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Breast Problems
Topic Overview
Breast lumps or changes are a common health worry for most women. Women may have many kinds of breast lumps and other breast changes throughout their lives, including changes that occur with menstrual periods, pregnancy, and aging. Most breast lumps and breast changes are normal.
Breast changes in young girls
Breast development is the first sign of puberty in young girls. Usually, breasts begin as small, tender bumps under one or both nipples that will get bigger over the next few years. It is not unusual for one breast to be larger than the other or for one side to develop before the other. A girl may worry that a lump under the nipple is abnormal or a sign of a serious medical problem when it is a part of normal breast development.
Noncancerous breast changes
Common, noncancerous (benign) breast changes include:
- Sacs filled with fluids (cysts).
- Generalized breast lumpiness.
- Painless, movable, and firm round lumps (fibroadenomas).
- Damaged fatty tissue (fat necrosis).
- Growths inside the ducts (intraductal papillomas).
- Enlargement of lymph nodes in the breast.
- Breast pain (mastalgia).
- Breast infections (mastitis) or abscesses.
- Nipple discharge.
- Inflamed blood vessels (thrombophlebitis).
If a woman has breast implants, there could be changes in the implant over time. Normal activity or an injury to the breast can damage the implant, causing it to leak, deflate, or rupture. The implant may harden, develop ripples, shift position, or change shape. The implant may need to be removed and replaced if any of these changes occur.
Breast changes that need follow-up
Many women with breast pain or breast lumps worry about breast cancer.
There are two common methods of early detection:
- Mammogram. A mammogram is an X-ray of the breast that can often find tumors that are too small for you or your doctor to feel. Experts do not agree about when or how often women should have mammograms. Some recommend that you begin screening at age 40, and some recommend that you begin screening at age 50. Your doctor may suggest that you have a screening mammogram at a younger age if you have risk factors for breast cancer.
- Clinical breast examination (CBE). During your routine physical exam, your doctor may do a clinical breast exam. During a CBE, your doctor will carefully feel your breasts and under your arms to check for lumps or other unusual changes. Talk to your doctor about whether to have a clinical breast exam.
Breast self-examination (BSE) involves checking your breasts for lumps or changes while standing and lying in different positions and while looking at your breasts in a mirror. Once you know what your breasts normally look and feel like, any new lump or change in appearance should be evaluated by a doctor. Most breast problems or changes are not caused by cancer. But BSE should not be used in place of clinical breast examination and mammography. Studies have not shown that BSE alone reduces the number of deaths from breast cancer.
Early breast cancer is often seen on a mammogram before there are any symptoms. The most common symptom of breast cancer is a painless lump. But sometimes painful lumps are cancerous. Other symptoms of breast cancer include:
- Skin changes, such as dimpling or puckering.
- Nipple discharge.
- Darkening of the area around the nipple.
- A nipple being drawn inward.
- Any breast problem that lasts more than 2 weeks.
- A breast lump in a man.
Breast changes in boys
In men, enlargement of male breast tissue (gynecomastia) is a noncancerous breast change. Breast buds are common in teenage boys during puberty. The buds may last up to 2 years, but they tend to go away within the first year. Breast buds develop because of rapid changes in hormone levels.
Treatment of a breast problem depends on the cause of the problem.
Check your symptoms to decide if and when you should see a doctor.
Check Your Symptoms
The medical assessment of symptoms is based on the body parts you have.
- If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
- If your symptoms aren’t related to those organs, you can choose the gender you identify with.
- If you have some organs of both sexes, you may need to go through this triage tool twice (once as “male” and once as “female”). This will make sure that the tool asks the right questions for you.
Many things can affect how your body responds to a symptom and what kind of care you may need. These include:
- Your age. Babies and older adults tend to get sicker quicker.
- Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
- Medicines you take. Certain medicines, herbal remedies, and supplements can cause symptoms or make them worse.
- Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
- Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.
Try Home Treatment
You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.
- Try home treatment to relieve the symptoms.
- Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.
Many prescription and nonprescription medicines can cause breast problems, such as breast tenderness or nipple discharge. A few examples are:
- Some antidepressants.
- Some blood pressure medicines.
- Corticosteroids, such as prednisone.
- Medicines that contain hormones, such as birth control pills, hormone therapy, and infertility medicines.
- Migraine headache medicines, such as sumatriptan.
Cimetidine, such as Tagamet, may cause nipple discharge and breast enlargement in men.
Symptoms of a heart attack may include:
- Chest pain or pressure, or a strange feeling in the chest.
- Sweating.
- Shortness of breath.
- Nausea or vomiting.
- Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
- Lightheadedness or sudden weakness.
- A fast or irregular heartbeat.
The more of these symptoms you have, the more likely it is that you’re having a heart attack. Chest pain or pressure is the most common symptom, but some people, especially women, may not notice it as much as other symptoms. You may not have chest pain at all but instead have shortness of breath, nausea, or a strange feeling in your chest or other areas.
Other breast symptoms to pay attention to can include:
- Skin changes, such as dimpling or puckering.
- Nipple discharge.
- Darkening of the area around the nipple.
- A nipple being drawn inward.
- Any breast problem that lasts more than 2 weeks.
Symptoms of a breast infection may include:
- Increased pain, swelling, redness, or warmth around a breast.
- Red streaks extending from a breast.
- Drainage of pus from a breast.
- Fever.
Certain health conditions and medicines weaken the immune system’s ability to fight off infection and illness. Some examples in adults are:
- Diseases such as diabetes, cancer, heart disease, and HIV/AIDS.
