At the Hunterdon Breast Surgery Center, we treat many conditions that affect the breast. For patients who need surgery to treat their breast conditions, there are a variety of options to best meet their physical and emotional needs. We offer board-certified surgical specialists who work closely with the Hunterdon Women’s Imaging Center and The Jack & Faith Cust Cancer Center.
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Conditions We Treat
Having an abnormal screening mammogram can be worrisome. Fortunately, most women with abnormal mammograms do not have breast cancer. An abnormal mammogram may be due to a mass/density, a collection of calcium deposits (called calcifications), cysts or other benign breast changes. Sometimes, normal breast structures can overlap in a way that can look abnormal even if nothing is really there.
- If you have an abnormal screening mammogram, the next step depends on the type of abnormality found.
- If the abnormality is likely benign, you may be advised to have a follow-up mammogram or ultrasound in six months.
- If the mammogram shows an area that is abnormal, the next step is to have additional imaging, such as a diagnostic mammogram and/or ultrasound. During a diagnostic mammogram, a mammography technician works with a radiologist to study the area that feels or appears abnormal. Different angles can be used, and the picture can be magnified and/or targeted to a particular area of interest. The radiologist will review the mammogram immediately and discuss the results with you. In some cases, an ultrasound may be performed to better define the abnormality.
- In many cases, the diagnostic mammogram shows that the abnormality is benign and no further testing is needed. However, if the diagnostic mammogram is indeterminate or suspicious for cancer, a breast biopsy is recommended.
If the imaging remains indeterminate after diagnostic imaging, the facility will refer you to a breast surgeon for evaluation and possible biopsy. During your consultation, the surgeon will review the images and perform a physical examination. If the surgeon is in agreement with the radiologist’s findings, a biopsy will be scheduled for a later date. The type of biopsy will be determined based on the modality the abnormality was seen with. If the abnormality was seen on mammography, a stereotactic biopsy will be performed, and if the abnormality was seen on ultrasound, an ultrasound-guided biopsy will be performed. These biopsies are performed by one of our breast surgeons using state-of-the-art technology offered at the Hunterdon Breast Surgery Center.
WHAT IS BREAST CANCER?
Breast cancer is an uncontrolled growth of breast cells. To better understand breast cancer, it helps to understand how any cancer can develop. Cancer occurs as a result of mutations, or abnormal changes, in the genes responsible for regulating the growth of cells and keeping them healthy. The genes are in each cell’s nucleus, which acts as the “control room” of each cell. Normally, the cells in our bodies replace themselves through an orderly process of cell growth: healthy new cells take over as old ones die out. But over time, mutations can “turn on” certain genes and “turn off” others in a cell. That changed cell gains the ability to keep dividing without control or order, producing more cells just like it and forming a tumor.
The term “breast cancer” refers to a malignant tumor that has developed from cells in the breast. Usually, breast cancer either begins in the cells of the lobules, which are the milk-producing glands, or the ducts, the passages that drain milk from the lobules to the nipple.
Over time, cancer cells can invade nearby healthy breast tissue and make their way into the underarm lymph nodes, small organs that filter out foreign substances in the body. If cancer cells get into the lymph nodes, they then have a pathway into other parts of the body. The breast cancer’s stage refers to how far the cancer cells have spread beyond the original tumor.
Breast cancer is always caused by a genetic abnormality (a “mistake” in the genetic material). However, only 5-10% of cancers are due to an abnormality inherited from your mother or father. Instead, 85-90% of breast cancers are due to genetic abnormalities that happen as a result of the aging process and the “wear and tear” of life in general.
There are steps every person can take to help the body stay as healthy as possible, such as eating a balanced diet, maintaining a healthy weight, not smoking, limiting alcohol, and exercising. While these may have some impact on your risk of getting breast cancer, they cannot eliminate the risk.
Developing breast cancer is not your or anyone’s fault. Feeling guilty, or telling yourself that breast cancer happened because of something you or anyone else did, is not productive.
STAGES OF BREAST CANCER
The stage of a breast cancer is determined by the cancer’s characteristics, such as how large it is and whether or not it has hormone receptors. The stage of the cancer helps you and your doctor figure out your prognosis (the likely outcome of the disease), as well as decide on the best treatment options for you.
Breast cancer stage is usually expressed as a number on a scale of 0 through IV — with stage 0 describing non-invasive cancers that remain within their original location and stage IV describing invasive cancers that have spread outside the breast to other parts of the body.
You may be familiar with the statistic that says 1 in 8 women will develop invasive breast cancer. Many people misinterpret this to mean that, on any given day, they and the women they know have a 1-in-8 risk of developing the disease. That’s simply not true. In reality, about 1 in 8 women in the United States - or about 12 out of every 100 - can expect to develop breast cancer over the course of an entire lifetime. In the U.S., an average lifetime is about 80 years. So, it’s more accurate to say that 1 in 8 women in the U.S. who reach the age of 80 can expect to develop breast cancer. In each decade of life, the risk of getting breast cancer is actually lower than 12% for most women.
