Archive for October 2018


Mastitis is a condition in which the breast becomes inflamed due to an underlying infection. Although mastitis usually affects women during breastfeeding, it can happen at other times, too. Bacteria can enter the breast duct through the nipple or a skin break and lead to infection. As the body fights the infection, the breast can become red, inflamed, and tender.

Other symptoms may include:

  • fever, headache, generally feeling ill
  • a lump in the area
  • thick, whitish nipple discharge
  • an abscess, or the collection of pus in the area

Mastitis is treated with antibiotics. It should get better within about 10 days or 2 to 3 weeks at the most. Over-the-counter pain relievers such as acetaminophen (brand name: Tylenol) or ibuprofen (brand names: Advil, Motrin) can be helpful, along with warm compresses applied every few hours. If an abscess forms, it may need to be drained using a needle or during a minor surgical procedure.

Although mastitis can be quite painful, it doesn’t increase your risk of breast cancer.

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Subareolar/Periareolar Infection

Subareolar and periareolar infections can occur under or around the nipple and areola due to a blockage forming in one or more ducts. These infections are directly linked to smoking, and it’s hard to get them to heal until a woman stops smoking.

The infection can present as:

  • inflammation of the area, with or without a mass
  • an abscess (collection of pus)
  • subtle retraction (pulling inward) of the nipple
  • a mammary duct fistula, which is an abnormal passage that joins the skin in the areolar region directly to a duct under the nipple (recurrent abscesses often occur before a fistula forms)

These infections are treated with antibiotics. If there is an abscess, it may need to be aspirated (drained with a needle) or your doctor may need to numb the breast and make a small incision to drain it. If the infection recurs repeatedly, your doctor may decide to remove all of the affected ducts.

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Galactorrhea is milky breast discharge that happens in women who aren’t pregnant or breastfeeding. It affects as many as 1 out of every 4 or 5 women. It can happen at any age, even after menopause, and even if you’ve never had children. Often it’s caused by excess levels of prolactin, the hormone that triggers milk production. Prolactin is produced by the pituitary gland, a small gland at the base of your brain. You may find that your menstrual periods stop or become less frequent while you have the milky discharge.

There can be a number of underlying factors at work, such as:

  • excessive stimulation of the breasts either as part of sexual activity, during frequent breast self-exams, or due to certain articles of clothing (such as rubbing against a sports bra during high-impact exercise)
  • use of certain medications, including antidepressants, sedatives, antipsychotics, or high blood pressure drugs
  • use of certain herbal supplements, such as fennel or anise
  • an underactive thyroid gland
  • disorders affecting the pituitary gland, such as a noncancerous tumor
  • birth control pills

Your doctor will work with you to figure out what may be causing the milky discharge. In addition to taking your medical history and examining your breasts, your doctor may order tests such as:

  • analysis of the nipple discharge
  • a blood test to measure levels of prolactin and possibly of thyroid-stimulating hormone (if a thyroid problem is suspected)
  • imaging tests such as mammogram and/or ultrasound, to examine the breast tissue
  • an MRI (magnetic resonance imaging) study to check your pituitary gland

Your treatment depends on the underlying cause of the discharge. Stopping certain medications or herbal supplements often improves symptoms. If you have an underactive thyroid gland, you can take medication to boost low hormone levels (thyroid replacement th…

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Eczema of the Nipple

Eczema of the nipple occurs when an itchy, scaly, irritated rash develops in the areola (area of dark skin surrounding the nipple). It can occur on one or both nipples. Usually it is caused by irritation from certain articles of clothing, soaps, laundry detergents, or lotions. Nipple eczema often gets better once you identify and remove the cause. Choosing hypoallergenic soaps and detergents free of perfumes and dyes often helps. You may need a short course of topical steroids to treat the eczema.

If you have redness or soreness around the nipple that looks like eczema and doesn’t go away with treatment, you and your doctor also should rule out another uncommon type of breast cancer, Paget’s disease of the nipple. Paget’s disease typically presents as redness, soreness, and flaking that affects the nipple and can easily be mistaken for eczema or infection.

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Breast calcifications are small deposits of calcium in the breast tissue that show up on mammograms as bright white specks or dots. This happens because the calcium readily absorbs the X-rays. Calcifications are frequently found on mammograms and are especially common after menopause.

Calcifications can appear in the breast’s ducts and/or lobules (these are called epithelial-related calcifications). They also can show up in other parts of the breast such as the supportive tissue and blood vessels. 

Calcifications aren’t connected to the calcium in your diet. They also can’t develop into breast cancer. Rather, they are a “marker” for some underlying process that is occurring in the breast tissue. In most cases, the process is benign (not associated with cancer).

Calcifications can be a sign of other benign conditions such as:

Calcifications are viewed with concern only because they sometimes develop in areas where an underlying breast cancer is present. This can be an early-stage ductal carcinoma in situ (DCIS, which is confined to the breast duct) or a true invasive cancer. Smaller, irregularly-shaped calcifications clustered together in one area of the breast are the most suspicious. You and your …

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Skin-associated Infection (Cellulitis)

Cellulitis is an infection of the skin and underlying tissue caused by bacteria. This condition usually affects the lower half of the breast where sweat and bacteria tend to build up. The skin becomes red, warm, and inflamed, and the rash tends to spread throughout the area. You also can develop flu-like symptoms such as a fever and chills. Risk factors include being overweight, having large breasts, and/or having previous breast surgery or radiation therapy.

Cellulitis is a fast-spreading infection that requires prompt treatment with antibiotics. If an abscess (collection of pus) forms, it has to be aspirated with a needle or drained through a local incision.

