How Is Benign Breast Disease Treated?
Print PageFirst Aid for Mastalgia
Hormone-related breast pain occurs in the second half of the menstrual cycle and resolves without treatment when the menstrual period is over. If it is particularly acute:
- Take acetaminophen (Tylenol®, paracetamol) or an NSAID
- (aspirin, Motrin®). Never use aspirin (acetylsalicylic acid or ASA®) for a child under 19 who has a fever of viral origin. Children can develop Reyes syndrome, a rare but deadly form of brain and liver damage, from aspirin exposure.
- Apply cold compresses. Place ice in a plastic bag and wrap it in a towel. Never allow ice to rest directly on the breast, because frostbite can occur. Hold the cold compress gently over the breast for a maximum of 20 minutes. Allow the breast at least 20 minutes to recover from the chilling.
- Avoid caffeine
- Take evening primrose oil and Vitamin E
See your doctor if the breast swelling does not resolve in two weeks, or if it recurs again next menstrual cycle.
Most cases of gynecomastia in children do not require treatment. Your doctor will probably adopt a “watchful waiting” approach for one or two years, in the hope that the child’s hormones will settle without intervention.
Fibrocystic breast disease
Prevention
Ovulation occurs about Day 14 of your menstrual cycle. Applying 20 to 32 mg of natural progesterone cream to your breasts daily from Day 14 to Day 26 of your cycle restores normal breast tissue in three or four months of continued cyclical use. A small maintenance dose is adequate once the breasts are no longer cystic. Supplement your diet daily with 400 to 600 mg of natural Vitamin E, 350 mg of magnesium, and a balanced B complex vitamin tablet. Do not consume high doses of Vitamin B6 alone, as it can cause irreversible nerve damage. Reduce your fat intake to 15% of your total diet and you may experience an improvement over time. A 500 mg daily omega-3 supplement (fish or flax oil) may help. Visit a qualified bra fitter, and buy two supportive bras to protect your sore breasts in the latter half of your cycle.
Intervention
Most fluid-filled cysts resolve spontaneously without any medical intervention by the end of the menstrual period. However, if your cyst does not drain by itself, or is causing you pain, then the first line treatment is to drain the fluid with a syringe. Cysts will most likely recur with the next menstrual cycle. A surgical biopsy could remove a persistent cyst, but leaves a scar. Remember, this is a disease of your childbearing years.
Your symptoms will likely disappear when you enter menopause.
If after three months of natural progesterone cream treatment your fibrocystic breast disease continues to cause you severe pain, then your doctor may offer you either tamoxifen, a drug that prevents breast cancer, or danazol, a synthetic male hormone. These two drugs change the way the female hormones estrogen and progesterone work on breast tissue. However, long-term tamoxifen use can cause uterine cancer, and danazol will put you in an artificial menopause.
Mastitis
Apply warm compresses to encourage milk and discharge to flow out of the breast. Postpartum mastitis is a medical emergency, so see a doctor or nurse practitioner within 8 hours. Do not stop breastfeeding; if your milk is green, express it with a pump. Infected postpartum mastitis and mammary duct ectasia both require prescription antimicrobials. Your doctor takes a swab for the microbiology lab determine if your infection is bacterial, fungal, or viral. If the drainage from your ectasia is not infected, then you do not require treatment, and will likely be told to accept it as a normal part of ageing. If an abscess forms, your doctor must lance and drain it. If the ducts remain clogged, then your doctor can perform a microdochectomy to remove only the affected ducts, or Hadfield’s procedure to remove all major milk ducts. Both types of duct removal require general anesthetic and an overnight hospital stay. If you are past childbearing, your doctor may prefer a Hadfield’s procedure to prevent a recurrence. Either procedure leaves you with diminished nipple sensation. The scar will be partially hidden by your dark areola.
Sclerosing adenosis
Your doctor measures your adenoma. If it is less than 3 cm in diameter, your doctor performs a fine needle biopsy and sends the drainage to a cytologist for expert examination. Your doctor may suction out small adenomas completely with a mammotone, but will need the help of a radiologist to image the site. If your adenoma is more than 3 cm in diameter and you want it removed, then your doctor must use a scalpel. You will have a small scar that fades over time.
Fatty necrosis
Cysts can be filled with solid lipids (fats and oils) instead of liquid. If you are young, your breast tissue may be too dense for a radiographer to find necrosis with a mammogram; you may require an ultrasound, instead.
Most often, fatty necrosis resolves by itself and does not require treatment. However, if the lump persists or enlarges, you do require aspiration. If you opt for a local anesthetic, then you can be treated as a day patient. If you opt for general anesthetic (unconsciousness), then you must stay in hospital overnight. The doctor inserts a fine needle into the cyst and tries to drain it. If the doctor cannot drain the cyst because it has solidified, he or she will send the cells in the needle to a pathologist for expert examination. The doctor may remove the necrosis with a scalpel, in which case you will have a few stitches. Your nurse demonstrates how to care for them afterwards.
Galactorrhea
Some women start lactating in their second trimester of pregnancy (Week 13 to Week 27) and continue to produce milk for two years after they cease breast feeding. See a qualified bra-fitter and replace your ill-fitting bras and clothing so that your nipples do not receive irritating stimulation. If you are taking body-building hormones, herbs, or prescription medication that causes you to leak milk, the obvious solution is to stop using the offending chemical and consult your pharmacist to find a safe alternative. Your doctor orders a urine test to rule out pregnancy (or cancer of the testicles, if you are a male with gynecomastia- also see www.understandinggynecomastia.com). You also require blood tests for the pituitary, thyroid, adrenals, kidneys and ovaries at the lab as a standard precaution. If your lab results are normal, the doctor orders a CT or MRI brain scan to rule out a brain tumor.
Treatment depends on whether or not you wish to conceive, and if you experience visual loss. You may be offered bromocriptine, pergolide, caberlogine, or brain surgery. It may take up to two years for your prolactin hormone to normalize, and you require regular blood tests during that time.
Noncancerous breast tumors
Since bloody nipple discharge is a sign of both noncancerous breast tumors and breast cancer, you need a mammogram and breast biopsy to differentiate between the two. Calcifications in your breast, often from irritation by an implant, can foreshadow cancer and are only detectable by mammogram or ultrasound if you are younger than 35 and have dense breasts. If you have a papilloma and the bleeding and constant bruising are bothersome to you, a surgeon can remove the duct containing the papilloma, and still preserve the cosmetic appeal of your breast.