Benign Breast Problems

Why do my breasts hurt?

Breast pain is the most common symptom that women complain of in my office. Most women with Fibrocystic changes will have breast pain. Breast pain is present in less than 10% of cases of breast cancer. Most of the time the pain seems worse because of fear that it may be cancer.There are three basic types of breast pain.1) Cyclic - has a pattern, usually surrounding the menstrual cycle. This is hormonal. Usually associated with cysts in the breast. Often in the upper outer quadrants and sometimes radiates to the armptit and arm. Pain is dull .2) Non-cyclic - no pattern, not associated with mentrual periods. Localized sharp pain to a specific area. Can be associated with certain medications, caffeine, Fatty Acid deficiency, Fibroadenomas, thrombosed veins in the skin of the breast, heavy breasts or improper fitting bras, injury, mastitis.3) Musculoskeletal - this is associated with chest wall tenderness, inflammation of the ribs, nerve injury from the neck or upper back. This is described as burning pain.Solutions: Try these treatment options

*Pain medicines

* Evening Primrose Oil

* Cut out caffeine

* Danazole

* Warm compresses

* Vit B, Vit E

* wear a proper fitting bra, sleep in a bra

* low dose birth control pills

* Bromocriptine

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Menopausaul Symptoms

Approximately 75% of women entering into Menopause (Perimenopausal) experience menopausal symptoms. The average age for menopause is arounf 50-55. This is when the ovaries stop decrease the producing estrogen and there is cessation or ending of the mentrual period.

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Nipple Discharge

Nipple discharge is when fluid is expressed from the nipples and you are not pregnant or nursing. It can be spontaneous (by itself) or non-sponaneous (only when you squeeze).68% of most women who are not pregant will have nipple discharge if they squeeze their nipples. This can be a normal process that occurs secondary to hormones. Often seen in woman with Fibrocystic breasts. The color can be clear, white, yellow, orange, brown, green or bloody.There are three main categories of discharge: *Physiologic - this is secondary to hormones, associatd with your mentrual cycle, Fibrocystic changes, associated with abnormalitles with Thyroid problems, abnormal Prolactin hormone levels from the Pituitary gland in the brain. * Pharmacologic - associated with birth control pills, Anti-depression/anxiety pills, weight loss pills. * Pathologic - cysts, Intraductal papilloma (benign mass growing inside the milk duct, Ductal ectasia (dilated ducts), Cancer.80% of the time frank blood coming from the nipple is not from cancer but from a benign growth within the duct called a Papilloma. 20% of time it is from cancer. You should always inform your doctor about discharge and have appropriate work up.

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High Risk Lesions

Some women will have cellular changes within their breasts that are consider high risk for developing breast cancer in their lifetime. If you have these high risk lesions you should talk to your doctor about which screening guidelines apply to you. Average risk (<12% lifetime risk), moderate risk (15-40% lifetime risk) or high risk (>40% lifetime risk) screening guidelines vary in recommendations. Certain risk assessment models can be used by your breast specialist to calculate your probability of developng breast cancer. There are the Care Model (for Back Women), Gail Model, Claus Model, Tyrer-Cuzick model and BRCAPRO.These breast lesions are not cancerous but are discovered by breast biopsies. - ADH (Aypical Ductal Hyperplasia) these are abnormal cells seen within the milk ducts - ALH (Atypical Lobular Hyperplasia) these are abnormal cells seen within the lobules -LCIS (Lobular Carcinoma InSitu) precancerous changes

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Microcalcifications

Microcalcifications, calcifications, calcium crystals, calcium deposits are the smallest particles visible on a mammogram. These are a normal occurrence in the aging breast tissue caused by death of cells, such as in injuries, cysts, mastitis, Fibrocystic changes, high risk lesions and even cancer. It's not the presence of the calcifications that are worrisome, but the particular arrangement or clusters that are formed that become suspicious. Calcifications associated with cancer have a irregular pattern, finely graned, pleomorphic. These may need to be biopsied by a minimally invasive technique called Stereotactic core biopsy.

Fibrocystic Changes

These are changes that are a normal response to hormonal stimulation to the breast tissue. This is a term applied to any changes in the breast that are not cancerous. 50% of all women will have irregular "lumpy bumpy" breasts. 90% of women will have microscopic fibrocystic changes (fibrosis, adenosis, dysplasia).The 3 most common symptoms of FCC is breast masses, Nipple discharge and breast pain. Certain medications can make the breast feel more lumpy as well.The most common solid mass in the breast is called a Fibroadenoma. This is normal breast tissue trapped by fibrous bands. This does not turn into cancer. It should be confirmed by needle biopsy, but it does not have to be removed.

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Itchy Nipples

Itchy nipples or breasts are usually a benign process involving the skin. This can be asscociated with contact dermatitis from new lotions, soaps, or clothing. This is secondary to irritation of the skin. Most contact dermatitis occurs several days after the contact. Worrisome signs for cancer are persistent crusting,scaliness of he nipple, bleeding, oozing from the nipple. Paget's is cancer of the nipple itself. and can be confused with nipple eczema.

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