Breast lumps and its solution during pregnancy: ‘’Breast Cancer awareness Month special’’ (By Dr. Akanksha Chikhlikar Aich, Specialist Breast Surgeon)

 

‘’October month is observed as breast cancer awareness month. During this month, through different activities worldwide, organizations create awareness about this type of cancer, which affects a large population of women. It tries to make people aware of the need for early detection of breast cancer, its treatment options and prevention methods that can help save lives. 

According to WHO, there are about 1.38 million new cases and 458 000 deaths from breast cancer each year (IARC Globocan, 2008). Breast cancer is by far the most common cancer in women worldwide.’’

It’s another regular day of your antenatal period, you get up looking forward to your daily chores, everything planned beforehand and then you notice a lump in your breast while bathing …anxiety and fear strikes like a jolt of electric shock. Now what?

Relax, all lumps are not cancer.

Here are some tips and guidance to help you with early detection.

We know we need to check our breast regularly and be on the lookout for unusual bumps you can't remember being there before. If you do find one, don't panic - some women breasts are naturally lumpy, without it being a sign of cancer. But if it's a new lump, feels different from other lumps, or you just want some reassurance, its advisable to visit your doctor.

Breast lumps sometimes develop during pregnancy. The most common ones are:

Cysts (fluid-filled sacs)

Galactoceles (milk-filled cysts) 

Fibroadenomas (which develop in the lobules of the breast)

These are benign breast conditions (not cancer).

A fibroadenoma prior to pregnancy may present as a bigger lump during pregnancy.

 In  early  second trimester our breasts starts preparing to nurse our baby, and sometimes a milk duct can get blocked  and enlarged during the process. How can you know for sure? Clogged milk ducts are usually hard, red lumps that are tender to the touch and tend to clear up after a few days (they may continue to clog up, same way when you’re lactating).These irritating bumps are a sign that your body is preparing to nourish your baby and if you do choose to breastfeed, it will reduce the chances of breast cancer later in life.

Blocked Duct

To feel better, apply warm compress to the lump regularly (or run hot water on the area during showers) and massage the duct, which should help unclog the milk build up and eliminate the lump. Some experts suggest to use good supportive bras rather than underwire ones. If the lump doesn’t clear up or gets worse, check with your doctor to ensure it’s not infected.

Choose a day each month that will be easy to remember and make breast self -awareness a regular part of your good health routine.

1. Stand before a mirror and look at both breasts. Check for anything unusual, such as nipple retraction, redness, puckering, dimpling or scaling of the skin. Look for nipple discharge. All discharge should be reported to your doctor.

Note the color, whether it came from one or more openings.

2. Next, press your hands firmly on your hips and lean slightly toward your mirror as you pull your shoulders and elbows forward with a squeezing or hugging motion. Look for any change in the normal shape of your breasts.

3. Looking in the mirror, raise your arms and rest your hands behind your head. This allows you to see the underside of your breasts.

4. Place your left hand on your waist, roll your shoulder forward and reach into your underarm area and check for enlarged lymph nodes (small glands that fill with fluid when you have  an infection). An enlarged node would feel like a corn kernel or a bean. Also check the area above and below the collar bone. Repeat on the right side.

5. Raise your left arm. Use the pads of three or four fingers of your right hand to examine your left breast. Use three levels of pressure (light, medium and firm) while moving in  a circular motion. Check your breast area using a set pattern. You can choose (1)lines, (2) circles or (3) wedges.

i. Lines

Beginning at the outer edge of your breast, move your fingers downward using a circular motion until they are below the breast. Then move your fingers slightly toward the middle and slowly move back up.

ii. Circles

Beginning at the outer edge of your breast, use the flat part of your fingers, moving in circles slowly around the breast. Gradually make smaller and smaller circles toward the nipple. Be sure to check behind the nipple.

iii. Wedges

Starting at the outer edge of the breast, move your fingers towards the nipple and back to the edge.

6. Lie flat on your back with your left arm over your head and a pillow or folded towel under your left shoulder. This position flattens the breast and makes it easier to examine. Use the same motion described in Step 5. Some women like to use body lotion in this step.

