Everything that can go wrong with your boobs (that isn't breast cancer)

Our greatest love-hate relationship is probably with our sports bras. There’s no running *scratch that* even jogging without a sports bra on if you’re anything over a B cup. But the process of getting into one, then getting our limbs and hair tangled up in death knots when taking it off, is a daily battle.

Breasts are ever-changing dynamic beings. They can be moody, swell up and simmer down. They go through a lot, from growth spurts at puberty to being mauled by your little ones.

We stuff them into daily restraints, dribble food crumbs onto them, hide them under dupattas and, let’s be real, sometimes let them swing free, just for fun too. Yet, growing up, we don’t learn much about our fun bags when it comes to their health and well-being (we’ve got a helpful guide to get you started). Panic sets in when a casual wash and rinse comes to halt when our hands brush past a lump.

With the conversation about self-checks and routine mammograms during breast cancer awareness month, we’re more knowledgeable now about what is and isn’t normal. It could be a lump or just a lumpy boob. As obstetrician-gynaecologist Rukhsana Hashim says, there’s no part of the body which has 100% symmetry. “Breasts are no different. One can be slightly turned out and the other, more round. They’re rarely identical. Not all lumps are the same either. Breast cancer accounts for 14% of cancers in Indian women. In a lot of the cases, lumps are benign and a different breast disease altogether.”

“When it comes to breast disease, anything irregular is felt and people’s minds automatically jump to cancer. Given the structure of the breast, there are several overlapping symptoms. But breast disease isn’t spoken about and can be common especially if it runs in your family,” says Dr Navin Bhatt, an oncological gynaecologist and breast surgeon.

Given the sexualised nature of breasts, talking about them, or even seeking help feels awkward for some, adds Hashim. 

With their help, we’ve created a helpful breakdown of what could possibly go wrong with your breasts and what to look out for when it comes to breast disease. Let our boob bingo cards do the talking for you the next time you visit the doctor. 

An itch you can’t stop scratching

The corner of a pillar, a door, a partner, a long wooden cooking spoon, even a specialised scratcher, there’s nothing we won’t use to get to an itch we can’t reach. But what about breasts?

We’re all familiar with that underboob itch after a long, hot and sweaty day out. But itchy breasts or nipples can be a real pain, embarrassing even. Because our first thought is that of poor hygiene.

Bhatt says when an insatiable itch is paired with a rash, you might be dealing with atopic dermatitis or eczema, and skin irritation like contact dermatitis set off by an external trigger like an ingredient in a soap or clothes detergent.

“Eczema’s caused by a combination of genetics, external triggers, immune system activation, and stress. It can be triggered by allergens and irritants and cause skin inflammation and itching. If you have sensitive skin, it’s possible your breast and nipple skin is also sensitive. It may have nothing to do with hygiene, so there’s nothing to be embarrassed about,” says Bhatt. Your skin texture may change in appearance, feel tender to the touch and there’s also a possibility of developing sores. Eczema can be difficult to manage because there are factors like genetics which can’t be controlled. With a doctor’s guidance, you can create a treatment plan using cortisone ointments and creams to keep your skin moisturised, mild soap and antihistamines for severe itching.

Breastfeeding women are highly prone to yeast infections on the nipples, or nipple thrush. “The skin can become cracked or damaged during breastfeeding, allowing the candida fungus that causes thrush to get under the skin,” says Hashim. It can cause soreness, itching, and flakey and dry skin that’s redder than usual. Hashim says you should also check your baby’s mouth for signs of oral thrush that may have been transmitted between mother and child. A few days of antifungal medication can clear it up.

Leaky nipples, even when you’re not breastfeeding

Speak to anyone who has given birth and they’ll tell you about the number of shirts and blouses that have been ruined by leaking breast milk. But what about when you’re not breastfeeding? Or have never had kids, for that matter.

Leaking nipples, which can be bloody or clear discharge, are a symptom of breast disease, namely in the milk duct, says Bhatt. Intraductal papillomas are benign tumours that make themselves comfortable inside the milk duct. Made up of fibrous tissue, blood vessels and gland tissue, it most commonly occurs in women aged 30 years to 50 years. These tumours are usually less than 1 centimetre in growth but, if not removed through minor surgery, can be painful and grow up to 5-7 centimetres in size.

Duct ectasia is another breast disease where inflammation within the wall of the milk duct makes it widen and thicken, causing the nipple to enlarge. The inflammation can cause a block in the milk duct and lead to an infection. Though, in most cases of breast disease that occurs in post-menopausal women, there are no painful symptoms, according to Bhatt. “For a lot of women, it is a normal part of ageing and doesn’t require treatment unless there is pain or infection. Rarely, surgical intervention would be required.”

Galactorrhea sounds like a villain from Star Trek but it’s actually milk or milky discharge unrelated to breastfeeding that itself isn’t a breast disease but a symptom of other underlying conditions. Namely a tumour in one of the hormone glands — thyroid or pituitary.

