Common causes of breast lumps in lactating mothers

Breastfeeding is a mother’s gift to her child and herself – there are innumerable advantages of breastfeeding to both the mother & child but sometimes mothers can face some difficulties during breastfeeding. One of them is the development of breast lumps during breastfeeding.

Breast lumps during breastfeeding can not only lead to anxiety in the mother but can sometimes be a sign of something as ominous as cancer. The common causes are:

Milk collection (Galactocele) – this is probably the most common cause of breast lumps in breastfeeding mothers. It commonly occurs due to a blocked duct and the patient can feel a painful lump in the breast. It can sometimes also occur, if breast milk is not emptied at regular intervals.

Management of a galactocele/ milk collection can range from emptying of breast milk either by feeding or by using a breast pump. Hot fomentation/ gentle massage also works well in this condition. If the problem occurs frequently, then one should consult a lactation expert/ doctor for further evaluation

 Breast abscess/ mastitis – this is inflammation of the breast tissue which can progress to pus formation as well. It is secondary to a bacterial infection and you would be surprised to know that the source of the bacteria is the child’s mouth. These bacteria can enter through the nipple (more common in ladies with cracked/ sore nipples) and lead to infection.

Patient usually develops intense pain in the breast, which can be associated with redness and fever as well. If one notices any such symptoms, they should visit their breast surgeon immediately. In the initial stages, this condition is managed using antibiotics. In case, pus develops, then the surgeon is left with no option but to drain the pus out by performing a minor surgery.  If the abscess is very large, your doctor might also recommend stopping breastfeeding using a drug.

Breast cancer – can sometimes be detected during breastfeeding. These lumps can initially be mistaken for a milk collection but unlike milk collections, they don’t respond to simple measures and keep on increasing in size. Sometimes these lumps might even be painless.

Due to these two reasons, cancers can often increase in size before they are detected in breastfeeding mothers.

If a mother notices a lump in the breast during breastfeeding, which does not settle in a few days, she should immediately visit a breast cancer surgeon and get herself evaluated. If the surgeon is suspecting a cancer, they will order an ultrasound followed by a needle biopsy to confirm the diagnosis.

These are some of the common causes of breast lumps during lactation. It is good to be aware of these lumps and one should not delay meeting a doctor in case they notice such problems. Having said this, majority of the mothers have an uneventful lactation period.

Over the last few years it has been seen that mothers are reducing the duration of breastfeeding due to professional commitments. Given all the advantages of breastfeeding for the mother and the child, this world breastfeeding week all ladies should pledge to complete breastfeeding at least for 6-8 months.

 

This information has been provided by

Dr. Rohan Khandelwal

Principal Consultant, Breast Cancer Surgeon

The Breast Centre

CK Birla Hospital, Gurgaon

 

World Breastfeeding Week 2020

Breast Cancer Care During COVID19 outbreak

At present, almost half the world is in lock-down due to the corona virus outbreak and it is difficult to predict for how long this situation might remain the same. In India, it is almost certain that the lock-down due to COVID 19 will be extended till at least end of April. Even though we are in a state of lock-down but our body is still functioning and that means diseases like cancer might still be growing inside our system. So how does one deal with a problem like breast cancer/ breast lump during this period.

Tips for existing breast cancer patients

  1. Remain in touch with your treating breast cancer surgeon/ breast cancer oncologist. They will outline the treatment protocol during this period
  2. If you have an early stage breast cancer which is curable, you should not defer your treatment during this period, as it can lead to progression of the cancer.
  3. If you are suffering from cancer which has spread to the body (metastatic breast cancer), then discuss with your doctor if the chemotherapy frequency can be reduced or if you can be shifted to hormonal therapy/ oral treatment for the time being.
  4. Corona virus infection is usually severe in patients who are suffering from pre-existing conditions like cancer, diabetes, hypertension. So, please take all precautions to prevent infections
  • Eat a healthy/ balanced diet. Avoid outside food.
  • Make sure you take your daily dose of  vitamin C. This can either be in the form of a supplement or just a glass of lemonade
  • If you are undergoing chemotherapy (which can lead to reduced immunity and white blood count), please monitor the blood counts and if they are low, consult your breast cancer doctor immediately
  • Wear a mask whenever you are venturing out of your home, especially, when you are going to the hospital
  • Maintain strict hand hygiene. Wash your hands multiple times a day and use a hand sanitizer liberally

 

 

 

 

Recently detected a breast lump – what should you do during this period?

