BREAST IMPLANT
DISORDERS OF THE BREAST
Disorders of the breast are mostly minor
and respond to treatment. Problems are
most commonly caused by infection,
hormonal changes, and tumours.
Infection
Mastitis
(bacterial infection of breast
tissue) often occurs with breast-feeding,
usually due to a blocked milk duct.
Untreated, it may lead to a
breast abscess.
Hormonal changes
Breast pain and tenderness is common
just before menstruation or when a
woman is taking hormones. Before
menstruation, breasts may increase in
size and become lumpy. Such lumps
shrink when menstruation is over.
Hormonal disorders may, rarely, cause
galactorrhoea
(abnormal production of
milk). In men,
gynaecomastia
(abnormal
breast development) may occur as a
result of hormonal disturbance or
treatment with certain drugs.
Tumours
The majority of
breast lumps
are non-
cancerous tumours, such as
cysts
(fluid-
filled sacs) and
fibroadenomas
(thickened
areas of milk-producing tissue). More
rarely,
breast cancer
may occur.
INVESTIGATION
Disorders o f the breast may be
discovered during
breast self-
examination
or physical examination
by a doctor. Special investigations for
the breast include
biopsy
(removal of
a small sample o f tissue for analysis)
and
mammography.
Breast cancer in women under the age
of 50 may be linked to genetic factors
and various genes, including
BRCA
1 and
BRCA
2 ,
have been identified. These
genes seem to account for some of the
breast cancers that occur within fami-
lies. Women with one or more relatives
who have developed the disease in their
30s or 40s may wish to seek specialist
genetic advice.
SYMPTOMS AND SIGNS
The first sign of breast cancer is often a
painless lump. However, it is important
to note that nine out of ten breast
lumps are not cancerous. Other symp-
toms of breast cancer may include a
dark discharge from the nipple, retrac-
tion (indentation) of the nipple, and an
area of dimpled, creased skin over the
lump. In the majority of cases, only one
breast is affected.
An abnormality may sometimes be
detected during a routine
mammography,
which is offered every three years to all
women between the ages of 5 0 and 65.
INVESTIGATION AND TREATMENT
If a lump is detected in the breast, an
imaging procedure, such as mammog-
raphy or
ultrasound scanning,
will be
carried out. Cells will then be collected
from
the lump
by needle
aspiration
(withdrawal by suction) or
biopsy
(sur-
gical removal of a small sample of tissue
for analysis).
A small cancerous tumour that is not
thought to have spread outside the
breast is removed surgically, along with
a surrounding margin of normal tissue.
Lymph nodes
in the armpit are usually
removed at the same time. Larger can-
cers may require
mastectomy
(surgical
removal of the whole breast). Surgery
can be combined with or followed by
mammoplasty
(breast reconstruction) to
help reduce the psychosexual impact of
the disease.
Any further treatment depends on the
size of the tumour; whether or not
there is evidence of spread to the lymph
nodes; and the sensitivity of the tumour
cells to hormones, which is assessed
in the laboratory using a technique
known as oestrogen receptor testing.
The woman’s age and whether or not
she has gone through the menopause
are also significant factors in determin-
ing appropriate treatment.
After surgery, most women have a
course of
radiotherapy
to any remaining
breast tissue and to the armpit, and/or
chemotherapy
(treatment with
anticancer
drugs). Tamoxifen,
an oral anti-oestrogen
drug, is commonly prescribed for five
years following surgery for breast can-
cer to reduce the risk of recurrence.
Women who are approaching the meno-
pause may be offered treatment to bring
on an early menopause if the tumour is
oestrogen-sensitive.
Secondary tumours in other parts of
the body, which may be present at the
time of the initial diagnosis or may
develop years after apparently successful
treatment, are treated with anticancer
drugs and hormones.
OUTLOOK
A complete cure or years of good health
can usually be expected after treatment
for early breast cancer. Regular check-
ups are required to detect recurrence or
the development of a new cancer in the
other breast. Mammograms should be
performed periodically for this reason.
If the cancer recurs, it can be con-
trolled, sometimes for years, by drugs
and/or radiotherapy
(See also
breast
self-examination.)
breast cyst
A fluid-filled lump that forms within
the milk-producing tissue of the breast.
Breast
cysts
most
commonly
affect
women in their 3 0s and 40s, especially
in the years leading up to the
meno-
pause
. A lump can be diagnosed as a cyst
by
ultrasound scanning,
a
mammography,
or by withdrawing fluid from it with a
syringe
and needle
(see
aspiration),
which usually results in the lump disap-
pearing. About half of all women with a
breast cyst will develop future cysts. Any
new breast lump should be seen by a
doctor to confirm the diagnosis.
breast enlargement surgery
A type of
mammoplasty
.
breast-feeding
The natural method of infant feeding
during the period between birth and
weaning.
Human
milk
contains
the
ideal balance of nutrients for a baby and
provides valuable
antibodies
(proteins
made by the immune system) against
infections. For the first few days after
birth, the breasts produce a watery fluid
known as
colostrum.
Milk flow is stimu-
lated by the baby’s sucking and is
usually established in three to four days.
Breast-feeding problems may occur
as a result of engorged breasts and
cracked nipples or if the baby has prob-
lems sucking; a breast-feeding advisor
may be able to help with these difficul-
ties. Breast-feeding can sometimes cause
an infection (see
mastitis)
that leads to a
breast abscess.
In such cases, treatment
with
antibiotic drugs
may mean that it is
possible to continue breast-feeding.
breast implant
An artificial structure surgically intro-
duced into the breast to increase its size
(see
mammoplasty).
B
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