BREAST ISSUES IN MEN AND WOMEN

Breast issues in men and women

       All men and women have breast tissue, and can develop related problems, from infections, growth issues, hormonal effects and also a variety of lumps, both benign and cancerous.As the male or female embryo grows, breast tissue cells develop on the chest wall and so we are all born with breast tissue. Sometimes this is very noticeable - newborn babies will be sensitive to the effects of their mothers hormones, which can cause them to have obvious swollen breasts or lumps, even a tiny amount of milk production, but this should soon settle. Breast development is a normal part of puberty for girls and also, to a much lesser degree, for boys. Girls first notice nipple enlargement at around the age of eight to ten years-old, or sometimes earlier. Gradually there will be swelling and darkening of the areola around the nipple, progressing to development of the breast tissue in the early teens to form a more adult shape with a flattening of the areola which will make the nipple appear more prominent.

       For boys, on average starting at around the age of 13 years-old or after, there will be slight swelling of the breast tissue which is normal as the tissue responds to pubertal hormone changes, although it can be a little tender for a short time. This doesn’t mean they are developing ‘man-boobs’, and gradually it should settle down. By the end of puberty girls will have developed breasts of an adult size and shape which are symmetrical. However there is great variation in normal breast size. Once developed, breast size will be affected by general weight gain, or loss, and also cyclically there will be changes due to the normal hormonal changes of the monthly menstrual cycle. Slight lopsidedness is also normal and doesn't need treatment, although very occasionally adult women do have such a difference between their breasts that surgery may be available on the NHS to match them. Similarly most women are of an average size but if a woman has extremely large breasts which are causing her problems, particularly with shoulder strain, and she doesn’t have weight issues which could be causing this, breast reduction surgery may be an option.

       There are also great differences in nipple size and shape. Inverted nipples are common, and don’t signify a problem unless one changes and becomes inverted (when it wasn’t previously), in which case you should see your doctor. During Pregnancy there are a variety of natural changes to the breast, including:

• Tenderness in the first trimester
• General growth of the breast tissue and nipples through pregnancy
• Darkening of the areolae
• The appearance of small whiter bumps within the areolae called Montgomery’s tubercles

Towards the end of pregnancy the breasts secrete a clear, golden coloured ‘pre-milk’ called colostrum, and then once the baby is born normal milk flow will begin. Milk production outside of pregnancy is uncommon but may not be serious. Nipple stimulation occuring in people who go jogging without wearing a firm support bra may be enough to cause milk to leak, but there are also possible serious causes so you should get your doctor to check you out.Other things that change adult female breast size include hormonal medication such as the combined oral contraceptive pill In men, a small amount of breast tissue is normal. There is some variation within what is considered normal, but if the breast starts to grow again there may be a problem. This growth, called gynaemastia could be due to taking certain medicines (prescription or over-the-counter) or could be due to illicit drug use such as anabolic steroids or  cannabis, or through heavy drinking. Very rarely, it may be caused by a tumour or other disease, especially of the  livel testes or  pituitary gland. The commonest cause of male breast enlargement however is simply being overweight t, giving false gynaecomastia (otherwise referred to as ‘man-boobs’ or ‘moobs’), as fat is deposited around the body, including on the chest wall. A weight management plan involving a moderately reduced calorie intake, reduced alcohol intake and increased activity or exercise, is the best way to manage this.

Breast lumps can occur in any part of the breast tissue, in men and women. Most lumps will turn out to be benign, non-cancerous changes:

• Fibroadenomas - hormonal lumpiness related to a woman’s menstrual cycle which comes and goes
• Lipomas (fatty lumps)
• Benign cysts of the milk ducts

However a small percentage could be cancerous. See your GP for advice if you develop a lump, particularly as a woman, if it remains after your next period, or for both men and women if you have associated problems such as a nipple discharge, or lumps in the armpit. If your doctor is concerned they can arrange an urgent specialist appointment, including mammogram or ultrasound scan of the breast and biopsy if the lump is suspicious.

                                                                                  Prof. John Kurakar