When I was about 21, I felt a hard place at the top of my right breast. Of course, I started worrying that I might have breast cancer, but I was too scared to call the doctor about it. When I went for my next check-up, I told him I found a lump. He felt it and said, “That’s not a lump. That’s your muscle.”
“But it’s on just one side.”
“You are right-handed,” he said, “so your muscle is more developed on that side.”
I felt like a fool, and my doctor’s attitude didn’t help. He acted like I should know the difference between a muscle and a lump, but how would I know? No one had ever explained to me what lumps feel like and what I should be looking for. My doctor should have praised me for noticing the difference between my breasts. Instead, his attitude made me feel afraid to ask doctors questions for years.
Here at HealthCentral, we get many questions from teenagers. Teens almost never get breast cancer, but between typical breast growth and non-cancerous breast problems, they have lots of questions about what’s normal. The questions tend to fall into four main categories: size, pain, skin, and lumps.
My breasts are different sizes. Should I be worried?
Many women have breasts that are different sizes — sometimes as much as a full cup difference. During puberty, this is especially common because breasts often don’t grow evenly. It’s nothing to worry about.
My breasts hurt. Could this be breast cancer?
There are quite a few common causes of breast pain. Breasts can have growing pains, just like legs. The growth stretches the skin and other tissues causing pain, and because breasts don’t always grow evenly, sometimes only one breast hurts.
Another normal reason for pain is something called cyclical breast pain. Many women have breast pain and tenderness, especially before their periods. If you have breast pain, notice when it happens. If it goes away after your period, it is just part of your normal cycle.
A painful spot on your breast could be a sign of an infection, especially if the skin is red. Although this isn’t common in teenagers, it can happen. Home remedies probably won’t help, so see a doctor.
Breast tenderness can also be an early sign of pregnancy. If there is a possibility that you might be pregnant, take a pregnancy test if you can. There is no age limit to buy pregnancy tests. If it’s positive, you’ll need to see a doctor or midwife as soon as possible to discuss next steps.
The skin on my breast is red, itchy, scaly, or dry. What should I do?
You can take care of some skin problems on your own, and others will require a doctor’s assistance.
A change in the color of your nipples and the darker area around it (called the areola) can be an early sign of pregnancy. As mentioned earlier, if there is a possibility that breast changes are signs of pregnancy, it is important to see a medical professional as soon as possible.
Many types of skin rashes can affect the breasts. Let your parents, the school nurse, or other trusted adult help you decide how to take care of a rash or other skin problem.
You can take some actions on your own to keep your skin healthy:
Let your breasts breathe. Don’t wear your bra at night, and be sure to rinse it thoroughly when you wash it. Some rashes and irritations can happen because the breasts create a dark, warm environment for organisms to grow.
Think about whether you have changed soaps and lotions. If you are having problems with skin irritation, switch to an unscented soap for sensitive skin. Some bath powder under your breast can help absorb moisture that sometimes leads to rashes.
Your breasts and other parts of your body that are growing fast like your hips may develop stretch marks — long lines that crease the surface of the skin. These are not dangerous, and usually fade over time. Nancy Redd, author of “Body Drama,” suggests drinking lots of water to hydrate the skin and help minimize the marks.
I feel a lump. Is it breast cancer?
For teenagers, the answer is almost always no. Breast cancer during puberty is exceedingly rare. But some lumps might need to be checked by a doctor. First of all, let’s talk about what is not a lump.
The first lump-like object you may feel when you enter puberty is called a breast bud. It is breast tissue that signals your breasts are about to grow. It is a hard and tender place right under the nipple.
You might be like me and mistake a muscle or rib for a lump because it feels different than the surrounding tissue. The little bumps around the edge of your nipples are called Montgomery’s glands, and they are normal. Pimples and moles can affect skin anywhere, including on your breast, and they are not considered lumps.
Your breasts are composed of milk ducts and lobules connected by fat and other tissue. When you examine your breasts, you may feel quite a few “lumps.” Probably what you are feeling is your own pattern of breast tissue. Women vary in how “lumpy” their breasts are, so it is important for you to get acquainted with what your breasts feel like.
In “Dr. Susan Love’s Breast Book,” Susan Love, M.D., describes how to find a real lump like this: “The lump will stick out prominently in midst of the smaller lumps that constitute normal lumpiness. You’ll know it’s something different.”
So, let’s say you do find a real lump. Does that mean you definitely have breast cancer? Absolutely not. According to Dr. Love, only one lump in 12 found in premenopausal women (meaning you haven’t yet gone through menopause) turns out to be breast cancer. Almost all of those will be in women well past their teens.
So what could that lump be? The most common type of lump found in teens is called a fibroadenoma. Usually a fibroadenoma is smooth and hard and can move around easily. It is not cancer, but you will need to let a doctor examine you to see if it needs to be biopsied or removed, just to be sure.
You might have a cyst, which is a fluid-filled sac in the breast tissue. Cysts may come and go with a woman’s menstrual cycle. They are not dangerous, but if they get too large or painful, a doctor can drain the fluid.
If you have found a lump in your breast, it is safe to wait for a month to see if it goes away or changes over the course of your menstrual cycle. However, if you have a lump that doesn’t change or gets larger, contact a doctor to find out what type it is. Don’t panic. Worry doesn’t help anyone, and the odds that your problem is dangerous are very small.
The bottom line
Part of growing up is becoming responsible for your own health, so it’s a good idea to notice how your breasts feel at different times of the month. Check them out in a mirror, and pay attention to how they feel when you shower. If you notice changes that concern you, let your mother, the school nurse, or another adult know. They can help you decide if this problem needs a doctor’s attention.
You may want to read more about puberty. Here are a few books I found helpful when I was writing this article.
“What’s Happening to My Body? Book for Girls: Revised Edition” by Lynda Madaras with Area Madaras. This book has complete information about all aspects of puberty.
“Body Drama” by Nancy Amanda Redd. This book is organized by questions girls have about the changes in their bodies. If you wonder whether your breasts look “normal,” you’ll find photos of real girls, real breasts, and other body parts in all shapes, sizes and colors so that you can see how wide the range of “normal” is.
“Dr. Susan Love’s Breast Book” by Susan M. Love, with Karen Lindsey. This is a big, thick book, and most of it is about breast cancer, but there are also excellent sections on normal breast development and about non-cancerous problems that women may have.
The Center for Young Women’s Health at Children’s Hospital in Boston has an excellent website with information about all aspects of teen health.
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Phyllis Johnson is an inflammatory breast cancer (IBC) survivor diagnosed in 1998. She has written about cancer for HealthCentral since 2007. She serves on the Board of Directors for the Inflammatory Breast Cancer Research Foundation, the oldest 501(3)© organization focused on research for IBC. She is a list monitor for an online support group at www.ibcsupport.org. Phyllis attends conferences such as the National Breast Cancer Coalition’s Project LEAD® Institute. She tweets at @mrsphjohnson.