Introduction
Breast changes are common even though the vast majority are benign, they can be worrisome. This booklet is designed to help you with these concerns. It will help you to be aware of your breasts and explain the various types of breast changes that women experience.

Each breast has 1 5 to 20 sections called LOBES each with many smaller LOBULES. Lobes and Lobules are linked by thin tubes called DUCTS. These ducts lead to the NIPPLE, which is centered in a dark area of the skin called the AREOLA. The spaces between the lobules and lobes are filled with fat. There are no muscles in the breast but muscles lie under each breast and cover the ribs. These normal features can sometimes make the breasts feel lumpy especially in women who are thin or who have small breasts.

In addition, from the time a girl begins to menstruate her breasts undergo regular changes each month. Many doctors believe that nearly all breasts develop some lasting changes, beginning when the woman is about 30 years old. Eventually, about half of all women will experience symptoms such as lumps, pain or nipple discharge. Generally these disappear with the menopause.

Some studies show that the chances of developing benign breast changes are higher for a woman who has never had children, has irregular menstrual cycles, or has a family history of breast cancer. Benign breast conditions generally involve the glandular tissue of the breast and is usually more of a problem for the women of child bearing age, who have more glandular breasts.

Types of Benign Breast Changes Common benign breast changes fall into several broad categories. These include generalised breast changes, solitary lumps, nipple discharges and infections and/or inflammation.

Generalised breast lumpiness
Generalised breast lumpiness is known by several names including fibrocystic changes and benign breast disease. Such lumpiness, which is sometimes described as "glandular", "nodular" or "ropy" can often be felt in the area around the nipple and areola and in the upper outer part of the breast. Lumpiness such as this may become more obvious as the woman approaches middle age and the milk-producing glandular tissue of her breasts increasingly gives way to soft fatty tissue. Unless she is taking hormone replacement therapy, this type of lumpiness generally disappears for good after menopause.

Menstral Cycle
During the Menstral Cycle many women experience swelling, tenderness and pain before and sometimes during their periods. At the same time, one or more lumps or a feeling of increased lumpiness may develop, because of the extra fluid collecting in the breast tissue. These lumps normally go away by the end of the period.

Pregnancy
During Pregnancy your breasts may feel lumpier than usual as the milk producing glands become swollen. Benign Breast Conditions also include several types of distinct solitary lumps. Such lumps which can appear at any time, may be large or small, soft or rubbery, fluid-filled or solid.

Cysts
Cysts are fluid-filled sacs. They occur most often in women 35 to 50 years of age. They often enlarge and become tender and painful just before the menstrual period. They can be found in both breasts. Some cysts are so small they cannot be felt. They show up clearly on ultrasound and are usually treated by fine needle aspiration.

Fibradenomas
Fibradenomas are solid and round benign lumps that are made up to both the structural and glandular tissues. Usually these lumps are painless. They feel rubbery and easily can be moved around. They are most often seen in women in their late teens and early twenties. They can enlarge with pregnancy and breast feeding.

Fat Necrosis
Fat Necrosis is the name given to painless, round, and firm lumps formed by damaged and disintegrating fatty tissue. It develops in response to a bruise or a blow to the breast, even though women may not remember the specific injury. Sometimes the skin around the lump looks red and bruised.

Some benign breast conditions produce a discharge from the nipple since the breast is a gland, secretion from the nipple of a mature woman are not unusual e.g. small amounts of discharge may occur in women taking birth control pills or certain other medications, including sedatives and tranquillisers. If the discharge is being caused by a disease it is more likely to be benign than cancerous.

Nipple Discharge come in a variety of colour and textures.
Nipple discharge is not very common and only rarely means there is a serious disease. The type of discharge often gives a clue to its cause. One if the most common reasons of a bloody or sticky discharge is an intraductal papilloma, a small "wartlike" growth that projects into breast ducts near the nipple, any slight bump in the area of the nipple can cause the papilloma to bleed. Single intraductal papillomas usually affect women nearing menopause. If the discharge becomes bothersome, the diseased duct can be removed surgically, without damaging the appearance of the breast.

Many women who have children continue to have a slight milky discharge from both sides which may continue for months after stopping breast feeding.

