Anita Schnapp, M.D., obstetrician/gynecologist
When most of us talk about breast health, we immediately think of breast cancer. But there are other breast diseases which are NOT cancerous or precancerous. First and foremost, I want to be very clear that any breast mass which has you concerned should be evaluated. However, from the time that you notice any masses until the time that you can be seen, hopefully some of the information in this article can help you stay calm and avoid focusing on the worst-case scenario.
One of the early stages of puberty is breast budding; and from that moment on, breast tissue can be a source of anxiety for some women. Normal breast development can vary widely, even among siblings. The process can start as early as 8 years old, but may not begin until a young lady is 15. Sometimes the initial breast buds can feel more like hard knots and can be quite tender. It is very common for one side to begin development before the other, raising concern that the first breast bud actually is something problematic. At this point, watching to see if the other side begins development and confirming that there is no discharge can help to confirm that this is part of normal development.
It also is very normal for one breast to be larger than the other. This often is a cause of concern and self-consciousness in teenagers (and even some adults). You can help your daughter by reassuring her and helping her find the right styles of shirts or bras to minimize the difference.
As teenagers start having more regular periods, many of them will notice breast pain associated with their cycles. Often, breasts become tender the week prior to a period. For some, this is simply due to hormone sensitivities. Other women have something called fibrocystic breast disease. These women have masses in their breasts that often enlarge with periods or with caffeine intake. These lumps tend to be oval-shaped or elongated and move freely under the skin. They range in size from small pebbles to much larger growths and will appear on a mammogram or ultrasound as a benign mass.
Fibroadenomas are another benign breast mass that can cause some concern. Like fibrocystic masses, these can range in size. However, they tend to be more stable in size throughout the month and regardless of any dietary habits. They do not typically cause any pain or tenderness. They are also freely mobile, but are a little harder than fibrocystic changes. These are more difficult to distinguish from concerning masses on a mammogram, so they are often biopsied after an imaging study.
Two conditions which tend to be specific to certain events are mastitis and fat necrosis. Mastitis is an infection of the breast most often, but not exclusively, associated with nursing. It is benign, but can be very painful and lead to significant illness. Women with mastitis usually have fevers, nausea and feel like they have the flu. One area of a breast tends to be red, inflamed, and hot to the touch and has one or more hard knots. Mastitis is treated with antibiotics and sometimes drainage if an abscess forms.
Fat necrosis sounds much more alarming than it is; it is the result of trauma to the breast. The most common example is a seat belt injury from a car accident, but I have seen it after a basketball player took an elbow to the chest or a woman got head-butted by her toddler. The lumps from fat necrosis can last for weeks after the injury and also are very tender. The best remedy for these really is just time and anti-inflammatory medications.
Again, if you have a breast issue that has you worried, please call your physician. I hope this information may give you some reassurance, but remember, it is not a substitute for an exam and a review of your personal and family history.
Dr. Anita Schnapp is an obstetrician/gynecologist on the medical staff at St. Anthony’s.