Underlying Masses: Both benign (like fibroadenomas) and malignant tumours can alter the shape of the breast.
  • Previous Surgeries: Scar tissue from prior surgeries can lead to changes in breast shape over time.


When to See a Doctor?

  • Noticeable changes that are unilateral (occurring in one breast only).
  • Persistent changes not associated with the menstrual cycle.
  • Accompanied by other symptoms like pain, a lump, or skin changes.


Nipple Discharge

Types of Nipple Discharge and Their Possible Implications

  • Milky: Non-pregnant and non-nursing women with milky discharge might have galactorrhea, possibly due to hormonal imbalances or certain medications.
  • Clear or Watery: Often benign but can be concerning if it's from one breast only.
  • Green or Black: Usually indicates benign conditions like duct ectasia.
  • Bloody or Pink: This can be a sign of more serious conditions, including breast cancer, and warrants immediate evaluation.


Common Causes of Nipple Discharge

  • Galactorrhea: Caused by excessive prolactin, possibly due to medications, thyroid problems, or pituitary tumours.
  • Infections or Inflammations: Can lead to purulent (pus-like) discharge.
  • Intraductal Papilloma: A benign tumour within the milk duct can cause bloody or clear discharge.
  • Breast Cancer: Particularly ductal carcinoma in situ (DCIS) or invasive ductal carcinoma.


When to See a Doctor?

  • Any new, unexplained nipple discharge, especially if it is unilateral and spontaneous (not associated with breast compression).
  • Discharge associated with a lump or skin changes.
  • Persistent or bloody discharge.


Diagnostic Evaluations for Nipple Discharge

  • Clinical Breast Exam: A thorough examination to assess any lumps, discharge, or changes in the breast tissue.
  • Imaging Tests: Mammography and ultrasound are used to look for underlying abnormalities. MRI may be considered in certain cases.
  • Ductography: Specifically evaluates the milk ducts if nipple discharge is the primary symptom.
  • Lab Tests: Blood tests might be conducted to check hormone levels, particularly prolactin.
  • Biopsy: May be necessary if there is an associated mass, persistent discharge, or suspicious imaging findings.


Skin Changes on the Breast

Types of Skin Changes on the Breast

  • Dimpling or Puckering: This can resemble the skin of an orange (peau d’orange) and may suggest inflammation or underlying masses pulling on the skin.
  • Redness or Swelling: This can indicate inflammation or infection, such as mastitis, especially if accompanied by pain or warmth. In some cases, it can also be a sign of inflammatory breast cancer.
  • Ulceration or Rash: Persistent sores or rashes, particularly around the nipple, may indicate severe dermatitis, infections, or a rare form of cancer known as Paget’s disease of the breast.


Potential Causes of Skin Changes on the Breast

  • Inflammatory Breast Cancer: This rare and aggressive form of breast cancer can cause redness, swelling, and dimpling.
  • Infections: Bacterial infections like mastitis or fungal infections can lead to skin changes.
  • Dermatological Conditions: Eczema or other skin disorders can also affect the breast area.
  • Lymphatic Blockage: Sometimes lymphatic issues can cause swelling and skin texture changes.


When to See a Doctor?

  • Any new or worsening skin changes that are localised to the breast area.
  • Symptoms that do not resolve with standard care, such as moisturisers or over-the-counter treatments.
  • Associated symptoms like pain, fever, or discharge.


Axillary Lump (Lump in the Armpit)

Axillary lumps can arise from several causes, ranging from benign to serious. They can be due to swollen lymph nodes or other conditions.


Common Causes of Axillary Lump

  • Swollen Lymph Nodes: Often a reaction to infection or inflammation in the area. In some cases, it can be a response to infection in the breast or surrounding areas.
  • Lipomas: These are benign fatty growths that are generally soft and movable under the skin.
  • Cysts: Fluid-filled sacs that may develop in the armpit.
  • Breast Cancer: Cancer cells from the breast can spread to the axillary lymph nodes.


When to See a Doctor?

  • A new lump that does not go away after a few weeks.
  • A lump that is hard, irregularly shaped, or does not move freely under the skin.
  • Accompanying symptoms such as fever, weight loss, or visible changes in the breast or skin over the lump.



Diagnostic Approaches for Axillary Lump

  • Clinical Examination: Both skin changes and axillary lumps require a thorough physical examination by a healthcare professional.
  • Imaging Tests: Ultrasound is commonly used to determine the nature of axillary lumps. Based on the findings, mammography or MRI might be recommended.
  • Biopsy: A tissue sample from the lump or affected skin might be taken to check for the presence of cancerous cells or other abnormalities.
  • Blood Tests: These might be conducted to check for infection or other systemic causes of lymph node swelling.
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