Traumatic Breast Injuries: When to Worry, When to Wait
Your breast can suffer a physical injury just like any other part of your anatomy. What kind of breast injury is serious enough to see a doctor? And can a breast injury lead to problems down the road – even breast cancer?
"My little brother punched me in the boob and it hurts a lot. Should I worry?"
"I was in a fender-bender, and the seatbelt really cut into my chest. Now I have a bruise. Should I see a doctor?"
"My basketball team was playing a really rough game, and I got elbowed in the breast going up for a rebound. That was a month ago; now I feel a lump. What is it?"
When you scrape your shin, bruise your thigh, or accidentally cut your finger, you don't really think too much about it, do you? Sure, it hurts; but given time, it'll heal. It's only a [shin] [thigh] [finger].
But somehow, an injury to your breast feels different. Not physically; a bruise is a bruise, and a breast bruise hurts just like one on your kneecap. But mentally – emotionally – breast injuries can be worrisome.
If you're a younger woman, you might worry about the effect of potential scarring on your love life, or your ability to nurse a baby. If older, you've automatically got breast cancer on your mind: can an injury lead to cancer?
Let's examine what happens when your breast suffers blunt trauma – the official medical term for a forceful injury to the breast.
Trauma can occur from a blow. Younger women sometimes contact us here to ask if their pesky little brother punching them is dangerous.
Trauma can also be the result of a car accident. Seatbelts save lives, but they've also increased the rate of blunt-force breast traumas significantly. An airbag deploying can also cause breast trauma.
Bruising and hematoma
Trauma almost always leads to internal bleeding; injury to the tissue in your breast, or both. Internal bleeding can be mild – that's what a simple bruise is, internal bleeding. Or it can be major, resulting in a hematoma, a large area of blood that's collected outside the blood vessels. In effect, a hematoma is simply a much larger bruise.
A simple bruise can be treated with cold compresses, to reduce both swelling and pain. Typical first aid would be to apply an ice pack for 20 to 30 minutes after the injury. Remove the pack for 15 minutes, to allow your skin to warm up; then repeat icing, for up to 3 hours. This should help keep any swelling to a minimum, and help control pain, as well.
If you're still experiencing bothersome pain the next day, ice it down again, this time for 15 minutes. After 3 or 4 days, switch from cold compresses to heat; a hot shower can help relieve any lingering pain.
A more serious bruise – a hematoma – will often appear not just discolored ('black and blue," or dark red), but may also bulge a bit. Hematomas can result not only from injury, but from surgery; so if you've had a mastectomy or lumpectomy, be alert for signs of swelling and discoloration.
If you think you have a hematoma, contact your doctor; s/he can decide whether to drain it, or to simply let it heal itself (which it usually will, in time). In the meantime, don't try to treat any pain with ibuprofen or aspirin; these drugs actually increase the likelihood of continued bleeding.** Tissue damage**
A blow to the breast may also cause tissue damage – often to fatty tissue, since breasts are usually composed mainly of fatty tissue. If the blow is hard enough, some of the tissue may die (undergo necrosis), which can lead to fibrosis: scar tissue. Necrosis can also result in the development of fatty cysts. Either of these may result in a lump or lumps you can feel.
Does injury lead to breast cancer?
The standard answer is no, it doesn't. Some small studies seem to show a possible relationship between breast trauma and breast cancer, but no large and reliable studies have shown a connection.
Breast injury can be dangerous for another reason, though
While a blow to the breast may not cause cancer, it can sometimes lead to false-negative mammograms – a mammogram that shows a "suspicious lesion," which turns out to be scar tissue.
Worse yet, scar tissue – the result of either a hematoma, or fat necrosis – can hide a cancerous tumor. Scar tissue (like a tumor) is opaque, and might block the mammogram's "view."
Thus it's important, if you've had a significant breast injury that might have resulted in scarring, that you let your doctor know about it. Armed with that knowledge, s/he may want extra views during your annual screening; and at the very least, she'll know ahead of time that a "suspicious" reading may show up in the radiologist's report.
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Breast cancer survivor and award-winning author PJ Hamel, a long-time contributor to the HealthCentral community, counsels women with breast cancer through the volunteer program at her local hospital. She founded and manages a large and active online survivor support network.