Any discharge which is yellowish and sticky, blood stained or watery should be reported to your doctor.

Some benign breast conditions are characterised by infections and or inflammation.

Mastitis Mastitis sometimes called "Postpartum Mastitis" is an infection most often seen in women who are breast feeding. A duct may become blocked allowing milk to pool causing inflammation and setting the stage for infection by bacteria. The breast appears red and feels warm, tender and lumpy. In its earlier stages, mastitis can be cured by antibiotics, if a pus containing abscess forms, it will need to be drained or surgically removed.

Mammary Duct Ectasia
Mammary duct ectasia where the ducts become inflamed and can become clogged mammary duct ectasia can be painful, and it can produce a thick and sticky discharge that is grey to green in colour. Treatment consists of warm compresses, antibiotics, and if necessary surgery to remove the duct.

Inverted Nipples
Inverted Nipples are quite common, the nipple lying flat on the breast rather that protruding from it. If it has always been like this there is nothing to worry about, however, if a nipple which normally stands out from the breast appears to flatten and become drawn in rather than out, this might indicate disease in the breast and you should seek your doctors advice.

Most Breast Lumps are not cancerous - Nine out of Ten Breast Lumps are benign or non-cancerous

Breast Cancer
Breast Cancer is uncommon under the age of 35 and very rare under 25. From around 40, it does get more common. Women are encouraged to have regular mammograms between the ages of 50 and 64 . You are well-advised to be aware of your Breasts if there is any cause for concern you should see your GP sooner rather than later either for reassurance that there is nothing seriously wrong, or to get prompt treatment.

MAMMOGRAM is the x-ray examination of the breasts
The radiographer usually takes a minimum of two images of each breast.

• Image one is taken from above
• Image two is taken at 5 degrees to the first image
• Further images of modification on the standard images may be required.

Each image requires the breast to be compressed between two plastic surfaces. The degree of discomfort experiences by patients varies greatly. You should try to tolerate the optimal compression.

This Compression

• Reduces Radiation
• Separates Overlapping Tissues
• Can make the difference between finding or missing a breast cancer

When the radiographer examination is complete the films will be examined by the radiographer and if satisfactory, shown to the radiologist (Specialists Doctor who reads the mammogram). The results will usually be forwarded to the referring doctor.

Ultrasound Examination is a technique whereby high frequency sound waves to high to be heard by the human ear are passed though the body. Distortions in the waves, caused by their passage through the tissues are picked up by special recording equipment and converted into untrasound scan. In younger women with denser breast tissue untrasound scans give a cleared picture than mammograms. Jelly is rubbed over the breast and the ultrasound transmitter is rolled over it. A radiologist watches on the screen and takes permanent pictures as required. Other than being cold and sticky, it is a painless procedure.

Fine Needle Aspiration (FNA)
The doctor may need to remove cells from a lump or lumpy area in the breast using a fine needle and hypodermic syringe and have the cells examined under the microscope. It is called fine needle aspirate because the cells are sucked up into a syringe. Having an FNA may be quite painless or very uncomfortable depending on whether your breast is tender or not.

Biopsy
The surgeon/doctor often may need to remove your lump or a portion of your lump to make certain of the diagnosis. There are two main ways of getting a sample of your lump to examine under the microscope:

• A small core of tissue can be removed under local anaesthetic using a hollow needle. This is called a tru cut biopsy, or core biopsy.
• The surgeon may decide to remove the whole lump, this is called an excision biopsy, it normally takes a few days for the result to come through:

Breast Awareness
It makes sense to be aware of your breasts and to know what is normal to you.

Breast Changes for which medical advice should be sought:

• Women who are breast aware are more likely to detect changes early
• Lump or thickening in the Breast tissue
• Swelling in your breast or armpit
• Dimpling or Flaking on the skin, creases
• Prominent veins on your Breast
• Unusual pain or discomfort or heavy persistent pain
• Any New difference between appearance of the breasts
• Change in size or shape of the breasts
• Discharge or bleeding from the nipple, a rash on or around it, moist reddish areas that do not heal.
• Change in the position of your nipple - inverted (pulled inwards) if used to stick out or pointing in a different direction