Even though studies have found that women have a 12% lifetime risk of developing breast cancer, your individual risk may be higher or lower than that. Individual risk is affected by many different factors, such as family history, reproductive history, lifestyle, environment, and others.
RISK FACTORS YOU CAN CONTROL
- Weight: Keep your body weight in a healthy range for your height and frame. Body mass index, though not a perfect measurement, can help you estimate your healthy weight.
- Diet:
- Eat plenty of vegetables and fruit (more than 5 cups a day).
- Try to limit your saturated fat intake to less than 10% of your total calories per day and limit your fat intake to about 30 grams per day.
- Eat foods high in omega-3 fatty acids.
- Avoid trans fats, processed meats, and charred or smoked foods.
- Exercise: Evidence is growing that exercise can reduce breast cancer risk. The American Cancer Society recommends engaging in 45-60 minutes of physical exercise 5 or more days a week.
- Alcohol consumption: Studies have shown that breast cancer risk increases with the amount of alcohol a woman drinks. Alcohol can limit your liver’s ability to control blood levels of the hormone estrogen, which in turn can increase risk.
- Smoking: Smoking is associated with a small increase in breast cancer risk.
- Exposure to estrogen:
- Taking combined hormone replacement therapy (estrogen and progesterone; HRT) for several years or more, or taking estrogen alone for more than 10 years.
- Being overweight.
- Regularly drinking alcohol.
- Recent Oral Contraceptive Use: Using oral contraceptives (birth control pills) appears to slightly increase a woman’s risk for breast cancer, but only for a limited period of time. Women who stopped using oral contraceptives more than 10 years ago do not appear to have any increased breast cancer risk.
- Stress and Anxiety
RISK FACTORS YOU CAN’T CONTROL
- Gender: Being a woman is the most significant risk factor for developing breast cancer. Although men can get breast cancer, women’s breast cells are constantly changing and growing, mainly due to the activity of the female hormones estrogen and progesterone. This activity puts them at much greater risk for breast cancer.
- Age: Simply growing older is the second biggest risk factor for breast cancer. From age 30 to 39, the risk is 1 in 228, or .44%. That jumps to 1 in 29, or just under 3.5%, by the time you are in your 60s.
- Family History of Breast Cancer: If you have a first-degree relative (mother, daughter, sister) who has had breast cancer, or you have multiple relatives affected by breast or ovarian cancer (especially before they turned age 50), you could be at higher risk of getting breast cancer.
- Personal History of Breast Cancer: If you have already been diagnosed with breast cancer, your risk of developing it again, either in the same breast or the other breast, is higher than if you never had the disease.
- Race: White women are slightly more likely to develop breast cancer than are African American women. Asian, Hispanic, and Native American women have a lower risk of developing and dying from breast cancer.
- Radiation Therapy to the Chest: Having radiation therapy to the chest area as a child or young adult, as treatment for another cancer, significantly increases breast cancer risk. The increase in risk seems to be highest if the radiation was given while the breasts were still developing (during the teen years).
- Breast Cellular Changes: Unusual changes in breast cells found during a breast biopsy (removal of suspicious tissue for examination under a microscope) can be a risk factor for developing breast cancer. These changes include overgrowth of cells (called hyperplasia) or abnormal (atypical) appearance.
- Exposure to Estrogen: Because the female hormone estrogen stimulates breast cell growth, exposure to estrogen over long periods of time, without any breaks, can increase the risk of breast cancer. Some of these risk factors are not under your control, such as:
- Starting menstruation (monthly periods) at a young age (before age 12).
- Going through menopause (end of monthly cycles) at a late age (after 55).
- Exposure to estrogens in the environment (such as hormones in meat or pesticides such as DDT, which produce estrogen-like substances when broken down by the body).
- Pregnancy and Breastfeeding: Pregnancy and breastfeeding reduce the overall number of menstrual cycles in a woman’s lifetime, and this appears to reduce future breast cancer risk. Women who have never had a full-term pregnancy, or had their first full-term pregnancy after age 30, have an increased risk of breast cancer. For women who do have children, breastfeeding may slightly lower their breast cancer risk, especially if they continue breastfeeding for 1 1/2 to 2 years. For many women, however, breastfeeding for this long is neither possible nor practical.
- DES Exposure: Women who took a medication called diethylstilbestrol (DES), used to prevent miscarriage from the 1940s through the 1960s, have a slightly increased risk of breast cancer. Women whose mothers took DES during pregnancy may have a higher risk of breast cancer as well.
HANDLING YOUR DIAGNOSIS
The actual process of diagnosis can take weeks and involve many different kinds of tests. Waiting for results can feel like a lifetime. The uncertainty stinks. But once you understand your own unique “big picture,” you can make better decisions. You and your doctors can formulate a treatment plan tailored just for you.
