Tubercle of Montgomery by A.Griguolo

Generality

The tubercles of Montgomery are the skin reliefs that emerge on the areola of the female breasts, when the Montgomery glands increase in volume.

In most cases, the presence of Montgomery's tubercles is associated with circumstances such as pregnancy, puberty and menstruation; more rarely, an excess of stress, sudden changes in weight, breast cancer, the use of certain drugs, the habitual use of a bra that is too tight, etc.

Normally the Montgomery tubercles do not represent anything dangerous and annoying; however, if their size is considerable and their presence is not related to anything physiological (as it could be in the case of a pregnancy), they could constitute an aesthetic problem to be treated carefully.

Brief anatomical review of the female breast

The woman's breast is a skin relief, even and symmetrical, located in the front and upper part of the chest.

In the female breast, the main anatomical parts are 4 and correspond to: the mammary gland, the nipple, the areola and the adipose tissue.

• Mammary gland: localized inside the breast, it is the exocrine gland responsible for secreting milk under the stimulus of the hormone prolactin.
• Nipple: with a conical shape, it represents the external apex of the breast and the outlet point of the galactophore ducts of the mammary gland (NB: these are the ducts from which the milk comes out).
• Areola: it is the characteristic pigmented region that surrounds the nipple; in general, its diameter is around 3-5 centimeters.
• Adipose tissue: resides inside the breast, around the mammary gland; its quantities vary from woman to woman and are affected by age.

What are the Tubercles from Montgomery?

The Montgomery tubercles are the small skin reliefs that appear on the areola of the female breasts as a consequence of the enlargement of the sebaceous glands present in the area in question and known with the name of Montgomery glands .

In other words, the Montgomery tubercles are the part of the Montgomery glands that emerge on the areolar surface, when the aforementioned glands become more pronounced than normal.

What are sebaceous glands?

The sebaceous glands are exocrine glands responsible for the production of sebum.

Sebum is a greasy and greasy substance, which helps keep the skin soft and defend it from potentially dangerous external agents (eg, germs).

Features

Montgomery tubercles can have the appearance and size of small pimples or resemble the skin reliefs produced by the phenomenon of goose bumps .

As a rule, they emerge on the areola; however, if some Montgomery gland is present even at the level of the nipple, they may also occur at the level of the latter.

For obvious reasons, the number of Montgomery tubercles depends on the number of Montgomery glands; in a woman, these glands can be from 4 to almost 30 units, therefore it is possible to come across subjects with only 4 tubercles of Montgomery and in subjects with 28-29 tubercles of Montgomery.

What are the Montgomery glands for?

The Montgomery glands produce the sebum assigned to:

• Keep the skin of the breast moist and soft, e
• Disinfect the nipple and the areola, so that when a woman has to provide breastfeeding, she will provide the baby with a contamination-free milk.

Origin of the name

The tubercles of Montgomery, as well as the Montgomery glands, owe their name to William Fetherstone Montgomery (1797-1859), the Irish obstetrician who first described them in 1837.

Causes

The Montgomery tubercles are the result of the enlargement of the Montgomery glands.

The most common causes of enlargement of the Montgomery glands are the typical hormonal changes that occur in women on three occasions:

• During and in the months following a pregnancy ;

• During puberty ;
• Shortly before and during menstruation .

It is important to point out that the hormonal changes characteristic of the three aforementioned circumstances are not always related to the enlargement of the Montgomery glands; in practical terms, this means that, for example, not all women who are pregnant or about to have their period present Montgomery's tubercles at areolar level.

Other factors that lead to the appearance of the Montgomery Tubercles

Although less frequent with respect to pregnancy, puberty and menstruation, it may be factors or circumstances that cause the enlargement of the Montgomery glands and the subsequent appearance of Montgomery tubercles.

• Excessive stress;
• Hormonal imbalances due to circumstances other than pregnancy, puberty and menstruation;
• Breast cancer (rare);
• A sudden increase or an equally sudden drop in body weight;
• The usual use of a bra too tight;
• Nipple stimulation;
• Taking certain medications.

Clinical meaning

The Montgomery glands become larger when they increase their activity, ie when sebum production increases ; this means that the tubercles of Montgomery represent the visual signal of a more intense activity by the homonymous glands.

