The 10 questions EVERY woman wants to ask a breast surgeon

The questions EVERY woman wants to ask about her breasts: NHS specialist surgeon reveals the explanation behind everything from leaking nipples to lopsided boobs

  • Lucy Khan, consultant cosmetic and oncoplastic breast surgeon, offers advice
  • Edinburgh-based surgeon revealed the importance of checking your breasts
  • Women quiz her about breast size and if discharge from nipples is ‘normal’ 

A breast surgeon has revealed the top ten most commonly asked questions in her clinic and explained why women should get a bra fitting every two years.     

During lockdown, patients with worrying symptoms, including lumps on their breasts, have been reluctant to make appointments with GPs. 

Lucy Khan, a consultant cosmetic and oncoplastic breast surgeon, based in Edinburgh, Scotland, revealed the importance of checking your breasts and explains how to do this at home. 

Many women quiz her about their breast size and if discharge from nipples is considered ‘normal’.  

Here Lucy – an NHS specialist in surgery for breast cancer and complex breast reconstruction  – shares the advice she regularly dishes out to women concerned about their breasts with FEMAIL.

Many women ask about their breast size and if discharge from nipples is considered ‘normal’ (file image) 

One breast is bigger than the other – should I be worried? 

Lucy revealed how a difference in cup size between breasts is ‘completely normal’ and referred to them as ‘sisters not twins’. 

The surgeon of 12 years said: ‘It is actually very rare for a woman to have exactly the same cup size for each breast.  

However, she added: ‘If you notice a sudden change in the size of one breast then this can rarely mean a problem. 

‘If one of your breasts swells up then it might be due to an infection or inflammation. 

‘You should get it checked out if the difference is new and see your doctor to arrange this.’ 

Is it normal to have discharge from my nipples?  

Most women will experience fluid from their nipples at some point in their lives, according to Lucy.   

She revealed how women who smoke are more likely to experience fluid from their nipples after the ducts become damaged and do not work as well. 

‘The general rule is that a small amount of creamy or greenish fluid coming from both nipples is safe. You might see it on your nightie when you wake up or if you squeeze the breast,’ Lucy said. 

Lucy Khan, a consultant cosmetic and oncoplastic breast surgeon, based in Edinburgh, Scotland

‘This is usually fluid coming from the ducts under the nipple. As you get a bit older, or if the ducts are damaged by smoking, then they don’t work as well. 

‘White or greenish mucus and material can build up before it escapes through the nipple.’ 

Lucy added how fluid that is coming from just one nipple should be checked over and women should seek medical advice if they notice clear, watery discharge or blood. 

What can I do about pain in my breasts?  

The surgeon revealed how breast pain is one of the most common reasons for women to seek medical advice. 

‘Breast pain is a really difficult thing and women often feel that the problem is ignored,’ Lucy said.  

‘The good news is that pain is not normally a symptom of serious disease or cancer.’

‘The breasts are held on to the front of your chest by strands of tissue – Cooper’s ligaments.

‘If you have large or heavy breasts, or as you get older and your breasts change, the weight of the tissue pulls on these ligaments. 

‘As they stretch sometimes they can actually break. A torn ligament heals by scarring and this can affect the nerves inside the breast which may cause electrical or shooting-type pains.’ 

She explained how ‘referred’ pain is another common problem which is caused by inflammation or damage to the muscles or ribs of the chest wall underneath the breast.   

Lucy added how a well-fitted bra that supports the breasts and ligaments can help and advises to get a fitting every two years to reflect changes in weight and size.  

Avoiding underwired and sports bras can also prevent pain in the lower crease of the breast and Lucy recommended paracetamol and topical gels such as ibuprofen to treat sore areas.  

My mother had breast cancer – will I get it too?  

Breast cancer is a very common disease, affecting up to one in seven women in the UK, Lucy explained. 

She said it is not uncommon to have a mother or sister who have experienced breast cancer but more than one first-degree relative might put you at a greater risk.   

You should see your doctor who may refer you on for an assessment of ‘family history’, Lucy said. 

GUIDE TO CHECKING YOUR BREASTS AT HOME 

Lucy revealed her quick guide to checking your breasts at home and advised setting a timer, such as in the bath or shower, to establish a routine.    

LOOK FOR CHANGES 

Have the nipples gone inwards? 

Is there a change to the breast contour? 

Can you notice any dimpling, swelling or puckering?

HOW TO CHECK 

1. While standing, use the three middle fingers to feel the breast with the flat of your hand

2. Starting clockwise from the top of the breast, feel around the surface, working from the outside towards the nipple to check for lumps or swellings

5. Lie flat on your back to spread the breast tissue out. Repeat step 2 to feel the whole breast

6. Feel under your armpits using the opposite hand on each side

7. If you feel a lump or a swelling, or it was very sore in one part, check again after one normal cycle

8. If the lump is still there after your cycle make an appointment to see your GP

‘If they find out that there are a lot of women (or even men) in your family who have had breast or ovarian cancer then you might have a gene test. 