Breast cancer can develop in the ducts that carry milk to the nipple, the lobules that produce milk, or the tissue in between. At your diagnosis, your breast surgeon will give you your diagnosis and will also give appropriate websites to research more about the diagnosis that is specific to you.
A pathology report contains the results of tests on the cancer and nearby tissues. It provides information that you and your doctor can use to make the best treatment plan for your particular diagnosis. This will include your receptor status (estrogen, progesterone, and HER2), and possibly your lymph node status based on your previous biopsy.
In recent years, there’s been an explosion of life-saving treatment advances against breast cancer, bringing new hope and excitement. Instead of only one or two options, today there’s an overwhelming menu of treatment choices that fight the complex mix of cells in each individual cancer. The decisions — surgery, then perhaps radiation, hormonal (anti-estrogen) therapy, and/or chemotherapy — can feel overwhelming. But our breast surgeons will help you understand your diagnosis in detail, and your available treatment options – so you can arrive at a treatment plan suited best for you.
TREATMENT
In recent years, there’s been an explosion of life-saving treatment advances for breast cancer, bringing new hope and excitement. Instead of only one or two options, today there’s an overwhelming menu of treatments that fight the complex mix of cells in each individual cancer. The decisions about surgery, radiation, hormonal (anti-estrogen) therapy, and/or chemotherapy can feel overwhelming. Yet our team of highly trained breast surgeons and oncology physicians will help you understand all the available treatment options and find the one that best suits you. All cancer treatment at The Jack & Faith Cust Cancer Center and the Hunterdon Breast Surgery Center is under the guidance of the National Comprehensive Cancer Network (NCCN Guidelines). These guidelines are the recognized standard for clinical policy in cancer care and are the most detailed and most frequently updated clinical practice guidelines available in any area of medicine.
Breast cysts are fluid-filled sacs inside the breast, which are usually benign (not cancer). You can have one or many breast cysts and they can happen in one or both breasts. They are often described as round or oval lumps with distinct edges. A breast cyst usually feels like a grape or a water-filled balloon, but sometimes a breast cyst can feel firm. Breast cysts usually do not require treatment unless a cyst is large, painful and/or uncomfortable. In that case, draining the fluid from a breast cyst, by a breast surgeon, can ease symptoms.
Breast cysts are common in women before menopause, between ages 35 and 50 years old but can be found in women of any age.
Breast cysts may be found in one or both breasts. Signs and symptoms of a breast cyst include:
- A smooth, easily movable round or oval lump with distinct edges
- Nipple discharge that may be clear, yellow, straw-colored or dark brown
- Breast pain or tenderness in the area of the breast lump
- Increase in breast lump size and breast tenderness prior to your period
- Decrease in breast lump size and resolution of other symptoms after your period
Having breast cysts does NOT increase your risk of breast cancer. But having cysts may make it more difficult to find new breast lumps or other changes that might need evaluation by your doctor. Be familiar with how your breasts normally feel, so if you feel any new breast lumps that persist after a menstrual period, or if an existing breast lump grows or changes, see your healthcare provider.
Breast cysts may be defined by their size (microcysts, macrocysts) or by their complexity (simple cysts, complex cysts). If one of the above types of breast cysts is palpated and/or seen on routine breast imaging, no further workup is usually required. If the area is painful and/or uncomfortable, consultation with a breast surgeon for a cyst aspiration will be advised.
A breast infection/mastitis is an infection located in the tissue of the breast and/or milk duct. Breast infections are usually caused by a common bacteria found on normal skin (Staphylococcus aureus). The bacteria enter through a break or crack in the skin, usually the nipple. The infection then takes place in the parenchymal (fatty) tissue and causes swelling of the parenchymal tissue outside the milk ducts. This swelling compresses on the milk ducts, and the result is pain and swelling of the infected breast. Breast infections most commonly occur in women who are breastfeeding. Breast infections that are not related to breastfeeding must be evaluated by a breast surgeon, to differentiate from a rare form of breast cancer.
Some common symptoms of breast infections include:
- breast pain
- breast lump
- breast enlargement on one side only
- swelling, tenderness, redness, and heat in breast tissue
- nipple discharge (may contain pus)
- nipple sensation changes
- itching
- tender and/or enlarged lymph nodes in armpit on the same side
- fever
Once an infection is suspected, evaluation by a healthcare professional is recommended. They will perform a physical exam, and likely will obtain imaging for further evaluation, with a mammogram or breast ultrasound.
Treatment usually includes applying moist heat to the infected breast tissue for 15 to 20 minutes four times a day, as well as antibiotics. If you are breastfeeding, you are encouraged to continue to breastfeed or to pump to alleviate engorgement while receiving treatment. At times an associated abscess may be present. A breast abscess is a painful collection of pus that forms in the breast. Abscesses require more extensive treatment, including incision and drainage. This can be performed by your healthcare provider or a breast surgeon, usually under ultrasound guidance. These are regularly performed by our breast surgeons at the Hunterdon Breast Surgery Center.