Strategies for preventing cellulitis of the breast include:

  • keeping the area as clean and dry as possible
  • washing and thoroughly drying the area twice a day
  • avoiding cream, lotions, and talcum powders in the area
  • wearing a cotton bra or vest or a cotton T-shirt under the bra

Women with large breasts who have recurrent cellulitis may find relief by having breast reduction surgery.

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Mastalgia (Breast Pain)

Mastalgia, more commonly known as breast pain, affects many women at some point in their lives. Many women fear that pain and tenderness are early signs of breast cancer, but usually that’s not the case. You and your doctor can work together to rule out breast cancer as a possible cause — especially if you have other symptoms such as a mass, growth, or area of thickened tissue in the breast, nipple discharge, and/or inflammation.

If your pain feels focused in one area of the breast, it can be worth checking that with ultrasound. But pain is more likely the result of an underlying benign condition such as fibrocystic breast changes or a single cyst or fibroadenoma. Often a definite underlying cause can’t be found.

Generally, mastalgia can be classified as either:

  • Cyclic breast pain: Cyclic mastalgia affects women in their 20s, 30s, or 40s, while they are still menstruating. This pain occurs toward the end of the menstrual cycle in the week or so before you get your period. The breasts are often painful, tender, and swollen at this time, but symptoms improve at other points in the cycle. The pain usually affects the outer and upper parts of both breasts, and it might involve your underarm area as well. Most cases of mastalgia are cyclic.
  • Noncyclic breast pain: This type of pain doesn’t bear any relation to the patterns of your menstrual cycle. It often feels like a sharpness, burning, or soreness in one area (or areas) of the breast instead of a generalized feeling of pain and tenderness. This type of mastalgia is more common after menopause. The pain may be cons…

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Benign Breast Changes Associated With Pregnancy and Breastfeeding

Even though most changes in the breast during and after pregnancy are benign, a word of caution: breast cancer can and does happen in pregnant women and new mothers. Any unusual symptoms, such as a lump or irritated area, should be reported to your doctor right away. It’s always best to err on the side of caution and get it checked.

If you have a breast mass, your doctor likely will examine the breast and order an imaging study (or studies). Mammography with an abdominal shield (a special shield to protect the fetus from exposure to the X-rays) is considered safe. However, ultrasound — which uses sound waves rather than X-rays — is usually the test of choice. It can help your doctor tell the difference between a cyst, which is filled with fluid, and a growth that has some solid parts. A cyst might have to be aspirated (drained with a fine needle), and a solid mass might require core needle biopsy to rule out cancer. For more information, visit Screening for Breast Cancer During Pregnancy.

During breastfeeding, an even more common problem is infection, which can cause pain, redness, and inflammation. Breast infections can be pretty persistent, but most respond to treatment with antibiotics. If your symptoms don’t improve, your doctor should rule out any possibility of inflammatory breast cancer. This is an aggressive but rare form of breast cancer that first appears as an area of redness and skin irritation, rather than a distinct lump. Your doctor may need to order a skin or tissue biopsy to be sure.

For most women, changes in the breast during pregnancy and breastfeeding turn out to be benign. Any of the benign conditions already discussed in this section can appear in a pregnant woman. The following are benign conditions specifically associated with pregnancy and breastfeeding. None is a…

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Juvenile Papillomatosis (Swiss Cheese Disease)

Juvenile papillomatosis, also called Swiss cheese disease, usually affects teens and young adults, although it can sometimes occur in women over 30. These papillomas are very much like fibroadenomas: free-moving, round and well-defined, and painless. Each growth can measure anywhere from 1 to 8 centimeters. Often, juvenile papillomatosis includes other benign changes to the ducts and lobules, such as cysts, papillary apocrine change, and sclerosis adenosis. It can be found in one or both breasts.

Generally, a young person diagnosed with juvenile papillomatosis is thought to have a slight increase in the lifetime risk of developing breast cancer. However, the risk may be higher if there is a family history of breast cancer and the condition affects both breasts. Whatever your situation, it makes sense to discuss your family history with your doctor so you can make a follow-up plan that’s right for you.

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Benign Breast Conditions

Benign (non-cancerous) breast conditions are unusual growths or other changes in the breast tissue that are not cancer.

Having a benign breast condition can be scary at first because the symptoms often mimic those caused by breast cancer. You or your doctor might be able to feel a lump or see nipple discharge, or your mammogram might pick up something that requires further testing.

Any abnormal change in the breast can be a sign of cancer and needs to be checked out. However, many changes turn out to be benign. In fact, benign breast conditions are quite common — even more common than breast cancer.

Although benign breast conditions aren’t cancer, some can increase your risk of eventually developing breast cancer. Experts often group benign conditions into three categories, according to whether they raise breast cancer risk:

  1. no increase in risk
  2. slight increase in risk
  3. moderate increase in risk

You and your doctor can develop a follow-up plan that suits your diagnosis. Conditions that carry “no increase” and a “slight increase” in breast cancer risk typically require no further action beyond the usual breast cancer screening recommendations for women at average risk.

For conditions that carry a “moderate increase” in breast cancer risk, your doctor might suggest you get more frequent screenings with mammography and/or other imaging tests such as an ultrasound or MRI (magnetic resonance imaging) scan. He or she also might recommend strategies for reducing your risk. If you have additional risk factors for breast cancer, such as a strong family history, this can influence your action plan. These decisions have to be made on a case-by-case basis. Your doctor can help you understand your lifetime risk of breast cancer.

This section includes information about some of the more commonly diagnosed benign breast conditions. (We have not included every possible diagnosis; there a…

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