During the lock-down, lot of ladies are taking out time to carry out breast self examination and they are picking up new breast lumps. If you are one of them, I would advise that you consult a breast lump surgeon immediately. This consultation can either be an online consultation or a physical visit to the hospital. In an online consultation, if the doctor feels the need to carry out a physical examination, he/she would call you to the hospital.

A breast lump should not be ignored because if it is cancerous, it can increase in size during this period. A mammography or an ultrasound should be done after physical examination and if the lump is suspicious, a biopsy/ needle test should be done to confirm the diagnosis. If the breast lump turns out to be non cancerous (benign), then the treatment can be deferred till the time COVI19 situation improves. Your doctor can provide you medicines during this period to deal with the problem/ breast pain associated with the lump.

If the lump turns out to be breast cancer, as I have highlighted above, please consult your doctor and make a treatment plan which is suitable to you.

These are testing times for everyone, including patients. One has to be cautious about not getting infected by the virus as well as make sure that their breast cancer/ breast lump treatment doesn’t suffer. If you follow the tips which I have highlighted above, you can tide over this phase without compromising your health.

 

 

This information has been provided by

Dr. Rohan Khandelwal

Breast Cancer Surgeon

CK Birla Hospital, Gurgaon

To book an online consultation with Dr. Rohan Khandelwal, click here

 

All breast fibroadenomas don’t require surgery

Breast fibroadenomas are the most common cause of breast lumps and they are commonly seen between 15-30 years of age group. We usually see a lot of anxious women presenting to the Breast Centre at CK Birla Hospital, Gurgaon with this complaint and all of them have two common questions:

  • can it turn into breast cancer?
  • does it require surgery?

I will address these two questions in the text below but before that I would just like to give you some information regarding breast fibroadenomas.

Clinical presentation  – Breast fibroadenomas usually present as painless (non painful) breast lumps which keep shifting their position within the breast. These lumps can remain the same size for long periods of time but sometimes they can present with pain, rapid increase in size. Approximately 10% women can have multiple fibroadenomas [read about the lady with 39 fibroadenomas in both breasts].

There is no known cause for fibroadenomas and no well defined risk factors.

On examination, these lumps are usually firm in consistency and mobile, which is why jokingly they are also known as a ‘breast mouse’.

Diagnosis of a fibroadenoma can be made out on an ultrasound of the breast (which is the preferred imaging technique in patients less than 40 years of age). If a mammogram is done, you can see a ‘popcorn appearance‘ of the lesion.

 

Calcified Fibroadenoma

Majority of the fibroadenomas can be clearly made out on an ultrasound but if a lesion is showing some atypical changes, then a tru-cut biopsy/ FNAC (needle test) is recommended to confirm the diagnosis. This is also indicated in patients with a family history of breast cancer.

Coming back to the two questions which all patients with breast fibroadenomas have running through their mind during their visit to a breast surgeon:

  • Can fibroadenomas turn into breast cancer?  —  Multiple studies have shown that the risk of a fibroadenoma changing into breast cancer is negligible (less than 2%). It is usually more in patients who have atypical fibroadenomas or an existing family history of breast cancer. Patients with a family history of breast cancer should not ignore these breast lumps and should get a biopsy to confirm the diagnosis.
  • Do all fibroadenomas require surgery? —- Well, not all of these breast lumps require surgery. There are certain indications to surgically remove these lumps:
  1. If the fibroadenoma is more than 5 cm in size. Such a fibroadenoma is known as a ‘giant breast fibroadenoma’.
  2. If there is a family history of breast cancer. In such cases, it is advisable to remove the lump.
  3. If there is rapid increase in size of the lump or it is associated with breast pain which is not getting controlled with medicines.

