NO doubt, you're one of those women who get perplexed when it comes to the changes that occur n your breasts. In the age where breast cancer is always a looming worry, many women get worried about every little lump and every change in their breasts - changes that have some running to the doctor for answers. This week Professor Horace Fletcher, gynaecologist and obstetrician, explains what's normal and what's cause for worry.

1. Hair growing from the nipples
Hair growing from the nipples may be normal especially as women get older. Excess hairiness on the chest (breasts) and chin may however be due to excess androgen (male hormone) production due to a hormonal imbalance. This is most commonly due to polycystic ovaries and  less commonly due to a hormone-producing tumour of the ovary (See your doctor).

2. Darkened areola
This is normal in women who are pregnant and is similar to the darkening of the face in some fair -skinned women (chloasma). It is due to excess Melanin Secreting Hormone, which occurs in pregnancy. Changes in skin colour and texture (rash) outside of pregnancy and breastfeeding should be evaluated.

3. Occasional changes in size of the breasts
Changes in breast size may be normal especially if this change is mild to moderate. It may result from pregnancy and breastfeeding. It can also occur with aging and with certain hormonal contraceptives or hormonal treatment for abnormal uterine bleeding. Sudden enlargement of the breasts, especially if there is a thickening or lump requires immediate evaluation by a doctor to rule out breast cancer.

4. Discharge from the breasts
Any abnormal discharge from the breasts needs evaluation by a doctor to make sure there is no serious problem in the breast, as it could be a small pituitary (part of the brain) tumour. Milky discharge may occur if recent breastfeeding or pregnancy occurred. Excess squeezing of the breast can also lead to a milky or clear discharge. Coloured discharges especially bloody are sinister and must be evaluated.

5. Sharp pains shooting in the breasts
Pains shooting in the breasts may be normal, especially if this is cyclical, that is, related to certain times of the menstrual cycle (near the period). Constant shooting pains in the breast sneed evaluation to rule out tumours.

6. One breast is larger than the other
This may be quite normal if the patient has been like this from menarche (when the periods started). However, a sudden change, in the relative sizes of the breast, needs evaluation by your doctor.

7. Extra nipples
This is a common finding and is a normal variation in some women.

8. Large breast swellings under the armpit
This may be normal in women who are breastfeeding and this is called the auxiliary tail. Large lumps under the armpit when not breastfeeding need evaluation, as this may be abnormal and can be a sign of cancer.

9. Nipple retraction (one nipple suddenly starts to pull inward)
This is when the breast is dimpling, or the breast looks like an orange. These are sinister signs, which need urgent medical evaluation. Longstanding nipple retraction may be quite normal if this is what the patient has known all her life.

10. Large bumps of the areola
Bumps around the areola are normal.

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