Written by Dr. Alyssa Dweck, MS, MD, FACOG, Chief Medical Officer
Your gynecologist is often the first stop when a breast concern arises. After all, we are the ones who have always encouraged a religious monthly breast self-exam and have helped decorate showers with reminder cards for years. But times are changing. While you should stay consistent with your breast self-exams, you should shift more focus on breast self-awareness. This means becoming familiar with what your breasts look and feel like and learning what is normal for you. While you should always check in with your gyno if you notice a significant change, the following are common breast concerns women experience:
Many women note general discomfort, swelling and sensitivity in both breasts as part of the premenstrual experience. This is cyclical and hormonally related and typically resolves with the onset of menstruation. The hormone changes during perimenopause may have similar effect, although less predictable.
Believe it or not, caffeine is another common cause of breast pain. Keep track of when you experience breast pain and see if you notice a connection with your caffeine consumption. You can also try reducing or eliminating caffeine outright, to see if it resolves the issue.
A poorly fitting bra, especially with underwire that digs or chafes, can be the culprit. Treat yourself to a proper bra fitting, especially after childbirth, nursing or a notable weight change.
A breast infection during lactation or from plucking hair can be painful as well, but usually resolves with warm compresses or topical/oral antibiotics.
Even if you’ve pinpointed the cause of your breast pain, be sure to check in with your healthcare provider if it persists or worsens over time. They may be able to provide treatment recommendations you haven’t considered yet.
Cystic Breasts and Breast Lumps
Nothing causes fear and angst in a woman like a palpable breast lump. In many instances, a benign breast cyst — a fluid-filled sac — is to blame. These cysts often resolve spontaneously, but occasionally may need to be drained. Cystic breasts are common, and often characterized by tender tissue on one or both breasts.
A solid mass, on the other hand, often warrants further investigation. A fibroadenoma is a type of benign solid breast growth. These are often diagnosed by clinical breast exam, or on a mammogram or ultrasound. A biopsy or excision might be recommended by your healthcare provider.
Other solid masses may be more concerning. When in doubt, a complete work-up with an exam, imaging, biopsy and specialty consultation are in order.
Needless to say, when there is drainage from one or both nipples, panic can set in. But fear not: clear or milky discharge from the breasts is usually a benign condition. Certain medications can cause a milky discharge. If you’ve recently been breastfeeding, residual lactation from the nipples after nursing can often persist despite weaning.
Rarely, a milky discharge results from excess prolactin (a hormone made by the pituitary gland) due to a growth in the pituitary gland in the brain called a prolactinoma. This can be ruled out with a blood test and brain MRI. A green or black nipple discharge typically signifies duct ectasia, a benign condition in which a breast duct gets clogged, inflamed, and secretes trapped fluid.
A bloody nipple discharge or discharge from only one breast may be cause for concern and require investigation. Be sure to contact your doctor if you are experiencing any unusual discharge.
Many women have extra breast tissue in their armpits. In most cases, this painless but prominent tissue is not a health concern. In fact, it may wax and wane in size and tenderness with the menstrual cycle, just as breast tissue does.
Additionally, from time to time, women might note smooth, moveable, and inflamed lymph nodes as a result of shaving, dental work, or a recent vaccination or infection. Such swelling is typically not cause for concern. That said, a lump that is fixed in place, persistent, or continuously enlarging in the armpit area should be evaluated by your healthcare provider.
A Word About Breast Imaging
A mammogram is the recommended screening tool for breast cancer. I recommend 3D mammogram for best results. Even if you’re not experiencing a specific breast issue, I recommend one yearly screening mammogram for the average risk individual beginning at age 40, although other screening regimens exist. . A breast ultrasound may be recommended in addition if your breasts are dense and therefore harder to evaluate. MRI scans have proven useful for screening and diagnostic purposes in high-risk populations, but they may prompt more biopsies.
Remember, it’s important to pay attention to your breasts, and note any changes or pain that may be out of the ordinary for you. Consider this to be a form of proactive and consistent self-care, helping to preserve your physical well-being and peace of mind.