Surgical removal for fibroadenomas is usually a minor surgery which is done as a day care procedure. The incision for this surgery is usually made around the areola (peri-areolar) as this incision heals with minimal scarring. Sometimes the incision can be made in the skin fold under the breast (infra-mammary crease). Some patients can candidates for scar-less fibroadenoma surgery, in which the lump is removed via a 3-4 mm incision using a special machine.

Peri-areolar incision – scar is hardly visbile after a month

Those patients who are not candidate for surgical excision are asked to follow-up at regular intervals, usually 6 months to 1 year. In addition to this, they are asked to monitor the size of the lump. In case there is a rapid increase in size of the fibroadenoma, they are asked to return immediately. Unfortunately, there is no credible medical management of fibroadenomas.

 

Information provided by:

Dr. Rohan Khandelwal

Breast Cancer Surgeon in Gurgaon

CK Birla Hospital

Dr. Rohan Khandelwal also performs scar-less fibroadenoma surgery at CK Birla Hospital

What does BIRADS on your mammography/ ultrasound report mean?

Lot of times in my Breast Clinic at CK Birla Hospital, Gurgaon, I get patients who come and tell me that they are suffering from stage III breast cancer. When I ask them how do they know about that, the answer which I usually hear is that “my mammogram/ ultrasound report shows BIRADS III.” Not only patients but I have also seen some doctors getting confused with the BIRADS reporting.

BIRADS (Breast Imaging Reporting and Data Systems) is a standardized way of reporting breast radiology reports.  This helps radiologists categorize patients from a score of 0-6 and it helps breast cancer surgeons in taking decisions based on this score. Having a uniform reporting system is useful because patients might get their radiology and breast disease treatment done at different places.

The score doesn’t imply the stage of cancer and patients should be aware of this to avoid unnecessary anxiety after seeing the radiology report.

  • BIRADS 0 means an incomplete investigation – This usually occurs when a mammogram is done in a patient with a dense breast and it does not yield any meaningful information. In such a case, usually an ultrasound or MRI Breast is done

 

  • BIRADS 1 is a negative scan, which basically implies that there is no lesion in the breast and everything is normal. In these patients we advise them to follow up after 1 year

 

  • BIRADS 2 is suggestive of a benign lesion, which has essentially a 0% risk of cancer and these lumps don’t require a biopsy. They can be followed up in a year’s time. Simple cysts, most typical fibroadenomas fall under this category.

 

  • BIRADS 3 lesions are probably benign and these breast lesions/ lumps should be followed up every 6 months (short term follow-up). These lumps do not require a biopsy/ FNAC but if you have a family history of breast cancer, then the clinician might be inclined to do more tests/ biopsy at this stage rather than wait for 6 months.  Fibroadenomas, duct ectasias can fall under this category of lesions.

 

  • BIRADS 4 breast lumps/ lesions are suspicious lesions and they need to be biopsied to confirm the diagnosis. They are further sub-divided into 4a, 4b, 4c which implies low, medium and high risk for cancer. These patients should be counselled accordingly and a tru-cut/ core needle biopsy should be scheduled as soon as possible. Atypical fibroadenomas, suspicious microcalcifications, duct papillomas usually fall under this category of lesions

 

  • BIRADS 5 lesions are highly suggestive of malignancy and the risk of cancer in these breast lumps is more than 95%. All patients with these breast lumps should be subjected to the tru-cut biopsy, which is preferred over a FNAC (fine needle aspiration cytology)

 

  • BIARDS 6 lesions are when a radiological test is done after confirming the diagnosis of breast cancer.

 

The table below summarizes the BIRADS score and the action which needs to be taken in each category.

The Radiology Assistant : Bi-RADS for Mammography and Ultrasound 2013

 

So the next time you receive your mammography / breast ultrasound report, don’t be surprised to see the BIRADS score. Discuss the report with your radiologist and breast cancer surgeon and take action accordingly. Remember, that all breast lumps are not cancerous and all of them don’t even require a biopsy/ FNAC test.

