What is it about ?
It is common for women to experience pain in one or both breasts. They, or their partner, sometimes feel a small lump or lump in the breast. It can cause anxiety. Fortunately, these are very often mild disorders. The doctor will always start with a clinical examination, namely an observation and palpation of both breasts and neighboring parts of the breasts.
The doctor examines whether the skin is retracted or hardened, whether fluid or blood is leaking from the nipple, etc. He feels the breasts according to a fixed pattern. If he discovers a mass, the doctor assesses its size, shape, hardness and whether it is mobile in relation to the skin covering it. The conclusions that the doctor draws from this examination strongly depend on the phase of the menstrual cycle. Ideally, palpation of the breasts is performed about ten days after menstruation. In addition, the doctor also palpates the armpits and the area above the collarbone. There are in fact the lymph nodes which are closely related to the breasts.
The doctor will then decide, based on the results of this clinical examination, whether further technical examinations are necessary, such as a mammogram and / or an ultrasound.
What benign changes can your doctor see in your breasts?
Normal variations
The two breasts are not always symmetrical. Even a large difference in size can be considered a normal variation. You may also have an extra nipple or extra glandular breast tissue in your armpit. None of these variations require further investigation.
Fibrocystic changes
Fibrocystic changes are breast changes affecting 1 in 4 women of childbearing age, and even up to 1 in 2 postmenopausal women. They are the consequence of changes in the ducts that bring milk to the nipple ( milk ducts), with the formation of fluid-filled cavities (cysts), and a kind of scarring. Characteristic symptoms are tenderness, pain, and swelling one to two weeks before your period. Cysts can be larger or smaller, depending on the time of the cycle. They are generally 1 to 2 cm in diameter but can sometimes reach 2 to 3 cm. Scarring inside a milk duct results in the formation of small hard cords. This scar tissue can degenerate into a malignant alteration, especially in women who have a family history of breast cancer or in the presence of calcifications in the scar tissue.
Adenofibroma or fibroadenoma
It is a small mass of glandular tissue, well defined, smooth and mobile, independent of neighboring structures and not sensitive. Fibroadenomas affect 1 in 10 women, especially young women. It is important to distinguish the fibroadenoma from what is called a ‘phyllodes tumor’, which is rather poorly delineated and shows specific cellular changes on microscopic examination of a biopsy. This type of lesion must be removed by surgery.
Lipoma
A lipoma is a small, soft, painless tumor that is mobile in relation to nearby tissues and is made up of fat cells. Lipomas are very common from the age of 45.
Intracanal papilloma
An intracanal papilloma is an overgrowth of cells in the milk duct, which is accompanied by nipple discharge in 3 out of 4 cases. The papilloma itself is usually not palpable. The presence of multiple papillomas increases the risk of malignant development, which is much less the case with an isolated papilloma.
Fat tissue necrosis
Adipose tissue (or fatty tissue) necrosis is an accumulation of dead fat cells. Since the area of necrosis is often irregular and tender to palpation, as well as hard to the touch and attached to nearby tissues, it may initially suggest a malignant tumor. However, adipose tissue necrosis is benign. It results from surgery, inflammation or trauma.
Painful breasts
This is a common complaint among healthy women. 7 in 10 women suffer from it cyclically, 1 in 4 women suffer from it continuously. Pain is chronic in 1 in 4 women. Painful breasts rarely warrant medical treatment. The most important thing is to be reassured about the benign nature of the complaint. In 1 in 20 cases, the pain comes from the costal cartilage (the cartilage of the ribs).
For every 100 women who have breast cancer, only 5 women only had breast pain as a symptom. Sometimes the pain is only felt in one breast and is present all the time.
What can you do ?
If you are healthy and there has been no breast cancer in your family, you do not need to have a monthly breast self-exam. If, on the other hand, there has been breast cancer in your family or if you have had breast cancer yourself, it may be helpful to regularly examine your breasts by self-examination. If you notice a lump, check the phase of your cycle. If the lump is still palpable 10 days after the start of your period, see your GP. If you notice other abnormalities, such as pain, retracting skin, nipple discharge, or the like, don’t wait and get checked right away.
What can your doctor do?
Any palpable or visible anomaly must be the subject of additional examinations. The examinations offered depend on the type of lesion. First come the imaging exams. This may be an ultrasound, an x-ray (mammogram), or an MRI (magnetic resonance imaging). If the nature of the lesion is not sufficiently clear, a biopsy will be performed.
Want to know more?
- Ultrasound here Where to find on this page of Cliniques St Luc UCL
- Mammography – Foundation against cancer
- MRI, here, Where to find on this page of Cliniques St Luc UCL
- Breast cancer – Foundation against cancer
- Breast cancer screening in Wallonia – CCR – Community Reference Center for cancer screening
- Breast cancer screening in Brussels – Brumammo
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