A breast lump is a mass that develops in the breast. Breast lumps vary in size and texture and may cause pain. Depending on the type, breast lumps may be large or small and may feel hard or spongy. Some lumps cause pain, while others go unnoticed until identified during an imaging test.
A lump may be discovered by a woman doing breast self-exam or by her healthcare provider during a physical exam. Suspicious lumps may also be detected during annual screening mammography. Although uncommon, breast lumps can occur in men.
It is important to become familiar with how your breasts normally look and feel so that you are able to report any changes to your doctor. Once detected, your doctor will likely perform a physical exam to evaluate a breast lump. To determine whether that lump is benign, your doctor will likely order a mammogram and/or breast ultrasound at one of our Imaging Centers for further evaluation. Most breast lumps are benign (not cancer). Proving that a lump is not cancer often involves imaging tests. One or more of the following imaging tests may be performed:
- Mammogram: Mammography uses low dose x-rays to examine the breasts. Either two single images or two tomosynthesis images (also called 3-D mammography) are taken of each breast to begin the evaluation. Additional images may be needed.
- Breast Ultrasound: Breast ultrasound uses sound waves to create pictures of the inside of the breasts. Breast ultrasound can capture images of areas of the breast that may be difficult to see with mammography. It can also help to determine whether a breast lump is solid or fluid.
If a lump is proven to be benign by its appearance on these exams, no further steps may need to be taken. Your doctor may want to monitor the area at future visits to check if the breast lump has changed, grown or gone away. If these tests do not clearly show that the lump is benign, evaluation by a breast surgeon and a possible biopsy may be necessary. These biopsies are performed by one of our breast surgeons, following a consultation, using state of the line technology offered at the Hunterdon Breast Surgery Center.
Breast pain involves any discomfort or pain in the breast. There are many possible causes of breast pain (ie: premenstrual breast tenderness). The most common cause of breast pain and/or tenderness is due to hormonal fluctuations related to menstruation, pregnancy or menopause. Some degree of swelling and tenderness just before your period is normal. The question is how tolerable (or intolerable) the discomfort is to you.
Although many women with pain in one or both breasts understandably fear breast cancer, breast pain is NOT a common symptom of cancer.
As a normal part of development, adolescent boys can also have some breast swelling and tenderness, because boys and men also have breast tissue. Like breast tenderness in women, this is due to hormonal changes.
Other causes of breast pain exist, and include some of the following:
- Puberty – in both girls and boys
- Breastfeeding, pregnancy or recent childbirth
- Approach of menopause (once menstrual periods have stopped completely, breast pain/tenderness often improves)
- Premenstrual Syndrome (PMS)
- Mastitis: a blocked/infected milk duct, that is usually associated with redness (usually associated with breastfeeding)
- Alcoholism with liver damage
- Injury
- Certain medications (make sure to disclose all medications taken to your health care provider)
Some remedies of controlling breast pain can include taking birth control if the pain is secondary to premenstrual syndrome. If the pain is secondary to breast injury, apply a cold compress for 15-20 minutes at a time, and take a non-steroidal anti-inflammatory drug (i.e Tylenol, ibuprofen, Aleve). If the pain is secondary to an infection you will require antibiotics. Signs of an infection include breast pain and tenderness associated with an area of redness, nipple discharge and/or fever. Schedule an appointment to see your healthcare professional regarding treatment, if you feel you may have a breast infection.
Please call your healthcare professional if you have any of the below symptoms:
- Discharge from your nipples, especially blood or pus
- If you have given birth within the last month and your breasts are swollen and hard
- Signs of a breast infection (redness, pus/discharge, fever)
- Notice a new lump associated with pain that does not improve after your menstrual period
- Persistent, unexplained breast pain
Most of the time breast pain is not a worrisome symptom, but more of a problem with everyday comfort. Prevention of breast pain is usually the best way to improve symptoms. You should wear a well-fitting brassiere for support, especially if your breasts are large. You should also perform a monthly breast self-exam 2-3 days after your period (when the breast tissue is the least tender). This is important to feel for any changes in your breast tissue. If you detect any change from the previous month, it is important to notify your doctor.
Women with close relatives who have been diagnosed with breast cancer have a higher risk of developing the disease. If you’ve had one first-degree female relative (sister, mother, daughter) diagnosed with breast cancer, your risk is doubled. If two first-degree relatives have been diagnosed, your risk is 5 times higher than average. If your brother or father have been diagnosed with breast cancer, your risk is higher.
In some cases, a strong family history of breast cancer is linked to having an abnormal gene associated with a high risk of breast cancer, such as the BRCA1 or BRCA2 gene. In other cases, an abnormal CHEK2 gene may play a role in developing breast cancer.
To find out more about your risk of developing breast cancer, depending on your family history and other associated risk factor, consultation with genetic counselors is recommended. Here at Hunterdon, our Family Risk Assessment Program offers consultation and genetic testing, to determine risk.