Occasionally, breast cancer is diagnosed in pregnancy, and early detection is the key to better outcome. Consultation with a breast specialist, a thorough physical exam, and an ultrasound helps in diagnosis. Nothing to worry about.

Most often we find cysts, without any increased risk of breast cancer. But in about 30 percent of women, excess proliferation is seen which can be cancerous or can be associated with an increased risk of breast cancer in future. We need to be vigilant and consistent with regular follow-ups and appropriate investigations.

 A Lump in the Armpit While Pregnant

Swollen Lymph Nodes

Ø  Coming across a pea-sized lump in the armpit during pregnancy will leave you all worried and tensed. But there is no reason to stress yourself. Among many other changes that your body goes through during pregnancy, this is one of them.

Ø  It is important to note that the lump is also a part of the breast. Yes, it may be strange to hear this since we believe that the breast is usually the portion that is present in the chest region. In reality, the actual section can extend to the armpit as well, reaching the point of division quite easily. The lines that occur when this happens, resembling a valley of sorts, are termed as milk ridges. Breasts undergo expansion during pregnancy and even when lactation sets in after the child has been delivered. This can cause the breast tissue to expand in the area of the armpit as well.

 

MORE ON BREAST CANCER AWARENESS

Risk Factors: who needs to be more careful

• Family History: Women whose mother or sister had breast cancer carry a higher risk of developing this disease.
• Breast lumps- Women who have had some type of non-cancerous breast lumps are more likely to develop cancer later on.
• Dense breast tissue - Women with dense breast tissue have a higher chance of developing breast cancer.
• Age: As women get older, they are at higher risk of breast cancer.
• Diet and lifestyle choices: Women who smoke, eat high fat diet, drink alcohol is more at risk of developing breast cancer.
• Radiation Exposure: Frequent exposure to X-Rays and CT scans may raise a women's chance of developing breast cancer. 
• Obesity: Overweight women are at a higher risk of developing breast cancer.
• Oestrogen exposure – Women who started having periods earlier or entered menopause later than usual are at a higher risk of developing breast cancer. This is because their bodies have been exposed to oestrogen for longer duration.

 

Tips for Breast Cancer Prevention

It is important to self-examine your breasts. Women should be aware as to how their breast normally look and feel. If you feel any change, then consult the doctor. 

·    It is advisable for women who are around 40 and above to get their mammography done. Mammography is a simple radiographic technique which helps in detecting irregularities in the breast tissue.

·    Addition of vegetables and fruits in your diet helps in maintaining a healthy body weight.

·    For new mothers, it is advisable to breastfeed their child for minimum of one year. 

·    Don’t smoke or drink alcohol in excess.

NEED OF THE HOUR - awareness about breast examination, beginning from 20 years of age, and regular screening from a qualified doctor, so that it can be detected early and treated successfully. 

 

      "Early detection is the key to prevention."

Dr. Akanksha Chikhlikar Aich, (Specialist Breast Surgeon & an Wonderful new Mom)

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Maintaining Oral Hygiene in Kids (By Dr Deepali Srivastava)

Many parents have a tough time wondering how much dental care their kids need. When should a baby starts brushing? 

When  should  they visit a pedodontist first  or which is  the right paste and toothbrush they should use for their children and many more of such questions. 

Well ! Good oral hygiene should be introduced as early as infancy. 

IMPORTANCE OF GOOD ORAL HYGIENE

Many parents may assume that primary teeth or baby teeth dont matter much as they will loose anyhow. But baby teeth actually matters a lot .

NEED TO MAINTAIN BABY TEETH 

1. Baby teeth assist in development of child's speech

2.  Tooth decay (early childhood caries) may lead to  pain, infections in other parts like ear ,sinus, and brain. 

3. May have a negative impact on the development of permanent teeth which may lead to future dental problems like crowded teeth, malocclusion, improper jaw development, problem in eating and many more.

BABIES TEETH DEVELOPMENT 

To our surprise ! babies are born with a full set of 20 baby teeth (primary or deciduous teeth) hidden in their gums ‐10 in the upper jaw and 10 in the lower jaw. Development of baby teeth starts within the womb itself. 

