What Causes Benign Breast Disease
Print PageMastalgia
Mastalgia is diffuse breast pain due to hormonal fluctuations, which predictably affects:
- Newly pregnant women
- Mothers three days after delivery
- Newborn babies
- Birth control pill users
- Menopausal women who take estrogen based hormone replacement therapy (HRT)
- Women with premenstrual syndrome (PMS)
(See www.premenstrual-syndrome.info) - Pubescent boys around age 14 with normal pubertal hypertrophy
Mastalgia is due to breast growth, and produces overall tenderness, rather than pain in a localized area. Mastalgia can occur with all of the following, more serious breast conditions.
Fibrocystic breast disease
Fibrocystic breast disease is liquid-filled cysts caused by an imbalance between the hormones estrogen and progesterone. Cysts can be too tiny to feel, or can be several inches across and easily found with an ultrasound. Near the skin’s surface, fibrocystic breasts feel soft, but the deep tissue feels lumpy or ropey. The cyst can be irregularly shaped. Your doctor may also call it mammary dysplasia, or chronic mastitis, or generalized breast lumpiness. Pain from fibrocystic breast disease is usually a burning sensation localized near the armpit, or around the areola and nipple. The breasts feel heavy and tender, especially during the second half of the menstrual cycle, when excess fluid collects in the breasts. Often fibrocystic breast disease arises upon commencing an estrogen based oral contraceptive or if already present, exacerbated by using the Pill. During pregnancy, when hormones stimulate milk production, women with fibrocystic breast disease often find their condition is aggravated. As women approach middle age, their breasts become lumpier because the milk-producing tissue shrinks and the fat content increases. Fibrocystic breast disease dissipates completely after natural menopause, when breast size decreases. However, if the woman takes a higher dose estrogen replacement therapy, fibrocystic breast disease can worsen.
Mastitis
Mastitis is breast inflammation. In women of childbearing years, mastitis is usually from an infection contracted through improper nursing technique. A baby who cannot latch properly is apt to inadvertently damage the nipple. Milk pools in the lobes. Tiny cracks in the skin allow micro-organisms into the breast. The infection can be bacterial, viral, or fungal (thrush). The breast is hot, hard, red and swollen, often with foul-smelling green or yellow pus leaking from the nipple. Pain is often localized to a specific milk duct in one breast, and is intense or stabbing. Mothers who bottle feed and allow their breasts to become engorged with milk also develop mastitis. Ectasia occurs when the milk ducts shorten and widen as a result of normal ageing. In menopausal women, mastitis is caused by mammary duct ectasia. A lump of scar tissue can sometimes be felt behind the nipple, which eventually can invert the nipple. The milk ducts are clogged, inflamed, and secrete a greenish-grey discharge.
Sclerosing adenosis
These are the growths most commonly found by women during breast self-examination. Your doctor may also call adenosis a fibroadenoma. Fibromas are overgrowths of fibrous connective tissue that support the breast. Adenomas are painless glandular masses from overgrowth of the lobes, which feel like a solid, rubbery ball about 1 to 3 centimeters in diameter. Adenosis is called “breast mouse” because it can be easily moved around. Unlike fibrocystic breast disease, which often has an irregularly shaped cyst, adenosis is smooth and round, with a clear-cut shape. If you develop adenosis, it means you are especially sensitive to the hormone estrogen. Hence, if you are a teenager, using an estrogen based oral contraceptive, pregnant, or breastfeeding, expect your adenosis to enlarge. Rarely does an adenosis grow to 5 cm. Often, adenosis (fibroadenoma) causes greenish nipple discharge.