The tumour leads to hormone dysfunction, causing the hormone prolactin (which is responsible for milk production post-childbirth) to go into overdrive. This can make you lactate which is why milk or a milk discharge may leak from your nipples. Galactorrhea can also be indicative of chronic kidney disease, injury to the spinal cord, medications such as birth control, antidepressants and blood pressure medication, and overstimulation of the breasts (through self-exams, sexual activity or ill-fitting clothing).

“It’s completely treatable with medication to lower prolactin levels (if that indeed is the cause), a change in lifestyle and other medication and attention to other ailments you may be facing,” says Hashim, adding that while it can be embarrassing to seek help for it, it’s important it’s addressed so the underlying health condition can be treated.

When a lump is not the lump

The experts concur that women aged 20 and above should come to terms with the fact that their breasts will always feel slightly uneven. Like eyebrows, the two are never the same. And a lumpy boob isn’t exactly abnormal, it’s about trying to figure out what is normal for you.

“Breast disease is primarily caused by tumours or cysts which give the feeling of ‘lumpiness’ to the breast,” says Hashim. Tumours are an unusual solid clump of tissue growth whereas cysts, she explains, are like small sacs filled with fluid, air and other biomaterials.

Fibrocystic breast change is a common and benign build-up of fluid-filled cysts and scar-like fibrous tissue that can make breasts feel bumpy and lumpy. It’s believed that everyone who undergoes fibrocystic changes during their menstrual cycle is usually symptomless, but for some, it can get painful and require medical intervention. It can also lead to fibroadenomas, usually painless but slow-growing masses. “The benign tumours are made of connective tissue and glandular tissue and don’t need treatment. Most don’t increase your risk of breast cancer but may require removal if the rate of growth is very high,” says Bhatt.

Fat necrosis and oil cysts can also make your breasts feel uneven and are caused by damage to the fatty breast tissue. In fat necrosis, the body replaces the breast tissue with hard scar tissue. When the cells don’t turn into scar tissue but instead die and release their contents into the rest of the organ, it is referred to as oil cysts. Both can present themselves as a lump that can be felt through the skin and the nipples. Few cases require treatment or surgical intervention if there is pain and swelling that does not subside.

On the other hand, phyllodes tumours do require treatment in the form of a lumpectomy or in some rare cases, a mastectomy as they can be reoccurring. This tumour grows in the connective tissue of the breasts, containing glandular and connective tissue. Women over the age of 40 are at higher risk of developing this rare breast disease, though it can be malignant.

Swollen and painful, and not in a PMS way

We’re accustomed to the monthly red wave that makes it feel like we just jumped up 3 cup sizes at supersonic speed. But hormonal changes during menstruation, childbirth and perimenopause/menopause that makes our breasts tender to touch are considered cyclical breast pain, according to experts. 

Breastfeeding women can pick up an infection if their nipple skin is broken, or more commonly from clogged milk ducts. There might be nipple discharge and redness, and a course of expert-supervised antibiotics should clear it up. 

Fibrocystic breast changes can also make you swell up with pain as can certain medications such as ones for congestive heart failure, thorazine for mental health disorders, potassium-sparing diuretics, such as eplerenone or spironolactone, methyldopa for high blood pressure and mediation to treat low red blood count. Hashim warns that you shouldn’t alter your medication dose without consulting your healthcare provider first.

A pulling-burning sensation sans muscle pull

Have you ever felt like you’ve pulled a muscle in your breast? It could be right after doing some pretty heavy lifting at the gym or picking up your screaming toddler who doesn’t understand that they’re too big to be carried now. But costochondritis can feel like a muscle pull with or without any physical activity.

Our ribs and the breast bone are connected by the costal cartilage. Costochondritis is inflammation of this cartilage and causes sharp chest pain and a burning sensation. The pain will be at its worst during physical activity, sneezing and coughing. It can even be triggered by wearing a seat belt and deep breathing. “Applying a hot compress to the area can help get some relief paired with some anti-inflammatory medication. Extreme cases can require corticosteroid injections and transcutaneous electrical nerve stimulation (TENS) for pain management,” says Bhatt.

Like breast cancer, breast disease may largely affect women, but men aren’t immune. Healthy breasts require a balanced diet, sustained daily physical movement and exercise as we get older, routine self-checks, mammograms and doctor’s visits at any sign of discomfort that lasts longer than five days, according to Hashim.

“We also need to start talking about our health with our family. Parents sometimes avoid sharing health conditions and family medical histories with their children because they don’t want them to worry. But it’s important to discuss what is and isn’t in the family to know what we should be on the lookout for. It’s not about getting paranoid or ‘overreacting’, but about awareness and genetic inclinations,” says Bhatt.

He has seen far too many patients come in too late or not be able to preventative measures because they weren’t aware of their genetic history. Good health, physical and mental, is fostered through open dialogue, not via whispers of the word ‘breast’ or ‘vagina’.

A note of caution: This story is for educational purposes and contains inputs from experts and personal experiences. Please consult your healthcare provider for a treatment plan that works for you.