The greater activity of the Montgomery glands does not always coincide with their enlargement. When this happens, it is impossible to observe the Montgomery tubercles.

Tubercles from Montgomery and Pregnancy

The Montgomery tubercles owe their notoriety especially to the correlation with pregnancy. Compared to this important moment in a woman's life, in fact, the tubercles of Montgomery represent a sort of symptom or sign of a conception, exactly like:

• Morning sickness and vomiting;
• The enlargement and increased sensitivity of the breast;
• The absence of menstruation;
• Mood swings;
• Foot edema;
• The sense of recurring fatigue;
• Cravings for certain foods;
• The need to urinate frequently.

According to the most recent statistics, the Montgomery tubercles would be found in 3-5 pregnant women every 10 (therefore in 30-50% of pregnancy). With this numerical data, it is intended to remind readers that not all pregnant women present the tubercles of Montgomery.

Remedies

For a woman who is healthy and not pregnant, the Montgomery tubercles can be a kind of imperfection, especially when they are large.

In such circumstances, various natural remedies exist to reduce the Montgomery tubercles, including:

• The application in correspondence of the breast of a towel soaked in warm water for about 20 minutes. The ideal time to implement this remedy is in the evening, before falling asleep;
• Increase your water intake. Water favors the release of excess sebum from the excretory ducts of the Montgomery glands; the excess sebum in the said excretors of the aforesaid glands favors the enlargement of the latter and the appearance of the Montgomery tubercles;

• Adopt a healthy diet, low in salt and sugar, and low in fat. Several experiments have shown that the excess of salt, sugar and fat in the diet favors the enlargement of the Montgomery glands and consequently the size of the Montgomery tubercles;
• Application on the nipples and on the areola of aloe vera gel, combined with shea butter and / or cocoa butter. Aloe gel absorbs fatty substances such as those contained in sebum; this frees the excretory ducts of the Montgomery glands, favoring the deflation of the latter;
• The application on the breast of an aqueous solution containing only dissolved green tea. Green tea is an antioxidant agent, which counteracts free radicals and cleanses the excretory ducts of the cutaneous glands such as the Montgomery glands;
• The application on the area of ​​the nipple and the areola of garlic juice for a total of about 20 minutes;
• The application on the nipple and areola of a calamine-based lotion. Calamine works by absorbing excess sebum present in the excretory ducts of the Montgomery glands.

  The best time to practice this natural remedy is in the evening, before going to bed;

• Breast washing with benzoyl peroxide based skin cleansers. Benzoyl peroxide reduces the production of sebum by the Montgomery glands, therefore it favors the deflation of the latter;
• Application on the breast of cucumbers. Cucumbers contain salicylic acid, which has an exfoliating and cleansing effect on the skin;
• The application on the skin of the breast of citrus juice. Citrus juice cleanses the skin, helps eliminate the excess sebum produced by the Montgomery glands.

If natural remedies fail, contact your doctor and seek advice from him on how to remove / reduce them.

What to do if the Montgomery Tubercles persist?

When the Montgomery tubercles persist despite the time and use of the above natural remedies, the referring physician could propose, as a solution, a surgical intervention aimed at their removal . The surgery in question is nothing particularly invasive, however it could compromise the ability to breastfeed (this is of interest, of course, for patients willing, sooner or later, to have children).

Important advice and recommendations

Regarding the management of Montgomery's tubercles, important advice and recommendations include:

• Take care of breast hygiene daily, in order to avoid infections or inflammation of the Montgomery glands. The enlargement of the Montgomery glands requires greater attention to breast hygiene, because it makes the glands themselves more susceptible to contracting infections or becoming inflamed.

  Daily breast cleansing is very important especially for breast-feeding women, who, if they develop an infection, could pass it on to a baby;

• Avoid applying oily substances on the breast, because these could favor the enlargement of the Montgomery tubercles;
• Wear a comfortable and clean bra every day . This behavior reduces the chances of developing infections in particularly sensitive Montgomery glands, when enlarged;
• Do not attempt to burst Montgomery's tubercles . This act could trigger an infectious process.