Breastmilk production is largely regulated by the hormone prolactin secreted from the pituitary gland. Normally prolactin is released when the pituitary gland is stimulated by other hormones or impulses from the breast tissue as is seen with the suckling infant. However, in galactorrhea there is usually an excess of prolactin levels in women when it should not normally be so. Galactorrhea is not a disease on its own but a sign of an underlying disturbance in the body which may be pathological (disease process).

Causes of Galactorrhea

Although galactorrhea is often a consequence of elevated prolactin levels, it can occur without any such elevation. Sometimes galactorrhea occurs for no known reason (idiopathic) but most of the time galactorrhea is due to one or more of the following causes :

• Excessive stimulation of the breasts as is the case in sexual activity or frequent self-examination of the breast. A skin rash on the chest, injury to the chest wall and even tight clothing rubbing against the breast can also stimulate the breast tissue.
• Prolactinoma which is a benign tumor of the pituitary gland composed of those cells that produce prolactin.
• Hypothyroidism which is low levels of thyroid hormones due to underactivity of the thyroid gland.
• Medication such as birth control pills, antidepressants or hypertensive drugs.
• Herbal remedies containing fenugreek or fennel.

Less frequently other conditions may also be responsible like kidney diseases and spinal cord injury.

Other Signs and Symptoms

Galactorrhea is marked by the secretion of a milky white discharge from the breast. The discharge may only be occasional or persistent and does not contain blood or have a foul odor. Any discharge from the breast that is sticky, yellowish, green or brown and has a foul odor and/or blood is not galactorrhea. It may instead be due to an infection or other injury within the breast caused by diseases like breast tumors.

In galactorrhea, the milky discharge may be from one or both breasts. It can be secreted on its own without any effort (spontaneous) or manually expressed. The presence of other symptoms like headaches, vision problems and menstrual disturbances may be indicative of conditions like a prolactinoma or hypothyroidism if no medication or herbal supplements are being used.

Treatment of Galactorrhea

Since galactorrhea is not a disease on its own but a feature of some underlying disorder, the causative factor needs to be identified and removed or treated. This may involve stopping any medication and herbal supplements, undergoing surgery to remove pituitary tumors, or use medication to shrink pituitary tumors and normalize the thyroid levels in hypothyroidism.

Breast Structure

The breast tissue is covered by the skin on the surface. Two prominent areas are the areola and nipple. The breast tissue under the skin can be divided into the functional tissue (intralobular stroma) and supportive tissue (interlobular stroma). The supportive tissue comprises fatty tissue and connective tissue. It provides strength and protection for the breast and the fat cells are rich store of energy for milk production. The functional tissue is made of secretory cells that are arranged into acini (alveoli). The cells empty its secretions into channels that run into ductules and then into terminal ducts. Groups of alveoli jointly make up lobules in the breast and these lobules are essentially teh functional components of the breast. Ductules eventually drain secretions into the lactiferous ducts which carry the milk to the nipple for expulsion into the exterior.

The Breast Before Puberty

The female breast has minimal fatty tissue prior to puberty and this accounts for its small size. The areola and nipple are also small in size. The channels in the breast end with the terminal ducts and lobular formation is at the minimum. The breast tissue cannot produce milk and is not at a point where it can even be prepared to do so within a short period of time. This is in conjunction with the reproductive system’s inability to release egg cells or sustain a fetus.

The Breast After Puberty

After puberty the fat accumulation in the breasts increases tremendously, largely driven by the effects of the hormones estrogen and progesterone. Lobules begin to form but are not fully active or structurally complete for breast milk production and secretion. A common misconception is that the postpubertal breast has the ability to produce milk prior to pregnancy. It is only once pregnancy occurs that the final structural changes are complete for milk production. Nevertheless, the postpubertal breast is structured such that these final changes can occur rapidly to make it fully functional. The size of the breasts, which are an aesthetic concern for many women, is determined both by hormonal and genetic factors. It does not represent a woman’s ability or inability to fall pregnant unless there is underlying pathology.