Mostly the 1st tooth appears between 6‐10 months but it  may vary and most children will have their full set of baby teeth by the age of 3yrs.

HOW TO MAINTAIN GOOD ORAL HYGIENE 

Dental care for babies should start before babies first tooth appears. Babies aged between 0 to 6 months need only breast milk or formula milk so u can simply wipe your baby's gums and tongue with a damp cloth or a gauze twice a day 

As soon as the first tooth erupts clean the teeth using a soft infant tooth brush. Cleaning and caring for children's teeth early on sets up good dental habits life long .

HOW TO BRUSH BABY TEETH

• Keep your baby in a position where you can easily see baby's mouth .

• Hold the baby's chin in your hand and baby's head resting against your body

• Lift your baby's lip to clean teeth using soft circular motions

• Make sure you spend time on front and back of each tooth and also the gum line

• Encourage to brush without swallowing 

• CAUTION:  Brushing should always be under strict supervision of parents upto the age 6-7 years as children might swallow the excessive amount of fluoride toothpaste which may harm the tooth enamel and may lead to dental fluorosis (stains on teeth) if continued for longer time. Also it may cause upset stomach if ingested in larger amount. 

If your baby does not like brushing you can try making it more fun by letting your baby play with their favorite toys or by singing songs or being a role model as babies have a tendency  to mimic.  

Encourage your child to hold the tooth brush which will make him feel that he/she is involved in the action. This way your baby will get to know that brushing is a normal part of daily routine. 

TYPE OF TOOTHBRUSH 

It is very important to choose the right kind of tooth brush . For children aged upto 2-5 years use a small oval heads ,soft bristles of different heights and non slip cushioned handles. For children below 2 yrs finger brush can also be used.

Keep the toothbrush clean and replace the tooth brush every 3-5months .

TYPE OF TOOTHPASTE 

•  Below 2years  ‐ use either low fluoride toothpaste or fluoride free toothpaste with amount not more than a rice grain. 

•  2 years and above ‐ you can use fluoridated tooth paste with amount of pea size. 

• When your baby starts using toothpaste teach them to spit it out . If your child is not able to rinse properly no need  to worry  as small amount of fluoride tooth paste left behind protects your child's teeth.

• You may use any of the good brands of toothpaste available in market like kidodent, candycop, cheerio etc. keeping the fluoride content in mind according to your child's age.

IMPORTANCE OF FLUORIDE IN TOOTHPASTE 

Fluoride is a natural and a safe mineral .it is made as an active ingredient of many toothpaste as it helps us in many ways‐

• Prevents tooth decay

• Reverse the early tooth decay

• Strengthens the weekend tooth enamel

• Slow the loss of minerals from tooth enamel

• Limit the growth of oral bacteria

 WHAT IS EARLY CHILDHOOD CARIES ???

Early childhood caries (ECC) are cavities that usually develops in the upper front teeth of children but may affect the other teeth also.

Initially it appears as white spots near gum lines and as it worsens it appears as brown spots, holes or broken teeth which may require more involved procedures to fix it. It is very important to stop the decay early to prevent it from getting worse.

 HOW ECC HAPPENS ?

• It happens when the liquids and the food that contains sugar are allowed to left in your baby's mouth for hours. Bacteria starts working in the presence of sugar and makes acid which overtime destroys the tooth enamel.

HOW CAN YOU PREVENT ECC ?

• One of the easiest and best way to prevent  it is  by not putting your child to bed with  bottles filled with milk ,or any other sweet liquids or juices.

 • Give your child bottles only during meals . Do not allow them to walk around with the bottle throughout the day.

• No dipping of pacifiers in any kind of sweetened liquid. More importantly pacifiers should not be given after 2 years of age as it may lead  to overbite or cross bite which may require orthodontic treatment in future. 

• Adopt a healthy balanced diet and limit the intake of sugary and starchy foods and snacks. Avoid too much of chocolates and candies. Avoid sugary foods in between the meals.

• Maintain a habit of daily brushing of the teeth twice a day ,one in the morning  before breakfast and other at night before bedtime.

