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Specialist consultation & Treatment for Breast related problems

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Is a breast lump cause for concern?
Breast lumps, pain or changes are a common cause of worry for women. Breast changes occur with menstrual periods, pregnancy, and aging. Most breast lumps and breast changes are normal. Breast lump, pain, discharge or skin irritation may have a simple or a serious cause and hence a surgeon should be consulted. Many women fear cancer though most breast problems are not cancer and are listed here:

Cyst - fluid-filled sac that feels like a lump
Fibrocystic breast / Fibroadenosis - lumpiness, uneven thickening and swelling of breast, often associated with pain before each menstrual period
Fat necrosis – lump of damaged fat in the breast
Galactocele – milk filled sac that feels like a lump
Abscess – pus collection, usually due to infection in blocked milk ducts
Antibioma – a walled off collection of pus that often feels like cancer
Hematoma – a collection of blood following injury
Lipoma - a collection of fatty tissue.
Mastitis - breast infections. It usually occurs in a lactating mother when bacteria from her skin and baby's mouth enter through a crack in the nipple or through milk duct openings. This leads to pain, swelling and redness of the breast. See Breast and Nipple Self-care for sore nipples and breast infection
Mastalgia - breast pain. See Self-care for breast pain
Accessory breast – extra breast usually in the armpit.
Intraductal papillomas – small bleeding growths inside the nipple presenting with bloody discharge. This can occur in cancer also.
Galactorrhea -- Milk discharge when a woman is not breastfeeding, can be due to side effect of certain drugs, decreased thyroid function, pituitary adenoma( noncancerous tumor under the brain) etc.
Nipple discharge of clear or colored fluid usually due to fibrocystic changes. It can be due to mammary duct ectasia- a swelling of breast ducts not caused by infection or cancer.
Thrombophlebitis breast -- Inflamed blood vessels with blood clots

When is Breast Cancer suspected?
The most common symptom of breast cancer is a painless lump. Sometimes it is painful. Other symptoms of breast cancer include:

A lump or thickening in the breast or armpit that is new or unusual.
A change in the size or shape of the breast.
Skin changes, such as a dimple or pucker in the skin of the breast. A change in the color or feel of the skin of the breast or the darker area around the nipple (areola).
A change in the shape of the nipple – it may turn inwards (inversion), scaling or crusting of the nipple.
Discharge or bleeding from one nipple (not both), that comes out without squeezing the nipple (spontaneous discharge).

How can breast cancer be detected early?
The earlier breast cancer is detected, the more easily and successfully it can be treated. Early detection is possible by a combination of

Breast Self Examination every month, after periods (if regular). It involves checking your breasts for lumps or changes while standing and lying down. Once you know what your breasts normally look and feel like, any new lump or change in appearance of skin, breast, nipple or nipple discharge should be evaluated by a surgeon. Lumps due to fibrocystic changes can make self examination confusing.
Clinical breast examination as part of routine twice a year checkup by a doctor, who carefully feels the breasts and armpits for lumps or other unusual changes.
Mammogram (X-ray of the breast) or Ultrasound scan can often find tumors that are too small for you or your doctor to feel. This is especially needed for those with large breasts, multiple breast lumps or high risk factors.
Genetic tests in those with a family history of breast cancer, to look for BRCA1, BRCA2 gene mutations
Recommendations on frequency of checkup by a doctor & mammography may vary. Men can get breast cancer.

How is a breast lump checked and treated?
Treatment of a breast lump depends on the cause.

Solid breast lumps are tested by FNAC (Fine Needle Aspiration Cytology) to check whether the lump is cancerous or not. If not a cancer, the lump is removed by surgery – called Lumpectomy. The lump is sent for a biopsy to be sure it is not cancer. We usually do this surgery under local anesthesia without having to admit the patient.
Fluid/ milk/ pus/ blood can be drained from Cysts, abscess, hematoma.
Breast infections require antibiotics.
Fibrocystic changes are managed with breast support (snugly fitting sports bra), birth control pills, vitamin E/ evening primrose oil supplements, pain killers, avoiding caffeine and chocolate, limiting fat in the diet and increasing fiber intake.
Breast cancer is treated with a specifically planned combination of surgery, radiation, chemo- and other therapies. At surgery- the entire breast (mastectomy) or part of the breast (partial/segmental mastectomy) is removed to ensure adequate removal of the main (primary) cancer growth. This is followed by radiation- to the chest wall to destroy any minute residual cancer tissue, chemotherapy- drugs to destroy any cancer spread to other parts of the body, and hormonal therapy- hormone blocking drugs to discourage growth of any surviving cancer, Biological/Immune therapy- special new immunologic agents (Trastuzumab, Bevacizumab, Lapatinib) to specifically attack cancer cells in advanced cancer.
Intraductal papillomas are removed by surgery called Microdochectomy
Recommendations on frequency of checkup by a doctor & mammography may vary. Men can get breast cancer.
 
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