- Long-term alcohol and drug problems.
- Steroid medicines, which may be used to treat a variety of conditions.
- Chemotherapy and radiation therapy for cancer.
- Other medicines used to treat autoimmune disease.
- Medicines taken after organ transplant.
- Not having a spleen.
Certain health conditions and medicines weaken the immune system’s ability to fight off infection and illness. Some examples in children are:
- Diseases such as diabetes, cystic fibrosis, sickle cell disease, and congenital heart disease.
- Steroid medicines, which are used to treat a variety of conditions.
- Medicines taken after organ transplant.
- Chemotherapy and radiation therapy for cancer.
- Not having a spleen.
Pain in adults and older children
- Severe pain (8 to 10): The pain is so bad that you can’t stand it for more than a few hours, can’t sleep, and can’t do anything else except focus on the pain.
- Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it’s severe when it’s there.
- Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.
Seek Care Today
Based on your answers, you may need care soon. The problem probably will not get better without medical care.
- Call your doctor today to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don’t have one, seek care today.
- If it is evening, watch the symptoms and seek care in the morning.
- If the symptoms get worse, seek care sooner.
Call 911 Now
Based on your answers, you need emergency care.
Call911or other emergency services now.
Make an Appointment
Based on your answers, the problem may not improve without medical care.
- Make an appointment to see your doctor in the next 1 to 2 weeks.
- If appropriate, try home treatment while you are waiting for the appointment.
- If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.
Seek Care Now
Based on your answers, you may need care right away. The problem is likely to get worse without medical care.
- Call your doctor now to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don’t have one, seek care in the next hour.
- You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.
Home Treatment
Breast self-exams are a simple way for you to learn what your breasts normally feel like. During a breast self-exam, you examine your own breasts to look and feel for changes from one month to the next. You will learn how your breasts feel and what is normal for you so that you can spot any changes early. For more information about how to do a breast self-exam, see the topic Breast Self-Examination.
If you have pain or a fever from a breast problem or injury, you can try nonprescription medicines for your symptoms.
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Try a nonprescription medicine to help treat your fever or pain: |
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Talk to your child’s doctor before switching back and forth between doses of acetaminophen and ibuprofen. When you switch between two medicines, there is a chance your child will get too much medicine. |
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Be sure to follow these safety tips when you use a nonprescription medicine: |
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Alternative medicines or supplementsmay help relieve breast tenderness, discomfort, or pain (mastalgia). Some studies have shown that magnesium reduces mild premenstrual symptoms. As with all alternative medicines and supplements, be sure to follow the directions on the label. Do not exceed the maximum recommended dose. If you are or could be pregnant, talk with your doctor before taking any medicine or supplement. For more information, see the topic Fibrocystic Breasts.
Symptoms to watch for during home treatment
Call your doctor if any of the following occur during home treatment:
- Skin changes, such as dimpling or puckering.
- Nipple discharge.
- Darkening of the area around the nipple.
- A nipple being drawn inward.
- A breast lump in a man.
- Symptoms of an infection develop.
- Symptoms that become more severe or more frequent.
Prevention
To prevent breast tenderness, discomfort, or pain (mastalgia), follow these tips:
- Wear a sports bra during exercise. A sports bra may prevent breast discomfort, pain, and injury during exercise or sports. It is important that the sports bra fit properly. It should keep the breasts almost motionless and allow them to move together with the chest, not separately. Be sure to replace your sports bra as the material stretches and become less supportive. A sports bra may need to be replaced every 6 months if it is used regularly.
- Limit your salt intake. High salt intake may cause fluid retention. Fluid retention may be the cause of premenstrual breast tenderness.
To prevent nipple irritation during exercise:
- Cover your nipple with a small bandage or a dab of petroleum jelly before you exercise.
- Wear a sports bra that fits you properly. Avoid sports bras that are lined with cotton.
- Avoid exercising in cold temperatures.
- Wear a vest or jacket made from fabric that blocks the wind.
Preparing For Your Appointment
To prepare for your appointment, see the topicMaking the Most of Your Appointment.
You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:
- What symptoms do you have?
- How long have you had your symptoms? Do your breast changes occur at the same time each month?
- What is your age and general health?
- Do you have menstrual periods? Are your periods regular?
- Are you pregnant?
- Have you had children? Did you breastfeed? Are you currently breastfeeding?
- Have you had a breast infection (mastitis) or a blocked milk duct in the past?
- What prescription and nonprescription medicines are you taking?
- Have you ever been diagnosed with breast lumps or had any fluid or cysts drained from your breasts?
- Have you ever had a mammogram or breast ultrasound?
- Have you ever been diagnosed with breast cancer?
- Do you have any relatives who have noncancerous (benign) breast lumps or breast cancer?
- Do you have any health risks?
References
Other Works Consulted
- American Cancer Society (2009). Prevention and Early Detection: American Cancer Society Guidelines for the Early Detection of Cancer. Atlanta: American Cancer Society. Available online: http://www.cancer.org/docroot/PED/content/ped_2_3X_ACS_Cancer_Detection_Guidelines_36.asp.
- U.S. Preventive Services Task Force (2009). Screening for breast cancer. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm.
Current as of: June 26, 2019
Author: Healthwise Staff
Medical Review:William H. Blahd Jr. MD, FACEP – Emergency Medicine & Adam Husney MD – Family Medicine & Kathleen Romito MD – Family Medicine
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