The test checks to see if the person is carrying the breast cancer BRCA gene. A positive result allows patients to consider surgery or medication in order to reduce the risk of cancer. 

Lucy explained how women with the breast cancer BRCA gene are closely followed to check for symptoms and all women in the UK are offered regular breast screening as they approach 50.  

What are breast cysts and why do I get them?  

With age, women experience changes to their breasts, which can cause cysts to form, Lucy revealed.   

‘These are little collections of fluid but they can grow and become large lumps as the breast tissue breaks down and liquifies.’ 

While it is unknown why some women are more prone than others to cysts, Lucy said: ‘We do know that if you have had breast cysts before, you are more likely to get them again but you are no more or less likely to get breast cancer. 

The surgeon added: ‘This means that you can’t just ignore new lumps and rely on them being cysts- always get a lump checked.

‘If it looks like a cyst in the clinic then the surgeon can easily drain the fluid using a fine needle and the cyst should disappear.’ 

I have extra folds of fatty tissue under my armpits – what are they?  

Surprisingly, Lucy revealed how breast tissue can develop anywhere in the lines on either side of your body going from the armpit to the belly.  

She said: ‘It is really common for women to have extra breast tissue at the upper/outer part of the breast and in the armpit. 

‘We call this axillary breast tissue. Some ladies even have a small nipple on top of it and the tissue will increase in size if you are pregnant or breastfeeding!

‘It isn’t something to worry about but it can make it difficult to wear a bra or you might feel it is a bit unsightly. 

‘If it is a big problem for you then you can have surgery or liposuction to remove the extra tissue, although this isn’t routinely available on the NHS.’ 

Do I have to take my top off at the breast clinic?   

Lucy explained how it is important for a surgeon to examine a patient fully if they have noticed a lump or other breast problem.  

She said patients or asked to remove their top behind a curtain and the surgeon will look at the breasts before examining.    

‘The surgeon will look at the breasts before checkin them by gently feeling all parts of the armpit and breast tissue. 

‘The good news is that you will always be offered a female chaperone to be with you.’

She revealed how, under normal circumstances, patients can be accompanied by a partner, parent or friend in the room.    

‘You can’t always guarantee having a female surgeon or doctor, but they should always be gentle and explain what they are doing. 

‘A breast surgeon examines hundreds of breasts of all shapes and sizes, with all kinds of weird and wonderful diseases and problems.’ 

She recommended speaking to your doctor before an appointment if you feel anxious and said there is no need to be embarrassed.    

Is a mammogram painful?    

A mammogram is an X-ray of the breast which is used in breast screening and assessment of a lump. 

The breast is placed between two flat screen ‘plates’ and gently squeezed to spread the tissue out. 

However, the more spread-out the breast tissue is, the easier it is for the X-ray doctor (radiologist) to check the breast for any abnormalities. 

A mammogram is an X-ray of the breast which is used in breast screening and assessment of a lump (file image) 

Lucy said: ‘Some women have no trouble at all getting their mammogram while others can find it quite painful. 

‘Most ladies have a degree of discomfort while having the X-ray but it gets better almost immediately afterwards.

FIVE WAYS TO MAINTAIN HEALTHY BREASTS

1. Check your breasts regularly and thoroughly

2. Wear a fitted bra: Sports-type bras are ideal and it’s fine to go bra-free if you feel like it

3. Avoid drinking too much alcohol 

4. Try and maintain a healthy weight: Too much body fat increases the production of the female hormone oestrogen and high levels can increase the risk of cancer

5. Seek advice from a professional if you have any concerns 

‘Breast screening saves lives so it is really important to attend if you can.’ 

The surgeon recommend speaking to your mammographer beforehand and they may be able to make it more comfortable.   

Can I breastfeed after a breast reduction?  

Lucy revealed how breast reduction surgery is becoming more popular as women look to get fit and undertake more vigorous exercise. 

She said the procedure, carried out by a qualified specialist, can produce good results and many women are pleased with the outcome.  

During a reduction operation, breast tissue is removed and the position of the nipples are changed to be higher and more youthful. 

This means that some of the ducts under the nipple need to be cut and re-arranged which can interrupt the flow of milk if you have a baby in the future.

Lucy said: ‘Some ducts are left undamaged and others may eventually heal but no surgeon can guarantee that you will be able to breastfeed in the future. 

‘If this is really important to you then you should wait until after your family is complete before you have breast reduction.’ 

Can I go from an A-cup to an E-cup with a boob job?  

The surgeon, who specialises in breast implant augmentation, reduction and uplift surgery, at her private clinic, revealed how implants are still popular with women. 

She said: ‘Careful surgery by a specialist surgeon can give a fuller, more shapely breast. But no careful surgeon can guarantee a particular cup size after the operation. 

‘They will fully assess you and give a recommendation on the size of implant that your breast can safely accept. 

Lucy added: ‘An increase of 300-400cc is normal and this might lead to going up approximately two cup sizes. 

‘The types of incision, implants and the place where implants are placed (under or in front of muscle) all have a big effect on the end result of surgery.’ 

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