"I've found a lump in my breast."
Don't panic. Nearly eighty percent of all breast lumps are benign (non-cancerous). Benign breast lumps are usually moveable and smooth, and can often be found in both breasts. There are several common causes of benign breast lumps:
- Benign breast changes
- Breast infection or injury
- Medications that may cause lumps or breast pain, especially birth control pills, hormone replacement therapy, soy products, and caffeine
Breast tissue changes during a woman's entire life. Breast tissue is particularly sensitive to estrogen and progesterone hormone levels that often fluctuate during the menstrual cycle.
What are the types of benign breast conditions?
- Fibrocystic changes - Changes in hormone balances during normal, monthly menstrual cycles can create, for some women, symptomatic breast changes that are referred to as fibrocystic changes. Cysts often are described as benign, tiny, fluid-filled sacs that may feel like lumps. Tenderness and lump size commonly increase the week before the menstrual period and lessen a week after. The lumps may be hard or rubbery and can appear as a single breast lump that may be large or small. Fibrocystic changes also can appear as thickening of the breast tissue. Fibrocystic changes can occur in one or both breasts and are the most common cause of benign breast lumps in women age 35 to 50. It is relatively uncommon for postmenopausal women to have symptomatic breast changes because of a lack of hormone stimulation of breast tissue.
- Simple cysts - Simple cysts are benign fluid-filled sacs that usually occur in both breasts. They can be single or multiple and can vary in size. Tenderness and lump size often change with the woman's menstrual cycle. Cysts may also be affected by caffeine (coffee, tea, chocolate, energy drinks).
- Fibroadenomas - Fibroadenomas are the most common benign solid tumors found in the female breast. They are round, rubbery, slippery lumps that move freely in the breast when pushed. They form as the result of excess formation of lobules (milk-producing glands) and stroma (connective tissue in the breast). Fibroadenomas are usually painless. They occur most often between the ages of 20 and 40 and are more common in African-American women.
- Intraductal papillomas - These are small, wart-like growths in the lining of the mammary duct near the nipple. They usually affect women 40 to 50 years of age and can produce bleeding from the nipple or nipple discharge.
- Traumatic fat necrosis - This condition occurs when there is trauma (sudden injury) or surgery to the breast. This causes fat to form in lumps. The lumps are usually round, firm, hard, single, painless and in the area of a surgical scar.
Can men have breast lumps?
Yes, adolescent boys and men can have tender breast enlargement, often with a lump beneath the nipple. Sometimes this is in one breast, often in both. This benign finding is called gynecomastia. Gynecomastia also can occur after taking certain types of medications.
Can a breast lump indicate an infection?
Possibly. Sometimes breast infections are first noticed as a painful lump, with or without redness. Mastitis is an infection that often occurs in women who are breastfeeding. Mastitis is caused by bacteria that enter the mammary ducts through the nipple. Localized pockets of infection will appear as tender, warm reddened areas in the breast.
By performing monthly breast self-exams, you can become familiar with the normal monthly changes in your breasts. Breast self-examination should be performed at the same time each month, 3 to 5 days after your menstrual period ends. If you have stopped menstruating, perform the exam on the same day of each month.
What should I do if I find a lump in my breast?
See your health care provider if you discover any new breast changes, changes that persist after your menstrual cycle, or changes that concern you. Conditions that should be checked by a health care provider include:
- An area that is distinctly different from any other area on either breast
- A lump or thickening in or near the breast, or in the underarm that persists through the menstrual cycle
- A change in the size, shape, or contour of the breast
- A mass or lump that may feel as small as a pea
- A marble-like area under the skin
- A change in the feel or appearance of the skin (dimpled, puckered, scaly or reddened area, thickened with orange peel appearance on the breast
- A change in the appearance of the nipple [inverted, creased, scaly, or reddened)
- Spontaneous bloody or clear fluid discharge from the nipples
What will happen at the appointment?
- A detailed health history will be taken.
- A thorough breast exam will be performed. Your health care provider will feel for lumps or other changes in the breast tissue.
- If there is a nipple discharge, a sample will be collected and examined under a microscope to detect the presence of cancer cells.
- Breast imaging (mammogram and/ or ultrasound) will be performed if your previous studies are not current. Ultrasound can help determine if the lump is a solid mass or filled with fluid.
Other diagnostic tests may be needed, such as:
- Fine needle aspiration (FNA): This is a non-surgical form of breast biopsy in which a small needle is used to withdraw a sample of cells from the breast lump. If the lump is a cyst (fluid-filled sac), removal of the fluid will cause the cyst to collapse. If the lump is solid, cells can be smeared onto slides for examination in the laboratory.
- Core biopsy: This is similar to FNA, but a larger needle is used because actual breast tissue is removed, rather than a sampling of cells. A sample of the lump is removed, but the whole lump is not removed. The types of core biopsies include ultrasound-guided core biopsy and stereotactic core biopsy.
- Ultrasound-guided core biopsy: This is a tissue sampling technique that does not require surgery. A biopsy needle is placed into the breast tissue. Ultrasound helps confirm the needle placement using sound waves reflected off breast tissue so the exact location of breast tissue is biopsied. The type of echo varies with each type of tissue. Ultrasound can distinguish many benign lesions, such as fluid-filled cysts, from solid lesions. Tissue samples are then taken through the needle.
- Stereotactic core biopsy: A biopsy needle is placed into the breast tissue. Computerized mammographic pictures help confirm the needle placement using digital imaging so the exact location of breast tissue is biopsied. Tissue samples are then taken through the needle.
- Open excisional biopsy: This is the surgical removal of the entire mass. The tissue is then studied under a microscope. If a rim of normal breast tissue is taken all the way around a lump (lumpectomy), biopsy can also serve as part of breast cancer treatment.
Cells or tissue that is removed are given to a pathologist, a physician who specializes in diagnosing abnormal tissue changes.
You may return to the health care provider for another evaluation in a few weeks.
How are benign breast conditions treated?
Fibrocystic breast changes do not require treatment. Your physician may recommend therapies that can help relieve monthly tenderness.
Large, painful simple cysts can be treated through fine needle aspiration, which may take place during or after the evaluation. After fluid is drawn from the cyst, the cyst collapses, and the pain goes away.
Fibroadenomas of certain size and if painful are recommended to be removed surgically.
Intraductal papillomas are removed surgically.
Mastitis can be treated with warm compresses. In some cases, an antibiotic medication may be prescribed.
What can I do for myself to maintain good breast health?
- Perform monthly breast self-examination.
- Have screening mammograms.
- Keep track of your family health history.
- Get a risk assessment by a medical breast specialist to determine if you are at high risk for developing breast cancer.