Anything and Everything
about breast
​Breast Pain
It is often recognized as pain or tingling, which can affect one or both breasts. It is more commonly happened on one side. Those with severe pain should not touch it, and sometimes even affect their daily lifestyle. Pain can radiate to the ipsilateral axilla or shoulder and back; some can be expressed as nipple pain or itching.
Breast pain often appears or worsens a few days before menstruation, and pain is significantly reduced or disappears after menstruation; pain can also fluctuate with changes in mood, fatigue, and weather. This pain associated with the menstrual cycle and mood changes is a major feature of the clinical manifestations of hyperplasia of the breast.
Breast Lumps
Lumps and hyperplasia are the most common symptom of breast cancer, so it is usually a terrible experience to find a change in the chest or a lump. However, most breast lumps are benign, meaning they are not and does not cause cancer
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Here are some benign lesions
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1. Fibrocystic disease of the breast)
You may be able to feel the rugged texture or clump structure of the chest, accompanied by swelling, sensitivity, or pain in the chest. Fibrocystic changes may present even after you are postmenopausal.
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2. Cyst
These fluid-filled sacs feel like soft lumps or tender points. It usually appears in women aged between 35-50, and the size of the cysts varies, and they may change with age.
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3. Fibroadenomas
It is a solid, non cancerous tumour that usually occurs in women during childbearing age. This tumour is generally not painful, smooth and mobile.
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4. Benign Proliferative Disease
Women with proliferative changes with atypia have an increased risk of breast cancer in future.
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5. Breast infection (mastitis)
It usually occurs in women who are breastfeeding. Non breastfeeding related mastitis can occur in women who are immuno compromised or smoker. The breasts may become red, swollen, and warm. The lymph nodes in the armpits might be swollen too.
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6. Trauma
Fat necrosis can happen as a result of severe trauma to the breast.
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7. Calcium deposits (microcalcifications)
They usually appear as white dots or particles on the mammogram. Most microcalcifications are harmless, but a tight cluster of microcalcifications with different size and shape may be associated with breast cancer.
Please keep in mind that if you are concerned about a breast lump or changes in breast, you are advised to see a doctor for a check up.
Nipple Discharge
Nipple discharge is one of the common symptoms of breast disease. Nipple discharge can occur in many non-lactating women, the common causes include papilloma in the duct of the breast, cystic disease of the breast and duct dilatation of the breast (ductal ectasia), 10-15% of the lesions are malignant.
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Important points to take note are patient's age, the nature of the discharge, whether accompanied by a lump, colour of the discharge, unilateral or bilateral nipple discharge, whether it is from a single duct opening or multiple duct opening.
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A bloody discharge could potentially be associated with cancerous disease, especially if accompanied by a palpable lump.
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If you have a similar condition, consult a doctor
Inverted Nipple
Congenital nipple retraction is generally caused by imperfect nipple tissue development during puberty. This is due to shortened breast ducts as a result of tissues contracture and fibrosis, associated with abnormal development of nipple smooth muscle. Inverted nipple has higher risk of breast mastitis and plasma cell mastitis.
If the degree of nipple retraction is mild, it can be corrected with the help of some device. However, severe nipple retraction requires correction surgery.
Breast/ Nipple Itchiness
Some patients may not have lump in their breasts, but complain of itchiness and rashes on the nipples and areola which resemble eczema. In some cases, this could be the presenting symptoms of a special type of breast cancer, which is called Paget's disease.
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Paget disease of breast cancer more commonly occurs in older-aged women.
Symptoms and signs are as follows:
The skin on the nipples and areola becomes rough and hard, and scaly changes on the skin with redness
Nipple discharge, such as blood
or pus
Burning or itchiness in the nipple area
Nipple areola mass
Note: If a lump or skin rashes is found in the nipple areola area and persists more than 2 weeks, please visit the doctor soonest.
Male Breast Disease
Will man get breast cancer too?
Yes they will! Breast cancer is not a women’s privilege
One out of every 100 breast cancer patients is male. The highest incidence of breast cancer occurs in men between 50 - 60 years old. Many men are often unaware of the signs of breast cancer , hence their condition is usually more advanced when diagnosed.
If more than one member in a man's family has breast cancer, he will stand a higher risk of breast cancer compared to average population.
