OpenHealth Q&A

Navigating Breast Health Concerns: Seeking Clarity

Greetings! I'm currently 22, nearly reaching my 23rd birthday, and I've struggled with weight issues for much of my life. To date, I have seen just one breast specialist for my concerns. Prior to consulting her, I visited a pediatrician and three different gynecologists, but I always felt my issues weren't taken seriously. Eventually, I requested a referral to see a breast surgeon, hoping for a more focused evaluation. Although she seemed to have good intentions with the information I provided, I find it difficult to trust her advice, particularly after she advised me that no follow-ups would be necessary until I reach 40, following our last visit early last year. My main source of doubt in my specialist’s evaluation stems from my worries that I didn’t adequately communicate my symptoms: flaking skin on the areola, waxy discharge from the nipple, and severe itchiness, all of which began simultaneously in 2021. Medical professionals have consistently assured me that my condition likely stems from hormonal factors along with a separate skin issue due to my age, yet this reasoning has been quite frustrating. Although my specialist indicated that I should return if I noticed any new skin changes, I'm contemplating getting a second opinion, even though it makes me feel apprehensive. The initial onslaught of symptoms began in early 2021 when I experienced intense itching in my right breast. I was devastated to discover the flaking skin and discharge. At that time, hydrocortisone provided some relief. However, earlier this March, the flaking returned. I was prescribed clotrimazole and betamethasone dipropionate in June, which alleviated some issues, but the flaking is making a comeback once more. A troubling thought that occupies my mind is the fact that around the same period when my breast symptoms first appeared (late February and March of this year), I also developed a persistent rash on my hand, which has proved resistant to topical treatments. As much as I hope I'm mistaken, I’m worried that my breast issues might point to a serious underlying condition and that the hand rash could signify a potential spread. This concern has only intensified since I lost two family members to metastatic cancer who were diagnosed late in their illness. I've hesitated to contact a dermatologist, but I'm starting to think it’s a necessary step. I've undergone ultrasounds and MRIs for both breasts, which revealed dense tissue, parenchymal enhancement, and 5mm foci of enhancement (though some MRIs noted “scattered foci”). These foci appeared stable for about a year, but I recently read some studies indicating that stability doesn’t fully exclude the risk of malignancy, even with small lesions. At my last consultation, I voiced my anxiety about the possibility of a biopsy, yet my specialist expressed a lack of confidence in proceeding with one due to the small size of the findings, suggesting that surgery would be the next option, which she felt was unnecessary. While I appreciated her candor, I couldn’t shake the feeling that my ongoing itchiness and concerns weren’t being taken seriously enough, and I often felt I had to advocate hard for any follow-up investigations. It also weighs on me that I might not have effectively from the outset conveyed that all these symptoms appeared simultaneously. For my next appointment, I intend to articulate my situation more clearly and seek to be truly heard. One question that arises for me: could doctors possibly doubt my account of symptoms? The visibility of discharge and flaking is often heightened post-shower, while the itchiness itself remains unseen. Even though these issues manifest randomly throughout my day, I find some comfort in knowing that my imaging results haven’t been entirely normal—even if they’ve been assessed as likely benign. **Questions for consideration:** 1. Would it be beneficial to obtain a second opinion from another breast specialist, or should I consider making another appointment with my original specialist? 2. I suspect my dermatologist appointment might lead to prescriptions for topical treatments for both my breast and hand. Would it be unreasonable to inquire about a skin biopsy? 1. Additionally, if a skin biopsy were performed on my areola, could there be issues with skin regeneration? 3. Do the combined symptoms of itchiness, discharge, and skin flaking suggest a potential need for further investigation? 4. Is there any clinical merit to conducting a skin biopsy in the affected region? 5. Can you clarify what the 5mm foci and parenchymal enhancement findings signify in my MRI results? 6. Would it make sense to advocate for an additional ultrasound and MRI? 7. Is obtaining a CD of the MRI, in addition to the report, likely to be more advantageous for any new breast specialist I consult?

Answers (1)

7/25/2025, 2:51:05 PM

OpenHealth AI

Main Points:

1. Seeking a second opinion can be beneficial to validate your concerns and symptoms.
2. Discussing the possibility of a skin biopsy with a dermatologist is reasonable, especially given your ongoing symptoms.
3. Your symptoms and MRI findings warrant further investigation and open communication with medical providers.

Explanation:

It’s completely understandable to feel anxiety and uncertainty about your breast health, especially given your personal and family history. Your symptoms—itchiness, flaking skin, and discharge—are significant and should not be dismissed. You've shown great initiative by seeking specialized care, but feeling heard and understood is just as important in managing your health.

1. Second Opinion: Consulting another breast specialist can help to affirm or challenge your current specialist's assessment. It allows you to discuss your symptoms and treatment options without feeling pressured. Trust in your caregiver is essential, and a second opinion can provide you with more information and peace of mind.

2. Dermatologist Visit: It is reasonable to inquire about a skin biopsy during your dermatology appointment, particularly since you have persistent skin symptoms. Skin biopsies, especially in the case of discharges or flaking, can provide crucial information that helps guide your treatment.

3. Skin Regeneration Concerns: A skin biopsy, although it can involve healing time and some discomfort, typically regenerates well. A dermatologist can explain what to expect if you decide to proceed with this option.

4. Need for Investigation: Yes, your combination of symptoms should indeed prompt further investigation. The ongoing nature of your symptoms suggests they may be more than just hormonal changes, and thus, further evaluation is necessary.

5. Understanding MRI Results: The "5mm foci" and "parenchymal enhancement" noted in your MRIs indicate small areas of tissue that may have increased blood flow (enhancement). While some findings can be normal, the stability over time is important; however, it does not guarantee that these findings are benign. Monitoring and possibly further imaging may be required.

6. Advocating for Further Imaging: Your symptoms and MRI findings can be valid reasons to consider additional ultrasounds or MRIs, especially if there are any changes or new symptoms. Expressing your concerns clearly can help your provider understand your need for further imaging.

7. CD of MRI: Obtaining a CD of your MRI along with the report can indeed be advantageous if you see a new specialist. It allows them to review the images in detail rather than relying solely on the written report.

Next Steps:

1. Consider making an appointment with a second breast specialist to discuss your history, symptoms, and the need for potential further investigation.
2. Schedule your dermatologist appointment, and prepare specific questions about skin biopsies and treatment options for both your breast and hand symptoms.
3. Communicate clearly with your specialist about your ongoing concerns and the importance of follow-up, so you feel more empowered in your care.
4. Gather your MRI documentation, including a CD of the images, to take with you for any new appointments to ensure comprehensive discussions about your symptoms and imaging.

Remember, advocating for your health is important, and it's perfectly valid to seek the answers and support you need.