Fatty necrosis
Obese, middle-aged women who have large, pendulous breasts are prone to develop lipid cysts that calcify and break down over time. Fatty necrosis is literally a calcium soap deposit. Your doctor may also refer to it as steatonecrosis. Unlike the fluid-filled cysts of fibrocystic breast disease, fatty cysts are solid, hard, round, and painless. Their size does not fluctuate with the menstrual cycle. The area usually affected is around the areola (darkly colored ring around the nipple). It may look like a bruise. Fatty necrosis is especially likely to occur in women who have had: A seat belt injury; blunt trauma; breast reduction; radiation therapy; a breast implant removal; lumpectomy; biopsy; hyperactive parathyroid glands; or who use the blood thinner warfarin (Coumadin®, Marevan®).
Galactorrhea
Galactorrhea is an inappropriate, large amount of milk or colostrum (clear or cloudy, slippery pre-milk) leaking from your breasts, when you are neither pregnant nor breastfeeding. Galactorrhea occurs when you produce too much prolactin hormone. Women and men who take prescription medication or over-the-counter herbs can unwittingly induce galactorrhea. Check your medicine cabinet for these likely suspects known to produce galactorrhea as an unwanted side-effect:
| DRUG | FUNCTION |
|---|---|
| Claritin® | Antihistamine |
| Famotidine, ranitidine, cimetidine | Antacids for stomach ulcers |
| Oral birth control pills, Depo-Provera® medroxyprogesterone injections, PremPro® | Contraceptives and hormones |
| Reserpine, Aldomet®, atenolol, verapamil | Control high blood pressure |
| Brewer’s yeast | B vitamin tablets, beer |
| Antidepressants | Fluoxetine, Paroxetine, Sertraline, Citalopram |
| Amphetamines | Street drug and diet aid for appetite suppression |
| Isoniazid | Tuberculosis treatment |
| Cyclobenzaprine (Flexeril®) | Muscle relaxant for injuries |
| Sumatriptan® | Migraine headache treatment |
| Valproic acid (Depokene®, Epilim®) | Anticonvulsant to prevent seizures |
| Phenothiazines, chlorpromazine, prochlorperazine | Psychiatric drugs (sedatives, tranquilizers, antipsychotics and anti-schizophrenics) |
| Fenugreek, anise, fennel, hops, nettles, red clover, red raspberry, and blessed thistle | Galactagogue herbs to increase milk production in new mothers and reduce menopausal symptoms |
Galactorrhea can also result from: A brain injury; irritation of the chest wall (e.g., breast implant, dermatitis, shingles, burns, ill-fitting clothes); a deficient thyroid gland in the neck (hypothyroidism); tuberculosis; swelling of the brain, often from infectious mosquitoes (encephalitis); Cushing syndrome; acromegaly; nerve disorders; Hodgkin’s disease; hydatiform mole; kidney or bronchial cancer; or a tumor in the pituitary gland of the brain. It almost always affects both breasts. Newborn babies often have galactorrhea (witches’ milk) for a couple of weeks after birth, through exposure to their mothers’ hormones, and this resolves spontaneously without medical treatment. Pubescent boys may notice rudimentary breast development and experience mild galactorrhea. Like newborns this is normal and symptoms resolve spontaneously. Galactorrhea can also be idiopathic, meaning it has no known cause.
Noncancerous breast tumors
A tiny amount of blood can occasionally be expelled from the breast with the milk during normal breastfeeding. However, significant bloody discharge from a nipple can indicate an intraductal papilloma is present, which is a benign (noncancerous) tumor in the milk duct that is nevertheless painful. Women near menopause most likely develop one lone papilloma (warty growth) near the nipple of one breast only, which bruises or bleeds when bumped or rubbed even slightly. Young women tend to develop papillomae in both breasts.
A rare form of breast tumor that starts out benign and can develop into cancer subsequently is phyllodes tumor. Your doctor may want to perform a core biopsy in hospital to confirm suspected phyllodes, rather than perform fine needle aspiration cytology (FNAC) in the office. Phyllodes are persistent, so even if your doctor surgically removes the tumor, it can recur. You require a mammogram every two years to detect recurrence early. Your doctor may suggest a mastectomy, or breast removal, followed by breast reconstruction to restore a normal appearance.