There are lifestyle choices you can make to keep your risk of developing breast cancer as low as it can be:
- Maintaining a healthy weight
- Exercising regularly
- Limiting alcohol
- Eating nutritious foods
- Never smoking (or quitting if you already smoke)
Along with these lifestyle choices, there are other risk-reduction options for women with a strong family history of breast cancer.
HORMONAL THERAPY MEDICINES
Four hormonal therapy medicines have been shown to reduce the risk of developing hormone-receptor-positive breast cancer in women at high risk. The SERMs (selective estrogen receptor modulators) Tamoxifen and Evista (chemical name: raloxifene) and the aromatase inhibitors Aromasin (chemical name: exemestane) and Arimidex (chemical name: anastrozole) are the four medicines used in this way.
- Tamoxifen has been shown to reduce the risk of first-time hormone-receptor-positive breast cancer in both postmenopausal and pre-menopausal women at high risk. Certain medicines may interfere with Tamoxifen’s protective effects. Visit the Tamoxifen page to learn more.
- Evista has been shown to reduce the risk of first-time hormone-receptor-positive breast cancer in postmenopausal women. Visit the Evista page to learn more.
- Aromasin has been shown to reduce the risk of first-time hormone-receptor-positive breast cancer in postmenopausal women at high risk. Aromasin isn’t approved by the FDA for this use, but doctors may consider it a good alternative to Tamoxifen or Evista. In 2013, the American Society of Clinical Oncology (ASCO) released new guidelines on using hormonal therapy medicines to reduce breast cancer risk in high-risk women. These guidelines recommend that doctors talk to high-risk postmenopausal women about using Aromasin to reduce risk. ASCO is a national organization of oncologists and other cancer care providers. ASCO guidelines give doctors recommendations for treatments that are supported by much credible research and experience. Visit the Aromasin page for more information.
- Arimidex has been shown to reduce the risk of first-time, hormone-receptor-positive breast cancer in postmenopausal women at high risk. Like Aromasin, Arimidex isn’t approved by the FDA for this use, but doctors may consider it a good alternative to Tamoxifen, Evista, or Aromasin. Visit the Arimidex page for more information.
Together, you and your doctor can decide if medicine to lower your risk is a good option for you.
MORE FREQUENT SCREENING
If you are at high risk because of a strong family history of breast cancer, you and your doctor will develop a screening plan tailored to your unique situation. Recommended screening guidelines include:
- A monthly self-breast examination
- A yearly/biannual breast examination by a healthcare professional
- A mammogram every year starting at 40 years old (or younger if family history of breast cancer at a young age)
- Breast MRI (magnetic resonance imaging) on an annual basis
- Ultrasound
PROTECTIVE SURGERY
Removing one or both healthy breasts and ovaries — called prophylactic surgery (“prophylactic” means “protective”) — are very aggressive, irreversible risk-reduction options that some women choose. Prophylactic breast surgery may be able to reduce a woman’s risk of developing breast cancer by as much as 97%. The surgery removes nearly all of the breast tissue, so there are very few breast cells left behind that could develop into cancer.
Women with an abnormal BRCA1 or BRCA2 gene may reduce their risk of breast cancer by about 50% by having prophylactic ovary removal (oophorectomy) before menopause. Removing the ovaries lowers the risk of breast cancer because the ovaries are the main source of estrogen in a pre-menopausal woman’s body. Removing the ovaries doesn’t reduce the risk of breast cancer in postmenopausal women because fat and muscle tissue are the main producers of estrogen in these women. Prophylactic removal of both ovaries and fallopian tubes reduces the risk of ovarian cancer in women at any age, before or after menopause.
Of course, each woman’s situation is unique. Talk to your doctor about your personal level of risk and how best to manage it. It is important to remember that no procedure — not even removing both healthy breasts and ovaries at a young age — totally eliminates the risk of cancer. There is still a small risk that cancer can develop in the areas where the breasts used to be. Close follow-up is necessary, even after prophylactic surgery.
Prophylactic surgery decisions require a great deal of thought, patience, and discussion with your doctors, genetic counselor, and family over time — together with a tremendous amount of courage. Take the time you need to consider these options and make decisions that feel comfortable to you.
Fibrocystic breast disease, commonly called fibrocystic breasts or fibrocystic change, is a benign (noncancerous) condition in which the breasts feel lumpy. Fibrocystic breasts are NOT harmful or dangerous but may be bothersome or uncomfortable for some women. Many women with fibrocystic breasts will not have any associated symptoms. Although it is not harmful to have fibrocystic breasts, this condition can make the detection of breast cancer more challenging.
Breast tissue changes in response to the hormones made by the ovaries. Fibrocystic breasts have more pronounced changes in response to these hormones. This can result in swelling and tender or painful breast lumps. Symptoms are most common just before or during menstrual periods. In addition to breast lumps caused by cysts and swelling of breast lobules, a lumpy thickening caused by an excess growth of fibrous tissue can also be noted.
