Protocol for Breast Injuries in Female Athletes

The popularity of female sport has been increased at an incredible pace over the last decade.

As a result, we have seen increases in funding, the uptake of better-quality coaches, and the introduction of high-level strength and conditioning programs into female sport across the globe.

In short, it is a very good thing.

However, because female athletes are now competing at such a high level, injury rates have been on the rise. And while there has been a large investment into injury prevention on a national scale, there is still very little attention paid to one of the most damaging injures on the planet.

Yep, you guessed it – breast injury.

How many athletes suffer breast injuries?

While not often discussed, breast injuries are extremely common (Smith, 2018).

In fact, recent research has suggested that up to 50% of all female collegiate athletes will receive a breast injury during their collegiate career. Obviously, this amount will be higher in team sports such as basketball, and lower in individual track events such as sprinting.

Just to reiterate the severity of this issue – one half of female athletes will receive a breast injury during their career.

And as bad as this is, it gets worse.

As breast injuries are rarely discussed, they seem to be considered less serious than other injuries. As a result, less than 10% of women who receive a breast injury will actually seek any advice or treatment – which is not a good thing. 

Common breast injuries

Within this, the most common breast injuries are generally those that involve some form of direct trauma to the breast.

This typically occurs in the form of direct contact from an opponent (whether it be a stray hand or elbow), direct contact from a ball (such as a baseball, soccer ball, or softball), or while making direct contact with the ground after a fall.

The next most common breast injuries appear to be those that are frictional in nature – which results in the skin of the breast becoming grazed.

Common sports breast injuries occur

So in what sports are breast injuries more likely to occur?

I alluded to this above, stating that individuals who compete in team sports are more likely to receive a breast injury than those who perform in individual athletic endeavours. Those sports where breast injuries are the most common are:

• Softball
• Basketball
• Soccer
• Volleyball

AS you would expect, there is also some evidence to suggest that breast injuries are extremely high among females who participate in combat sports, such as boxing, mixed martial arts, and taekwondo (Brisbine, 2019).

Current medical protocol for breast injuries in female athletes

While breast injuries are common, there is very little information when it comes to breast injury treatment.

In fact, most of the medical protocols surrounding breast injuries comes from research supporting the treatment of seatbelt related injuries to the breast tissue, which are often the result of car accidents (Sanders, 2011).

While the way in which these two types of injuries occur is markedly different, the way they present is quite similar. In fact, the he physiological response to these injuries is ultimately the same – being comprised of contusions, bruising, hematomas, oedema, and pain.

With this in mind, following a seat belt related breast injury, it is typically recommended that the athlete has a physical breast exam 3-6 months after the injury has occurred, as well as yearly mammograms and breast examinations.

This should remain the same for sport related breast injuries.

Additionally, considering their physiological presentations, the acute treatment of breast injuries should also include the application of cold, firm support, and even surgical consultation in the presence of a severe hematoma.

Is there a higher rate of breast cancer following breast injuries?

I have already alluded to the fact that breast injures can be quite damaging, but I didn’t actually outline any of the long-term effects of breast injury.

Which leads us to one of the most common questions that surrounds breast injuries: being, ‘is there a higher rate of breast cancer following breast injuries?’

And to put it simply, there appears to be a link (Rigby, 2002).

Evidence has shown that women with breast cancer were more likely to have experienced physical trauma to their breast in the last five years than those individuals who have not reported any breast injuries.

In short, there appears to be a causal link between breast injury and breast cancer.

Which is why getting regular check-ups after a breast injury is so damn important.

Related Article: Breast density, Exercise, and Breast Cancer: What You Need to Know

Relationship between breast injury and fat necrosis

While on the topic of breast injuries, it is important to discuss fat necrosis.

Breast fat necrosis essentially describes the development of dead adipose cells within the breast, that result from injured or ischemic breast tissue which has been replaced with scar tissue. Fat necrosis presents as a physical lump that is very similar to breast cancer.

It is essentially irreparably damaged breast tissue.

And why is this important?

Well the development of fat necrosis within the breast tissue is an extremely common occurrence after physical trauma to the breast – and considering that fat necrosis has been linked to increased incidence of chronic pain and anxiety, this needs to be considered closely (Vasei, 2019).

Tips for female athletes who have had breast trauma

I wanted to finish this article with a step by step approach regarding what to do if breast injury occurs. So, without further ado:

1. Immediately apply ice to the injured area (and continue to apply ice sporadically over the next 48 hours to keep inflammation down)
2. Implement firm support to take the load off the damaged tissue
3. Avoid running and other high impact sports for at least 72 hours after injury
4. Seek the advice of a medical professional within a week
5. Make sure to have a physical exam 12 weeks after the injury has occurred
6. Commence a routine of yearly mammograms

As simple as this treatment plan may look, I can assure you that it will offer an effective protocol you can follow in response to a breast injury occurring.

Handling future mammograms

Just to add some further information to the yearly mammograms, there are some additional factors that need to be mentioned.

See, in the case of a breast injury, it is essential that your healthcare professional is able to distinguish between scar tissue and fat necrosis, and a cancer of the breast.

This ability to distinguish between the two is what prevents the misdiagnoses of breast cancer.

With this in mind, those individuals with a past history of breast trauma should report their injury history in detail when getting future mammograms to give their healthcare professional as much information as possible.

This information is extremely helpful to the practitioner. It will help them interpret the result of the mammogram much more effectively – which in turn, improves their ability to treat you.

Take Home Message

Despite their extremely common occurrence, breast injuries are rarely discussed – and unfortunately, even less frequently reported.

And this must change.

In this article we highlight the potential long-term damage that a breast injury can cause. While offering some steps you can take immediately if one does happen to occur.

And importantly, if you know someone who has experienced a breast injury in the past, encourage them to get themselves checked out by a professional immediately. It could make a world of difference in the long run.

Related Article: 5 Ways HIIT Improves Fitness in Women

References

Smith, Laura J., Tamara D. Eichelberger, and Edward J. Kane. “Breast injuries in female collegiate. basketball, soccer, softball and volleyball athletes: prevalence, type and impact on sports participation.” European journal of breast health 14.1 (2018): 46.

Brisbine, Brooke R., et al. “The occurrence, causes and perceived performance effects of breast injuries in elite female athletes.” Journal of sports science & medicine 18.3 (2019): 569.

Sanders, Christopher, et al. “Blunt breast trauma: is there a standard of care?.” The American Surgeon 77.8 (2011): 1066-1069.

Rigby, J. E., et al. “Can physical trauma cause breast cancer?.” European journal of cancer prevention 11.3 (2002): 307-311.

Vasei, Narges, et al. “Fat necrosis in the Breast: A systematic review of clinical.” Lipids in health and disease 18.1 (2019): 139.

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