• Frequent rinsing of crowded teeth as proper brushing is difficult in such teeth.

• Make them learn to drink liquids from glass as early as possible preferably before they turn one year of age as children who do bottle feeding after 15 months are at higher risk of getting ECC.

• Do not scare from a dentist. Plan a visit to a pedodontist for an early evaluation and discuss with him your child's developing caries and its treatment and the best way to prevent it.

Remember practicing good oral hygiene and making your child learn early to maintain proper oral hygiene can save him from all the pain and infections and  cumbersome dental treatment procedures .

Maintaining baby's teeth is of utmost importance as not only it affects the eating and speaking but may affect the permanent teeth in a manner as they may come out crowded, crooked which may affect their smile. 

A child's smile may affect their self esteem and confidence. A child's smile is the purest thing you could  ever see ,so let them enjoy the confidence of a beautiful smile as well, by teaching them the key points to maintain good oral hygiene.

Dr Deepali Srivastava (Dentist, and beautiful mom of an Angel)

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Most Beautiful Phase Comes With Dental Challenges as well (By Dr. Deepali Srivastava)

They get big.. veiny.. leaky.. and what not !! (By Dr. Akanksha Chikhlikar Aich, Specialist Breast Surgeon)

All kinds of wacky things happen to your body while it's making a baby—and your breasts, well, they are changing' big time. Here's everything you ever wanted to know about how your breasts will take shape as your pregnancy progresses.

It’s important to be aware regarding the changes in breast during and after pregnancy. This means getting to know how your breasts look and feel so you know what’s normal for you. This will help you feel more confident about noticing any unusual changes.

Dr. Akanksha Chikhlikar Aich (Specialist Breast Surgeon)

Breasts change a lot during pregnancy, so it can be difficult to notice any unusual changes at this time. If you’re unsure about any change to your breasts, talk to your specialist.

Breasts are made up of lobules (milk-producing glands) and ducts (tubes that carry milk to the nipple). These are surrounded by glandular, fibrous and fatty tissue. This tissue gives breasts their size and shape. The darker area of skin around the nipple is called the areola. On the areola there are some small raised bumps called Montgomery glands, which produce fluid to moisturise the nipple.

 They get big!!! Your belly isn't the only thing to expand during your pregnancy. From the start, the amount of fatty tissue and blood flow to your breasts increases in order to help the milk ducts and mammary glands grow. By just six weeks into pregnancy, many women's breasts have grown a full cup size or more.

 They get heavy!!! With all that increased blood flow and expanded glandular tissue, your breasts begin to swell. "Plus, your breasts and body begin to retain fluid, which is a side effect of increased progesterone and estrogen. By the ninth month of your pregnancy, the average woman has gained two pounds just in her breasts, according to the March of Dimes.

 They hurt!!!  Yes most of the times your breasts become increasingly tender. All that blood, swollen tissue, and fluid retention can leave your chest aching. In fact, sore breasts are one of the very first signs of pregnancy.

 They get veiny!!! You might notice a more prominent map of blue rivers snaking their way across your boobs as your pregnancy progresses. "Your veins are more noticeable underneath your skin because they are dilating to accommodate the increase in blood flow". Blood volume typically increases by 50% throughout pregnancy.

 They get Nipply !!! Your nipples start to take center stage, growing and becoming more defined, often sticking out more than they did before pregnancy. In addition, the areola will get larger and darker, which is a result of high-levels of estrogen.. The Montgomery glands (those small bumps dotting the areola) begin to enlarge and produce an oily substance that protects your nipples and areolas from cracking or drying out during this, uh, transformation.

 They might leak!!! In the second or third trimester, you might notice some golden-white kind of fluid leaking from your nipples. That's Colostrum the initial milk a woman produces midway through pregnancy and during the first few days after the delivery. This thick, concentrated fluid can also simply dry and crust on your nipples without much wetness. Still, some women may actually find that their breasts squirt or leak milk. "Towards the end of pregnancy, your breasts are excessively producing colostrum and milk and, sometimes, it's bound to come out," I suggest wearing breast pads if you find your boobs and your top—and bit damp.