Any woman can get fibrocystic breast disease, but it most commonly occurs in women in their 30s to 50s. Birth control pills may reduce your symptoms, and hormone therapy may increase them. Generally, symptoms typically improve or resolve after menopause.
Fibrocystic breast disease does NOT increase the risk of developing breast cancer, but the breast changes can make it more difficult to identify potentially cancerous lumps during breast exams and on mammograms. Annual mammography and regular self-breast examinations are advised. It is important that you become familiar with how your breasts look and feel so that you will know when new changes arise.
If you have fibrocystic breast disease, you may experience the following symptoms:
- Swelling
- Tenderness
- Pain
- Thickening of tissue
- Breast lumps
Swelling or lumps in one breast can occur. Your symptoms will probably be worse right before your period due to hormonal changes, but you may have symptoms throughout the month.
The lumps in fibrocystic breasts tend to fluctuate in size throughout the month and are usually movable. But sometimes if there’s a lot of fibrous tissue, the lumps may be more fixed in one place. You may also experience pain under your arms. Some women have a green or dark brown discharge from their nipples. See your doctor immediately if clear, red, or bloody fluid comes out of your nipple, as this may be a sign of breast cancer.
Your doctor can diagnose fibrocystic breast disease by doing a physical breast exam. Your doctor may also order a mammogram, ultrasound, and/or MRI to get a better look at the changes in your breasts. If your doctor is concerned about the appearance of a cyst or other finding in your breast, they may order a biopsy to see if it is cancerous. This can be performed by a breast surgeon.
Most women who have fibrocystic breast disease do not require invasive treatment. Home treatment is usually sufficient to relieve associated pain and discomfort. Over-the-counter pain relievers can usually effectively relieve any pain and discomfort. You can also try wearing a well-fitting, supportive bra to reduce breast pain and tenderness. Some women find that applying warm or cold compresses relieves their symptoms.
Gynecomastia is the swelling of the breast tissue in boys or men, caused by an imbalance of the hormones estrogen and testosterone. Gynecomastia can affect one or both breasts, sometimes unevenly. Newborns, boys going through puberty and older men may develop gynecomastia as a result of normal changes in hormone levels, though other causes also exist. Generally, gynecomastia is not a serious health condition, but it can be tough to cope with. Men and boys with gynecomastia sometimes experience pain in their breasts.
Signs and symptoms of gynecomastia include:
- Swollen breast gland tissue
- Breast tenderness
See your doctor if you have swelling, a palpable mass, pain, tenderness or nipple discharge in one or both breasts.
Gynecomastia is triggered by a decrease in the amount of the hormone testosterone compared with estrogen. Several things can upset the hormone balance. The hormones, testosterone, and estrogen control the development and maintenance of sex characteristics in both men and women. Testosterone controls male traits, and estrogen controls female traits, including the growth of breasts. Most people think of estrogen as an exclusively female hormone, but men also produce it (normally in small quantities). However, male estrogen levels that are too high or are out of balance with testosterone levels can cause gynecomastia. Gynecomastia during puberty is also seen. Gynecomastia caused by hormone changes during puberty is relatively common. In most cases, the swollen breast tissue will go away without treatment within six months to two years.
A number of medications can cause gynecomastia. These include:
- Anti-androgens used to treat prostate enlargement, prostate cancer, and some other conditions. Examples include flutamide, finasteride (Proscar, Propecia) and spironolactone (Aldactone).
- Anabolic steroids and androgens.
- AIDS medications. Gynecomastia can develop in HIV-positive men who are receiving a treatment regimen called highly active antiretroviral therapy (HAART). Efavirenz (Sustiva) is more commonly associated with gynecomastia than are other HIV medications.
- Anti-anxiety medications, such as diazepam (Valium).
- Antibiotics.
- Ulcer medications, such as cimetidine (Tagamet HB).
- Cancer treatment (chemotherapy).
- Tricyclic antidepressants.
- Heart medications, such as digoxin (Lanoxin) and calcium channel blockers.
- Gastric motility medications, such as metoclopramide (Reglan).
Substances that can cause gynecomastia include:
- Alcohol
- Amphetamines
- Marijuana
- Heroin
- Methadone
Several health conditions can cause gynecomastia by affecting the normal balance of hormones. These include:
- Hypogonadism: Any of the conditions that interfere with normal testosterone production, such as Klinefelter’s syndrome or pituitary insufficiency, can be associated with gynecomastia.
- Aging: Hormone changes that occur with normal aging can cause gynecomastia, especially in men who are overweight.
- Tumors: Some tumors, such as those involving the testes, adrenal glands or pituitary gland, can produce hormones that alter the male-female hormone balance.
- Hyperthyroidism: In this condition, the thyroid gland produces too much of the hormone thyroxine.
- Kidney Failure: About half the people being treated with regular hemodialysis experience gynecomastia due to hormonal changes.
- Liver Failure and Cirrhosis: Hormonal fluctuations related to liver problems as well as medications taken for cirrhosis are associated with gynecomastia.
