All About Breasts: Cysts, Lumps, Infections, Enhancement and More

We talk a lot about breast cancer, but when it comes to female breasts, there is a lot more to learn from puberty through menopause. Female breasts serve a physiological function, providing vital nutrition for babies. They also serve a sexual function, providing pleasure when stimulated. They consist of fatty and fibrous tissue, lobules, milk ducts, the areola and the nipple. The predominant component of the breast is fatty tissue with lobules and ducts throughout. The areola houses glands that provide lubrication for the nipple during breastfeeding, as well as smooth muscles that aid in the nipple's protrusion, facilitating a better latch for the baby.

Breasts can experience changes that require medical intervention. Women may also find that over time, their breasts change in size, shape and fullness. As a board-certified, fellowship-trained breast surgeon, I can answer your most pressing questions about your breasts. Let's dive right in.

Breast Cysts

What is a breast cyst?

A breast cyst is a fluid-filled sac within the breast. Breast cysts are most common in premenopausal women but can be found in those who are postmenopausal. Often, women don't know they have them as they don't cause any pain or problems, but sometimes they can grow large enough to cause pain, or many can develop, causing pain. 

How does a breast cyst feel?

Breast cysts can be painful. They can feel like a lump in the breast, can change in size and can fluctuate with periods. 

What treatment options are available for a breast cyst?

If someone is experiencing pain or a cysts keeps enlarging, our WakeMed breast surgery team can have them drained. Breast cysts are usually drained in a simple procedure called an aspiration where we place a needle in the cyst under ultrasound guidance and remove the fluid. If the cyst looks abnormal on an ultrasound, a radiologist can also do a biopsy (take a small sample of it) to make sure there is nothing suspicious causing the cysts. It is rare for a simple cyst to pose any threat to a someone's health.

Breast Mass

What is a benign breast mass?

A benign breast mass is a lump in the breast that is not cancerous. A common example is called a fibroadenoma.

How would a benign breast mass feel?

A benign breast mass feels mobile (not usually fixed to the skin or chest), rubbery but firm and different than the surrounding breast tissue. Sometimes these masses are tender to touch. 

Does a benign breast mass feel different than a malignant mass?

To my patients, benign and malignant mass can feel the same, but, to me, they feel different. Benign masses are more rubbery whereas cancer is typically hard and not tender to the touch.

Does a benign breast mass have different symptoms from a malignant mass?

Although it can happen, cancer rarely is painful. Benign masses can cause pain. 

Does a benign breast mass require treatment?

We remove benign breast masses when they have some suspicious characteristics on imaging, are rapidly growing and/or when they cause pain. The treatment would include surgically removing the masses. Sometimes if I cannot feel it very well, I will have a magnetic seed placed within the mass by my radiology colleagues and with the help of special instruments in the operating room, I will remove the mass.  

Breast Infection

What causes breast infection (mastitis)?

Mastitis is most commonly seen in patients who are breastfeeding. It is caused by a break in the skin or nipple allowing bacteria from the skin or the baby's mouth to get in. Clogged milk ducts can also lead to mastitis. Other risk factors are smoking and poor diet.

What are the symptoms of mastitis?

The most common symptoms are as follows:

• Redness 
• Warmth 
• Tenderness
• Swelling
• Pain with breastfeeding
• In more severe cases, fever and feeling ill

What are the risk factors for mastitis?

In lactating patients, breastfeeding, itself, is a risk factor as a result of milk stasis, clogged ducts and bacteria from babies mouth or skin entering within a break in the skin/nipple. 

In nonlactating women, smoking is the biggest risk factor in addition to cuts in the breasts, nipple piercings and poor diet.

What treatments are available for mastitis?

• For women who are lactating
  • we recommend breast rest, meaning no aggressive breastfeeding or pumping. 
  • Women could also consider over-the-counter aids including, ibuprofen, Tylenol and ice. 
  • Avoid massaging the breast to "help break down clogged ducts" as it can cause more harm than good. 
  • If this doesn't help after 24 to 48 hours, then we can try antibiotics. 
• For nonlactating women
  • Determining the cause is important. Antibiotics may be prescribed. 

Could mastitis be dangerous?

Sometimes mastitis can develop into an abscess (a collection of pus) or make a woman more ill. If the breast rest, ibuprofen, Tylenol and ice don't help, I recommend seeking medical attention. 

Breast Pain

What causes breast pain?

Breast pain is a common complaint. Women can have pain with their menstrual cycles as the breast is growing and changing to prepare for possible pregnancy and breastfeeding. Breast pain can also be caused by extra stress or trauma to the breast. Larger breasted patients can also have pain simply because of the weight of the breast stretching the ligaments within the breast. Some treatment options are a well-fitting, non-underwire bra that provides support and even a little bit of compression. Wearing a sports bra daily can also help. Over-the-counter medications, such as ibuprofen or Tylenol are effective along with avoiding caffeine. 

Breast Enhancement and Enlargement

Is it safe to enhance breasts size, shape and feel?

Many women want to alter the shape, fullness and perkiness of their breasts. They may consider creams, pumps, surgery or other options. 

Besides a healthy diet and exercise, I would recommend a well-fitting bra. I am not familiar with the efficacy of any creams or pumps for long-lasting changes, but surgery is safe although with every surgery there are potential risks. 

If someone is unhappy with her breast shape and size, I would recommend speaking with a plastic surgeon. 

Breast Care

What should women know about caring for their breasts?

Many women ask me about timing of their self-breast exam. I recommend doing breast exams one time a month at the same time every month. For those who still have a regular period, I would recommend choosing the last day of the period. For women who no longer have periods, choose the first day or last day of the month for the exam. Doing this, will help identify changes as opposed to daily or sporadically. 
 

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About Sindi Diko, DO

Dr. Sindi Diko is a board-certified, fellowship-trained surgeon with clinical interests in cancer in young patients as well as survivorship after cancer. She began her postsecondary education at University of Washington in Bothell, WA. She earned her doctor of osteopathic medicine medical degree at Rocky Vista University College of Osteopathic Medicine in Parker, CO. She completed her residency through St. Joseph’s University Medical Center in Paterson, NJ. She then served as a breast surgical oncology fellow at Women and Infants Hospital/Brown University in Providence, RI. She is a member of American Society of Breast Surgeons, Society of Surgical Oncology, American Society of Women Surgeons, American College of Surgeons and American Osteopathic Association. She has numerous publications, presentations and awards to her credit.

Dr. Diko is committed to affording each patient the same level of compassionate care she would extend to her own loved ones. She wants patients to feel safe in her care and empowered in making the best decisions for their individual breast health journey.

It is vitally important for Dr. Diko to be an ally throughout the process, and she has discovered this is best done through patient partnerships.

Outside of work, Dr. Diko is an avid traveler and nature lover. She also enjoys reading and painting.