 And They get stretch marks too!!! All that enlargement and swelling leads to your breast skin getting stretched—and that, unfortunately, can lead to stretch marks. As the skin stretches, your breasts might also start to itch.

However, current research suggests that topical treatments, such as cocoa butter and other oils specially coconut oil, do not prevent the formation of stretch mark. Research also says stretch marks and other skin changes usually fade after the birth of the baby.

Soothe the itching and keep your breast skin supple by applying a good moisturizer after showering and at bedtime, massaging with coconut oil also helps big time…..

 Yes They need your support!!!  It is prudent to invest in a supportive bra, which will help to relieve the new weight of your breasts and supporting your back. Look for one with a thick band (no underwire!) beneath the cups, wide shoulder straps, and an adjustable closure. Always go for cotton bras over synthetic ones; they're more comfortable as they allow the skin to breathe. And don't forget to keep them supported at night: A cotton sports bra, maternity bra, or a pregnancy sleep bra may make you more comfortable while you sleep.

When choosing a bra, look for one that has:

• good support
• wide straps
• adjustable closures
• no underwire
• cotton fabric composition
• seam-free design near the nipple

 AND…They will be forever changed!!! After you wean, your nipples will go back to their regular color and your breasts will return to roughly their pre-pregnancy size. But because your skin has been stretched, the loose skin and stretch marks are most likely there to stay. So instead of pining for your fingers on your big, heavy, veiny breasts, embrace this as they truly mark motherhood.

Hope these pointers will help you prepare better for the upcoming physiological changes.

I will be back with more, changes and problems in breast during and after pregnancy and lactation and how to deal with them.

Most Beautiful Phase Comes With Dental Challenges as well (By Dr. Deepali Srivastava)

Expecting a baby is the most exciting experience of women's life , pregnancy brings immense happiness and excitement however it comes along with wide range of challenges and surprises too.

I am Dr. Deepali Srivastava and being a dentist and a public health professional I would discuss few very common dental challenges which pregnant ladies face. 

One of the most common dental issue is bleeding gums others may include tooth caries, pregnancy tumor or pyogenic granuloma, halitosis or bad breath,loose tooth etc. During pregnancy women undergoes greatest hormonal and physiological changes of their lives which may affect their mouth as well. Almost every part of our body is affected not leaving behind the dental issues. Some women may experience various dental problems and some may not experience any. One of the most common dental problems which a pregnant women may experience is pregnancy gingivitis or bleeding gums. 

Around 60-75% of women experience bleeding gums. Bleeding gums usually appears in second and third trimester. Pregnancy causes hormonal changes that increases the risk of developing gingivitis. Signs of pregnancy gingivitis may vary from red swollen gums to severe swelling and mild bleeding from gums while brushing . As there is an increase in progesterone hormone so the plaque accumulation also increases and this might lead to bleeding gums or dental caries . Also due to increased hormone levels there is decreased salivation and this also adds to plaque accumulation . 

Dietary changes during pregnancy like increased consumption of carbohydrates also leads to plaque accumulation which may lead to bleeding gums and dental caries. Maternal oral health is a significant public health issue due to its prevalence and life-course connection with adverse pregnancy birth outcomes or early child hood caries. It is important to maintain the oral hygiene as it is related to our over all health. Pregnancy gingivitis if left untreated might be an added risk factor to preterm baby or low birth weight baby. During pregnancy the probability of developing dental issues increases which may have impact on foetus as well so it's important to maintain regular oral hygiene through out your pregnancy. 

Regular brushing of teeth twice daily, regular usage of dental floss ,mouth wash , gargles with Luke warm water with a pinch of salt in it will be helpful in preventing dental problems. If you are pregnant or plan to get pregnant visit your dentist for oral health check up. Schedule a dental check up for each trimester to keep your oral health check. Small dental procedures like scaling or tooth filling or tooth extraction can be done in the second trimester as it is the safest one if advised by your dentist. 

The physiological changes in your body will remain there for few months but the beauty of motherhood will be there lifelong so ladies enjoy your pregnancy with a beautiful smile on your glowing face by visiting your dentist regularly.

Dr. Deepali Srivastava (New Mom & Dentist)

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