- Malnutrition and Starvation: When your body is deprived of adequate nutrition, testosterone levels drop, but estrogen levels remain constant, causing a hormonal imbalance. Gynecomastia can also occur once normal nutrition resumes.
Your healthcare professional will ask you questions about your medical and drug history and what health conditions run in your family. The doctor will also do a physical examination that may include careful evaluation of your breast tissue, abdomen, and genitals.
Initial tests to determine the cause of your gynecomastia may include: blood tests, mammograms, computerized tomography (CT) scans, magnetic resonance imaging (MRI) scans, testicular ultrasounds or tissue biopsies.
Your healthcare professional will want to be sure your breast swelling is actually gynecomastia and not another condition. Other conditions that can cause similar symptoms include:
- Fatty Breast Tissue: Some men and boys have chest fat that resembles gynecomastia. This is called false gynecomastia (pseudogynecomastia), and it is not the same as gynecomastia.
- Breast Cancer: This is uncommon in men, but can occur. Enlargement of one breast or the presence of a firm nodule raises the concern for male breast cancer.
- A Breast Abscess (Mastitis): This is an infection of the breast tissue.
Most cases of gynecomastia regress over time without treatment. However, if it is caused by an underlying condition, such as hypogonadism, malnutrition or cirrhosis, that condition may require treatment. If you are taking medications that can cause gynecomastia, your doctor may recommend stopping them or substituting another medication.
In adolescents with no apparent cause of gynecomastia, the doctor may recommend periodic re-evaluations every three to six months to see if the condition improves on its own. Gynecomastia often goes away without treatment in less than two years. However, treatment may be necessary if it does not improve on its own or if it causes significant pain, tenderness or embarrassment.
If you still have significant bothersome breast enlargement despite initial treatment or observation, your doctor may advise consultation with a plastic surgeon. Gynecomastia surgery reduces breast size in men, flattening and enhancing the chest contours. In severe cases of gynecomastia, the weight of excess breast tissue may cause the breasts to sag and stretch the areola (the dark skin surrounding the nipple). In these cases, the position and size of the areola can be surgically improved and excess skin may be reduced.
Plastic surgery to correct gynecomastia is technically called reduction mammoplasty, and unfortunately is generally not covered by medical insurance.
Breast cancer in men is a rare disease. Less than 1% of all breast cancers occur in men. In 2018, about 2,550 men were expected to be diagnosed with the disease. For men, the lifetime risk of being diagnosed with breast cancer is about 1 in 1,000. Although the disease is rare, it has been on the rise over the past few decades, and early detection is key.
Boys and girls, men and women all have breast tissue. The various hormones in girls and women’s bodies stimulate breast tissue to grow into full breasts. Boys and men’s bodies normally don’t make much of the breast-stimulating hormones. As a result, their breast tissue usually stays flat and small. Still, you may have seen boys and men with medium-sized or big breasts. Usually, these breasts are just mounds of fat. But sometimes men can develop real breast gland tissue because they take certain medicines or have abnormal hormone levels.
A number of factors can increase a man’s risk of getting breast cancer:
- Growing Older: This is the biggest factor. Just as is the case for women, risk increases as age increases. The average age of men diagnosed with breast cancer is about 68.
- High Estrogen Levels: Breast cell growth — both normal and abnormal — is stimulated by the presence of estrogen. Men can have high estrogen levels as a result of:
- Taking hormonal medicines.
- Being overweight (which increases the production of estrogen).
- Having been exposed to estrogens in the environment (such as estrogen and other hormones fed to fatten up beef cattle, or the breakdown products of the pesticide DDT, which can mimic the effects of estrogen in the body).
- Being heavy users of alcohol, which can limit the liver’s ability to regulate blood estrogen levels.
- Having liver disease, which usually leads to lower levels of androgens (male hormones) and higher levels of estrogen (female hormones). This increases the risk of developing gynecomastia (breast tissue growth that is non-cancerous) as well as breast cancer.
- Klinefelter Syndrome: Men with Klinefelter syndrome have lower levels of androgens (male hormones) and higher levels of estrogen (female hormones). Therefore, they have a higher risk of developing gynecomastia (breast tissue growth that is non-cancerous) and breast cancer. Klinefelter syndrome is a condition present at birth that affects about 1 in 1,000 men. Normally men have a single X and single Y chromosome. Men with Klinefelter syndrome have more than one X chromosome (sometimes as many as four). Symptoms of Klinefelter syndrome include having longer legs, a higher voice, and a thinner beard than average men; having smaller than normal testicles; and being infertile (unable to produce sperm).
- A Strong Family History of Breast Cancer or Genetic Mutations: Family history can increase the risk of breast cancer in men — particularly if other men in the family have had breast cancer. The risk is also higher if there is a proven breast cancer gene abnormality in the family. Men who inherit abnormal BRCA1 or BRCA2 have an increased risk of male breast cancer. The lifetime risk of developing breast cancer is approximately 1% with the BRCA1 gene mutation and 6% with the BRCA2 gene mutation. Because of this strong association between male breast cancer and an abnormal BRCA2 gene, first-degree relatives (siblings, parents, and children) of a man diagnosed with breast cancer may want to ask their doctors about genetic testing for abnormal breast cancer genes. Still, the majority of male breast cancers happen in men who have no family history of breast cancer and no inherited gene abnormality.
