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Breast Pathology

Abnormal Breast Presentations

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Updated June 30, 2014

Breast Pathology
Photo © A.D.A.M.

There are many possible breast abnormalities that breastfeeding mothers may encounter. Identifying these issues is very important to continue a healthful breastfeeding relationship with your child. Crucial to recognizing any potential problem is doing a breast assessment, which involves inspecting your breasts. It is highly recommended, though, that you have a lactation consultant or physician perform an evaluation to follow up with any concerns that may arise.

Breast Unevenness (Asymmetry)

There are three typical diagnoses associated with asymmetrical breasts: One breast may be slightly larger than the other, but it is not causing any concern; another breast may be dramatically larger than the other, and Mom may find that she's producing much more from that side; or there can be a temporary slowdown in production if a baby begins to favor one side over the other.

Widely Spaced, Long or Thin Breasts (Hypoplasia)

This may signify insufficient breast tissue, which can lead to milk supply problems.

Signs of Retraction and Inflammation

  • Dimpling: A wide, shallow dimple is a sign of skin retraction. This can be caused by shortening of the suspensory ligaments, which can occur in malignancy or if there has been an inflammatory response in the breast. Distortion of the areola can also cause dimpling.
  • Nipple retraction: The pulling back of the nipple may be either harmless (the majority of retractions) or malignant (occasionally associated with breast cancer). Make sure not to confuse retraction with nipple inversion.
  • Fixation: In a forward-bending position, examine your breasts for any unevenness, distortion or decreased movement. With invasive cancer, fibrosis "fixes" the breast to the underlying muscles.
  • Edema or swelling (appearance is like the peel of an orange): This is caused by lymphatic obstruction, which in turn causes a thickening of the skin. It typically originates in the surrounding skin and underneath the areola.
  • Deviation in nipple pointing: This is typically a sign of cancer as the nipple angle is pulled toward a fibrosis in the mammary ducts.
  • Prominent venous (vein) pattern: Lactating mothers will always have very visible veins on both breasts. A venous pattern that is on one breast only, however, may develop with certain types of breast tumors.

Breast Lumps

There are three general categories that breast lumps may fall under:

  • Benign breast disease: You will most probably feel swelling and tenderness, breast pain, general lumpiness, dominant lumps or cysts, nipple discharge and/or infections and inflammations.
  • Cancer: You may feel an isolated painless mass on one side, which will be solid, hard and dense. The borders of the mass will be irregular and is most commonly found in the upper-outer quadrant of the breast (closest to the armpit).
  • Fibroadenoma: You may feel an isolated painless mass, but it is solid, firm, rubbery and elastic to the touch. The moveable mass can be round, oval or made up of many lobes, and it is generally between 1 and 5 centimeters in size.

Abnormal Nipple Discharge

This may indicate either:

  • Mammary duct ectasia: This is a benign breast condition, very similar to plugged ducts, as they are noticeable by touch. You will probably notice a multicolor, paste-like discharge coming from the nipple, which stems from the ducts just behind the areola. You may have redness and itching around the nipple as well.
  • Intraductal papilloma: This is a benign breast condition. You will probably notice a watery or bloody watery discharge from the nipple. They are typically spontaneous, on one side, and in one duct, but can cause moderate pain.
  • Paget's disease: This is an intraductal carcinoma, which initially appears as dry, scaly crusts and later spreads to the areola. The nipple may also become reddened, inflamed and irritated.

Problems During Lactation

While breastfeeding, some disorders you may see are:

  • Plugged ducts: This is a sensitive, reddened area of the breast, but there is no infection associated with it. Plugs typically clear up in less than a day.
  • Mastitis: This is an inflammatory mass that causes the breast to be red, swollen, tender, hot and hard. Flu-like symptoms are associated with this condition.
  • Galactocele: This is a cyst filled with milk. It typically calls for drainage.
  • Breast Abscess: This is a rare complication stemming from a breast infection. It is a pocket of pus that usually builds up in one area, but there have been cases where women have had two in the same breast. Surgical incision, aspiration and drainage are necessary to treat an abscess to prevent it from rupturing and to allow it to heal.

      Increase in Blood and Lymph Supply

      In simpler terms, engorgement. This is one of the most common problems that breastfeeding mothers encounter. It can cause a great amount of pain for Mom and create a difficult latch for the baby. Unfortunately, the severity of engorgement is increased in Moms who have had breast reductions or augmentations.

      Skin Conditions

      Myriad skin problems can affect the breast. The most common are:

      • Psoriasis (which can appear on your breast, nipples and trunk)
      • Poison Ivy
      • Impetigo (It is very easy to confuse the appearance of this with candida, so be sure to check in with your doctor!)
      • Dermatitis
      • Candidiasis (This can present itself in many different ways on the nipple and areola.) This is also referred to as "thrush." It can also appear deep in the breast. Sometimes a Mother won't have any symptoms on the outside of the breast, but she feels sharp pain in the breast.
      • Herpes: Although uncommon, Herpes Simplex of the Nipple is a recognized problem. It is typically infant-to-mother transmission.
      • Raynaud's: This rare phenomenon causes a blanching and painful vasospasm in the nipple and may occur only in the nipple or in the breast and areolar tissue at the same time. During the spasm the nipple will turn white and after it will gradually return to its original color.

      Sources:

      American Cancer Society. Non-cancerous breast conditions. 2008

      American Cancer Society. Paget's Disease: A New Form of Breast Cancer? 2008.

      Wilson-Clay B, Hoover K. The Breastfeeding Atlas. 2002

      Smallwood JA, Kye DA, Taylor I. Mastalgia Ann R Coll Surg Engl 1986 Sep;68(5):262-263

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