 

This information has been provided by

Dr. Rohan Khandelwal

Principal Consultant,

The Breast Centre

CK Birla Hospital, Gurugram

Types of Breast Cancer – Invasive vs Non invasive

Breast cancer is the most common cancer amongst Indian women. Majority of these cancers arise from the 15-20 ducts present in the breast. These cancers can be of two types, invasive and non invasive. These terms are often mentioned in the pathology report after the breast cancer surgeon does the biopsy. This simple patient information video explains these terms and their practical implications.

If the patient is diagnosed with an invasive cancer, then the patient often requires chemotherapy, whereas, if the patient has non invasive cancer (ductal carcinoma in situ), chemotherapy can be avoided.

To diagnose the type of breast cancer, a breast biopsy is required (tru-cut or core needle biopsy). FNAC (fine needle aspiration cytology) is not useful in distinguishing between the two types of cancers.

This information has been provided by Dr. Rohan Khandelwal, Breast Cancer Surgeon at W Pratiksha Hospital, Gurgaon & Delhi NCR.

Fibroadenoma – clinical presentation & surgery

Fibroadenomas are the most common cause of a breast lump, especially in young ladies. Due to increased awareness, more and more ladies are getting scans done, on which fibroadenomas are detected. In this video, I have explained the presentation and the surgical management of fibroadenomas in Hindi.

 

If these breast lumps are very small, they can be managed conservatively (without surgery) but if they are causing pain, increasing in size or there is a family history of cancer, it is best to get these lumps removed by a minor breast surgery.

As these lumps occur in young patients, it is important that the surgeon removes them without leaving a scar behind. In case you are detected with a breast lump, which is suggestive of a fibroadenoma, it is best to consult an expert breast surgeon, who is routinely performing such surgeries.

For more details regarding fibroadenoma surgery, please click here

 

Greenish Nipple Discharge

 

 

 

Nipple discharge is a common problem with which ladies present to our Breast Clinic. Nipple discharge can be of many types ranging from clear fluid to frank blood.

Greenish nipple discharge is commonly seen in ladies between the ages of 40-55 years. It is common in ladies who smoke and those are suffering from diabetes.

Breast Cancer should be ruled out in all these patients by doing a triple assessment, i.e. clinical examination, imaging & biopsy. Once cancer has been ruled out, patient should be re-assured and if there is any inflammation, antibiotics can be given. In case of persistent discharge and a lump, the implicated ducts can be surgically removed.

 

 

Don’t ignore a lump in the breast, it could be breast cancer!

 

Breast cancer is the most common cancer among Indian women now. The most common presentation of this condition is in the form of a painless lump in the breast. Early diagnosis of this dreaded condition can lead to complete cure. So, don’t ignore a lump in the breast as it could be cancer.

 

Interesting Mammogram #5

41 year old lady with a left breast lump since last 6 years with rapid increase in size since the last 4 months. Patient was concerned that she is suffering from breast breast cancer and therefore got a mammography done and presented to my clinic.


A tru- cut biopsy was done and it revealed it to be a phyllodes tumor, which after resection turned out to be a malignant phyllodes tumor with Liposarcomatous differentiation. 

Case uploaded by:

Dr. Rohan Khandelwal

Breast Cancer Surgeon

W Pratiksha Hospital, Gurgaon 

Interesting Mammogram #4 

47 year old lady with complaints of bilateral breast pain since 3 months. Pain was non cyclical and relieved by oral paracetamol. She had a hysterectomy 6 years back and she was a known asthmatic.

On examination, she has multiple tender nodules in both the breasts, localised in the peri-areolar region. 

Mammogram revealed multiple, well defined, rounded densities in both the breasts with a rim of calcification around them (refer to figures). 

Multiple round densities in the breast


Ultrasound done revealed dense fibroglandular tissue with multiple sub-centimetric cysts in the breasts. 

Differential – 1. Multiple oil cysts with calcification 

2. Cysts secondary to fibroadenosis

Case managed by:

Dr Rohan Khandelwal

Consultant, Department of Breast Diseases and Cancer Care

W Pratiksha Hospital, Gurgaon