Higher level of estrogen is an important cause of breast cancer. Obese men is lack of androgen and abnormally high estrogen. Obesity is associated with higher level of estrogen in the body. To prevent obesity from causing breast cancer, it is advisable to exercise regularly and maintain a healthy weight. It is recommended to exercise at least 150 minutes of moderate intensity every week, such as brisk walking.
Man who consume excessive alcohol is more likely to develop breast cancer. This is because long-term drinking causes damage to the liver's metabolic function (the liver is responsible for breaking down and excreting estrogen in men). Therefore, long-term excessive drinking will cause higher estrogen level in the body resulting in breast hypertrophy and increase risk of breast cancer.
Men suffering from breast cancer symptoms
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Lump in the breast
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Nipple discharge
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Redness around the breast
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Sudden nipple retraction
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Sunken skin (if there is a small "dimple")
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'Orange peel' like skin
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Axillary swelling (Axillary swelling may represent a symptom of breast cancer metastasis in the axillary lymph nodes)
Changes in breast size or shape
Both breasts of a woman are not never exactly the same size and shape. There is always one breast which is slightly larger than the other one.
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A woman's breasts begin to develop around the age of 10, and the side that is more sensitive to estrogen and progesterone in the body will develop first and grow faster and appears to be larger. As the body development reaches maturity, both breasts will eventually be similar in size, but not completely symmetry.
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Another main reason for the size difference between both breasts would be the unequal size of the underlying pectoral muscle as a result of exercise. Regular exercise can cause hypertrophy of the pectoral exercise.
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Breastfeeding mothers who often use only one particular breast for breastfeeding for a long time, will notice asymmetry of the breast size after weaning.
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If the breasts are asymmetrical in teenager, they can wait for the body growth to mature and see a doctor after puberty. If the breast becomes swollen suddenly, please see a doctor as soon as possible. This may be the presentation of certain breast diseases, such as inflammation or tumour.
If I have an issue with my breasts, who should I see?
In Malaysia, the diagnosis and treatment of breast diseases is handles by surgeon.
Breast surgeon is surgeon who specializes in breast surgery and breast cancer management.
Breast surgeon is usually well updated with the latest therapies and surgical innovations for breast
disease.
How is the diagnosis made?
When diagnosing a breast condition, patient will undergo triple assessment.
1. Clinical Assessment
Breast surgeon will take a detailed medical history of the patient, including the risk factor for breast cancer.
A clinical breast examination is performed.
2. Imaging
< 40 years old, ultrasound as first line of investigation
> 40 years old, mammogram and ultrasound recommended
3. Histopathological Examination
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Fine-Needle Aspiration
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Core-Needle Biopsy
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Vacuum Assisted Biopsy
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Open Biopsy**
​​ ** Less recommended compared to core biopsy
See a breast surgeon for professional and comprehensive treatment.
FAQs
Minimally invasive breast surgery
Minimally invasive surgery can be used for benign breast surgery and cancer surgery, this can avoid the traditional large wound scar.
The wound of endoscopic breast cancer surgery is about 3 cm, which can be hidden under the axillary and areola.
Benign breast lump removal using vacuum assisted excision technique can safely removed a < 3 cm lump with a 5mm scar.
Are you wearing your bra correctly?
1. The upper body is tilted forward 45 degrees, arms pass through the shoulder straps, hang the shoulder straps on both shoulders, support the lower part of the cup with both hands to cover the lower part of the breast, and then hook the back buckle. (If you wear your bra straight, it is difficult to place the whole breast into the cup, therefore resulting in the wrong way of wearing bra, and the breasts are deformed).
2. Keep leaning forward, pull the back and bottom line of fat and residual meat forward, place it into the cup, and then the ‘secondary breast’ at the underarm part also pull it into the center and centralise later.
3. Adjust the shoulder strap to the most comfortable position. It is advisable that the comfortable level would be within two fingers space, not too tight or too loose.
4. Stand straight, then put your hand into the cup (cross direction) to support the breast, hold the steel ring on the same side, the back hook should be fixed parallel to the scapula.
5. Do a final check, move your shoulders and raise your hands to see if the straps will come off? Is the breast in the center of the cup? Is the center of the bra smooth? Are the underarm fats included? Are the shoulder straps horizontal?
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