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Female doctor in Durban

Dr H Ganesen( MBCHB, MMed Fam Med) 

Most breast related problems can be divided into 3 broad categories:

1.  I have a breast lump

2.  I have breast pain

3.  I have a nipple discharge

Benign Lumps

The most common benign tumor is fibroadenosis.  This is normal and refers to changes that occur during the normal menstrual cycle.  Most of the nodules are found just before and during menstruation.  Women are therefore advised to re-examine the breast two weeks after a normal cycle.

A fibroademona is a hard round lump felt in the breast of young females. Your doctor will confirm the mass clinically and refer you for further relevant investigations

Cysts are common and tend to appear and regress randomly. It can be confirmed clinically by your doctor who may then order further tests to establish a diagnosis.  Your doctor may consider aspirating the fluid in the cyst for further analysis. Cysts are common in women who are breastfeeding.  These cysts can lead to a breast abscess which may require prompt treatment.

Malignant Lumps

Breast malignancies occur in 8-10% of the general population.  However in women who carry the BRCA1 or 2 gene this occurrence can be as high as 60-80%. Only 1-2,5% of women actually carry the BRCA gene. About 1% of all breast cancer detected occur in men. Men who have female family members with breast cancer are at risk of prostate cancer.

Breast cancers maybe detected clinically by your doctor, on mammogram or ultrasound. 

Mammogram screening is recommended from age 40-45 on a regular basis. If a lump is detected in a younger female (who generally has more dense breast tissue), an ultrasound of the breast is recommended. If a suspicious lesion is detected, a biopsy maybe required.

 

Pain from within the breast

 

Fibroadenosis occurs just before the menstrual cycle. It is part of the premenstrual syndrome(PMS). There is swelling of the breast and in some cases lumpiness and pain. It may start the week before the period and resolve during the period.  In a few cases it may last all month. 

 

Infections in the breast commonly occur during breastfeeding.  The nipple may develop a crack or fissure which may then become infected.  The mother then avoids breastfeeding on that breast due to pain.  The breast becomes engorged.  It becomes painful and red.  A fever may then develop. This often results in a breast abscess.

 

Infections can also occur in the breast when not breast feeding.  Duct Ectasia, which a degenerative disease of the breast ducts may result in inflammation. The nipple may become inflamed, maybe inverted and a nipple discharge can occur.

 

Cysts in the breast may become inflamed.

 

Tumours are rarely painful.  If there is pain related to a tumor it usually is related to tumor spread to the muscles or nerves of the breast.

 

Pain from outside the breast

The most common cause for pain from outside the breast is costochondral junction.  This is due to inflammation over the site where the rib bones attach to the sternum.  

 

Physiological nipple discharge

 

Nipple discharge frequently occurs for up to a year after childbirth and cessation of breastfeeding.  It can also be the result of hormonal changes in the body or from hormonal treatment.  Certain medications such as antidepressants and diuretics may cause a nipple discharge.

                                                                           

Pathological nipple discharge

 

Duct ectasia may cause a watery or milky discharge.  A tumor in the brain called a pituary adenoma, may cause an increase in prolactin hormone levels which can then result in a bilateral nipple discharge.

 

A bloody discharge may be the result of duct ectasia but can also be caused by cancer so further investigations are required.