- Radiation Exposure: If a man has been treated with radiation to the chest, such as for lymphoma, he has an increased risk of developing breast cancer.
Some signs and symptoms of male breast cancer include:
- A palpable breast lump
- Nipple pain
- A newly inverted nipple
- Nipple discharge (clear or bloody)
- Sore on the nipple and areola
- Enlarged lymph nodes under the arm
Earlier diagnosis could make a life-saving difference. With more research and more public awareness, men will learn that, just as women, they need to go to their doctor right away if they detect any persistent changes to their breasts.
After an abnormality of the breast is found, tests are performed to see if the problem is cancer. One or all of these tests might be done:
- Mammogram
- Ultrasound
- Nipple discharge examination: If you have nipple discharge, some of the fluid may be collected and examined under a microscope to see if any cancer cells are present.
- Biopsy: A biopsy is necessary to distinguish normal tissue from cancer tissue. If cancer is present, the biopsy also helps your doctors zero in on the size, type, and kind of breast cancer. Biopsies are performed on any kind of abnormality that your doctor can feel or that looks suspicious. Various techniques are used to biopsy tissue, and it’s likely that your surgeon will try to use the least invasive procedure possible while making sure that enough tissue is removed to make a clear diagnosis.
If a cancer diagnosis is made, your doctor might recommend more tests. For example, an MRI can show how much cancer is in the affected breast relative to the normal tissue right under and next to the breast cancer. This information may help the surgeon plan the extent of surgery. Plus, an MRI can help evaluate the other breast. Other tests, such as blood work, chest X-ray, and bone scans, might be done to see if the cancer has spread to other parts of the body.
Most men who have been diagnosed with breast cancer will undergo some form of treatment for the disease. The most favorable course of treatment will depend on a number of factors, including the size and location of the breast tumor, the stage of the cancer, and the results of other laboratory tests. Treatment is similar to female breast cancer and may include a mastectomy (removal of breast tissue), chemotherapy, radiation therapy and/or hormonal therapy.
Nipple discharge refers to any fluid that excretes out of the nipple of the breast. Nipple discharge in women who are not pregnant or breastfeeding may not be abnormal, but it’s wise to have any unexpected nipple discharge evaluated by a doctor. On the other hand, nipple discharge in men under any circumstances could be a problem and needs further evaluation.
One or both breasts may produce a nipple discharge when you squeeze your nipples or breasts. Any nipple discharge may look milky, or it may be clear, yellow, green, brown or bloody. The consistency of nipple discharge can vary — it may be thick and sticky or thin and watery. Nipple discharge that occurs spontaneously and/or is brown or bloody in color, is more concerning and should be evaluated by a healthcare professional.
Nipple discharge is a normal part of breast function during pregnancy or breastfeeding. It also may be associated with menstrual hormone changes and fibrocystic changes. The milky discharge after breastfeeding will normally affect both breasts and can continue for up to two or three years after stopping nursing.
A papilloma is a noncancerous (benign) tumor that can be associated with bloody discharge. It appears spontaneously and involves a single duct. Although the bloody discharge may resolve on its own, this situation requires evaluation with an ultrasound of the area behind the nipple and areola. If the ultrasound shows a lesion within a milk duct, you may need a biopsy to confirm that it’s a papilloma or to exclude cancer.
Often, nipple discharge stems from a benign condition. However, breast cancer is a possibility, especially if:
- You have a lump in your breast
- Only one breast is affected
- The discharge contains blood
- The discharge is spontaneous and persistent
- The discharge affects only a single duct
Possible causes of nipple discharge include:
- Abscesses
- Birth control pills/oral contraceptives
- Breast cancer
- Ductal carcinoma in situ (DCIS)
- Endocrine disorders
- Excessive breast stimulation
- Fibrocystic disease of the breast
- Injury/trauma to the breast
- Intraductal papilloma
- Mammary duct ectasia
- Mastitis
- Medication usage
- Menstrual cycle/hormonal changes
- Paget’s disease of the breast
- Pregnancy and breastfeeding
- Prolactinoma
Nipple discharge is rarely a sign of breast cancer, but it might be a sign of an underlying condition that requires treatment. If you are experiencing bloody nipple discharge, spontaneous nipple discharge, or continuing nipple discharge that has not resolved, see your healthcare provider for further evaluation. They will perform a physical examination, possibly culture the discharge fluid and will likely order additional testing like a mammogram and/or ultrasound. Following imaging, they might refer you to a breast surgeon for evaluation and/or biopsy.
In the meantime, avoid nipple stimulation, including frequent checks for discharge, because stimulation can cause continued discharge.