Female Breast in Pregnancy

Once pregnancy occurs, the lobules take on a more definitive shape. The breast size also increases substantially at this time due to fat accumulation. Both the areola and nipple enlarge. The duct system completes its development and these changes gradually progress throughout pregnancy. It is fueled by the elevated levels of estrogen and progesterone in pregnancy. However, the action of another hormone known as prolactin is important to fully activate the milk production feature of the female breast.

When the levels of estrogen and progresterone drop after childbirth, prolactin levels surge and the breast tissue starts producing milk. Suckling stimulates the breast and along with the constant drainage of milk, prolactin levels are maintained for milk production. The functional breast tissue remains active and the fat stores in the breast are maintained at a high level during this entire period. Discontinuing  breastfeeding, will eventually ‘deactivate’ milk production and the quantity of fat tissue reduces slightly.

Mastitis is the term for infection of the breasts and while acute cases are more common in breastfeeding women, it can also arise in non-lactating women particularly when there is a structural defect of the breast or chronic systemic disease. The possibility of developing an infection should not detract mothers from breastfeeding but immediate medical attention should be sought once the symptoms start to develop. Breastfeeding mothers will not definitely develop mastitis and a little caution may help in preventing an infection.

Causes of Mastitis in Women

Breast infections in lactating women (lactational mastitis) typically arises in the first 6 weeks of breastfeeding. The nipple is generally sore and develops small cracks and fissures which allow bacteria to invade the underlying tissue.  These infections are more central (from the nipple), superficial and may lead to the formation of abscesses. This may be just a single abscess or multiple abscesses. The bacteria involves in these infections are typically found on the skin of humans. It includes Staphylococcus aureus, Streptococcus epidermidis and other streptococci. Although the infection is superficially initially, it may spread to deeper layers without appropriate treatment as early as possible. An entire lactiferous duct and its ductules as well as the lobules may be involved. Frequent drainage of milk may play an integral role in ‘washing’ away the bacteria and preventing deeper infection.

Non-lactational infections may be associated with other causes like injury to the breasts, postoperative infection and in immunocompromised patients like those with HIV or uncontrolled diabetes mellitus. The infection is more likely to affect the periphery of the breast and is usually chronic in nature. Another types of chronic mastitis is perilobular mastitis where keratin plugs arise within the ducts and block it. A secondary infection then sets in. It is more often associated with nipple deformities.

Signs and Symptoms of Mastitis

Mastitis, as with any inflammation, presents with tenderness or pain of the breasts, swelling and redness. The skin over the infected area may feel warmer than normal. An abscess may be seen as obvious bump on the breast surface with redness of the skin over the abscess and warmth. Initially an infection may present as just mild discomfort but quickly progresses to more acute symptoms if there is no intervention. A discharge from the breast may be present and this is often yellow to green with a foul odor. Other features may include a fever, fatigue and headaches.

]]> http://www.phaa.com/mastitis-breast-infection-in-breastfeeding-non-lactating-women.htm/feed 0 http://www.phaa.com/one-side-breast-swelling-single-breast-enlarged-swollen.htm http://www.phaa.com/one-side-breast-swelling-single-breast-enlarged-swollen.htm#comments Thu, 29 Apr 2010 17:32:05 +0000 Dr. Chris http://www.phaa.com/?p=294 Any breast swelling, whether it is on one side or both, is likely to be a cause for concern as the worry of breast cancer is always on a woman’s mind. While it is absolutely necessary for all breast swellings or lumps to be evaluated by a doctor, in most cases they do turn out to be non-threatening in nature and can be treated effectively.

It is important to note that if you do discover one sided breast swelling, with or without any palpable lumps, it is advisable to consult with your doctor or gynecologist first before you jump to any conclusions or decide to ignore it. The reality is that both breasts are not exactly the same size or shape, but it is usually such a subtle difference that it cannot be easily noticed.

Causes of Breast Swelling on One Side

Young girls often find that one of their breasts is slightly larger than the other. This is a normal finding and should not be a cause for concern. Women on contraceptive pills or hormone replacement therapy (HRT) may also have slight breast enlargement, usually on both sides (bilateral), but sometimes it may be only on one side (unilateral). These are two of the most common causes of noticeable one-sided breast enlargement.

Other possible causes of one-sided breast swelling may include :

Infection

Mastitis which is breast infection is common in women who are breastfeeding. It can cause swelling of the breast on one side.

A breast abscess is a collection of pus which forms within the breast as a result of infection. It usually occurs in a woman who is breastfeeding.

Cellulitis or inflammation of the skin as a result of an infection can cause swelling of the breast.

Trauma/Injury

Any injury to the breast may cause a swelling due to collection of blood within the breast. A firm irregular mass due to fat necrosis may follow trauma.

Fibrocystic Breast Disease

Fibrocystic disease of the breast (fibroadenosis)  may occur in one or both breasts. It is usually seen during the child bearing years and is common in pre-menopausal women. The lumps may be painful but there is no fear of them becoming cancerous.

Fibroadenoma

A fibroadenoma is also called a “breast mouse” because it is felt as a smooth swelling which is quite mobile within the breast. It usually occurs in young women, causing a painless swelling in the breast and is usually not pre-cancerous.

Cysts

Cysts are little sacs filled with fluid. A cyst may cause swelling of the breast which sometimes becomes painful just before the onset of periods.

Milk cysts may form due to pockets of milk collection within the breast during lactation. These can become infected and form a breast abscess at a later stage.

Cancer

Breast cancer continues to rise globally and a regular mammogram and routine breast examinations are advisable. A biopsy of a lump will assist with the final diagnosis.

Lipoma

A breast lipoma is a lump formed by collection of fatty tissue within the breast.

Lymphatic Obstruction

Lymphatic obstruction is the blockage in lymph flow within the breast and this may be due to a tumor, infection, injury or surgery and can cause a unilateral breast swelling.

Infants, New Born Babies

Breast lumps are sometimes seen in newborn babies and this is formed by the action of the of the maternal hormones. These usually disappear in due course, without any treatment, as the estrogen level falls.

Implants

Toughened silicone implants or scar tissue after breast augmentation surgery  may be felt as pseudolumps in the breast.

Causes of Itchy Breasts

In most cases of itchy breasts, clothing and underwear are the problem. The fabric used may be causing an allergic reaction (contact dermatitis) or it may be too tight or not allowing adequate ventilation, especially if you live in a hot and humid environment. Women who tend to spray perfume directly on the skin of the chest or breast are likely to suffer with skin irritation as well.

At other times, itching of the breasts may be associated with hormonal changes like prior to your period (premenstrual). While breast swelling and/or tenderness is thought of as the main premenstrual breast symptom, itchy breasts are also a possibility in some young girls and women.

In both these instances, the breast itching is more likely to affect both breasts simultaneously.

The above causes are not serious and will pass with a change of clothing, after bathing or after the onset of menstruation.
Other causes of itchy breasts which needs more attention include :

• A breast fungus tends to occur under the breast or on the sides of the breast

• Skin disorders like atopic dermatitis, seborrheic dermatitis, urticaria (hives) and even chest acne can contribute to itching of the breasts. A rash is almost always evident.

• Sunburn may also cause itchy breasts along with redness of the skin. Tenderness may not always be present. Any mole or skin ‘bump’ that tends to become more itchy in sunlight needs to be investigated immediately.

• Breastfeeding mothers are more prone to breast infections (mastitis) which may initially appear as an itchy breast with mild pain and cracking of the nipple.

• Itchy breasts that are accompanied by nipple discharge and/or any fixed and growing lump in the breast should be taken more seriously. This can at times be an indication of breast cancer.

• Trauma to the skin of the breast may also cause itching. If it is a slight injury to the skin like in scratching the skin with long fingernails, an itch may develop. This is usually not serious.

• Post operative itching, after a mastectomy or breast augmentation is also a possibility and will reduce with time. Larger breasts due to augmentation may also cause mild itching as the skin may be stretched excessively.

• Certain drugs may also cause itchiness of the skin which may not be isolated to the breasts. Consult with you doctor if you noticed that the breast itching started after taking a new medicine.

If you have breast implants and are experiencing intense itching, pain, redness of the skin and/or fever, consult with your doctor immediately.

Treatment and Prevention

Treatment of the itchy breasts should be directed at the cause. While you may assume that the cause of your breast itching is superficial (on the skin), other conditions may cause the sensation of an itch although it is not related to any skin disorder. The presence of a skin rash usually alerts you to a dermatological cause although this is not always the case. Other causes with accompanying symptoms in the deeper breast tissue should warrant a visit to your gynecologist.

If your beast itching is not due to any serious cause and is intermittent and infrequent, then take note of factors that tend to trigger the itching. Try to wear bras made of light fabrics with good ventilation. Do not use tight fitting bras or lingerie. Always practice good hygiene – regular bathing with thorough washing around and under the breasts is important. Dry your breasts throughly after bathing and avoid strongly scented creams and perfumes. Beware of breast enlarging creams – they rarely work and can cause dermatitis.

A larger bust is often portrayed as key to feminine beauty and an indication of a woman’s appeal to the opposite sex. In the search for larger breasts, many women undergo breast augmentation, opting for implants rather than accepting their natural form. breast enlargement creams, push up bras and even vibration belts for the breast continue to sell globally as less ‘well endowed’ women grasp onto the hope that one of these methods will be the answer. However breast size can significantly impact on the spine, hip and major muscles and nerves of the body and this should always be taken into consideration before opting for breast augmentation.

Why do large breasts affect the back and spine?

large breasts usually cause a significant shift in the center of gravity resulting in a number of effects on the body’s musculoskeletal system. The additional weight extending beyond the center will add up to 10 times its weight in pressure on the spinal column due to the action of gravity. Over time, this can affect the spine and cause long term back problems, initially experienced as back pain. Over time, the altered gait and posture may complicate to other spinal complications and nerve problems like a ‘pinched nerve’ or ‘bulging disc’ (herniation).

How do larger breasts change the posture?

Women with large busts change their posture, unconsciously, to compensate for the additional weight. The upper back (thoracic spine) is pulled back, often appearing like the chest is being pushed out further. The lower back then adjusts accordingly by arching, distributing some weight to the front (slightly protruded belly) and the rest to the back, resembling a protruding buttock or ‘big bottom or bum’. These changes in the spine does give temporary relief to the weight distribution associated with large breasts but over time, it is difficult to maintain this posture without affecting the spine and causing back pain.

What are the effects and complications of large breasts on the back and spine?

The obvious change in the curvature of the spine leads to a host of back problems that affects the vertebrae (back bones), back skin, muscles and nerves. A large bust often needs better support with an appropriate bra, the straps of which keep ‘digging’ into the skin causing bruising of the skin of the back and under the breast. This can contribute to chaffing (intertrigo) which could result in a breast fungus over time. The increased curvature of the spine to compensate for the additional weight may lead to lordosis which causes neck and back pain on the upper and lower back. This often occurs as a combination of back muscle spasm (cramps) and ‘pinched nerve’ syndrome. The disordered weight distribution in the upper torso is compensated by the lower body with the hips tilting to distribute the weight appropriately to both legs. This change in posture may affect the gait giving some women with very large breasts a characteristic ‘duck walk’ which causes long term muscle and spinal problems.

Opting for larger breast sizes through breast augmentation should only be conducted once a woman considers the possible complications of an enlarged bust. Many women want to go as ‘big’ as possible when considering breast enlargement and many unscrupulous practitioners are willing to assist without explaining the host of problems associated with bigger breasts. Consider your options carefully before considering a significant enlargement through breast augmentation and if you have a naturally large bust, speak to your doctor about some of the symptoms you may be experiencing as a result of your bust size.