Breast Lump

Reviewed By:   Anil Ghimire, MD

Breast lump is the growth of  extra tissue within the breasts. The extra tissue may be felt like a distinct mass or it can be felt as a firm, thick and hard area or as a red and swollen area. There may other associated finding like  nipple retraction, nipple discharge, dimpling of the skin and breast pain. When women feel a lump in their breast, they are worried about it being a cancer. That is a valid concern but you don’t need to panic. Upto 80 % of breast lumps are non cancer. Apart from cancer, breast lumps are be caused by benign changes of the breast., infection and injury to the breast.

 

Common Causes

  • Benign Breast diseases: These include fibrocystic breast disease, breast cyst and fibroadenoma. These are common between 20-50 years of age.
    • Fibrocystic breast disease is very common. More than half of women experience it at some point in their life. Hence, some people don’t call this  a disease and rather call it as fibrocystic changes of the breast. The breast feels lumpy with indistinct nodular feeling of the whole breast. These are small fluid filled sacs that fluctuates with menstrual cycle. Sometimes one of these sacs attain bigger size and present as a breast cyst which again changes size with menstrual cycle.
    • Fibroadenoma is the most common lump found in female breast. It presents as rubbery to firm, smooth and well defined lump that easily slides under the skin.
  • Infection: Infections can cause lump in the breast. Infection is common in breastfeeding women but can occur in non breastfeeding women. In breast feeding women it occurs 6-12 weeks after delivery but can occur at later stage. Continuing breastfeeding to recommended even if you develop mastitis or even if you are on antibiotics. If not controlled with antibiotics the infection turns into an abscess that needs to be surgically drained.
  • Malignant breast cancer: discussed elsewhere.
  • Injuries: Injury to fatty tissue in the breast can also cause a lump in the breast.
  • Others:
    • Intraductal papilloma: These are small wart-like growths of gland, fibrous  and blood vessels that develop in the milk duct. These are often single and frequently occur in the period around menopause.
    • Lipoma: Fatty growth within the fatty tissues of the breast. It is non-cancerous growth.
    • Galactocele: harmless mild filled sac

 

Diagnosis

Your doctor will obtain a medical history of your symptoms including a family history of any breast cancer. Your doctor will also perform a complete exam of your breast. If the breast exam is suggestive of fibrocystic changes, your doctor will ask you to come back after your menstrual period to repeat the breast exam. If the changes have resolved, you don’t need any further tests.If the changes persist you will need a mammogram or an ultrasound of the breast. Based on the results of ultrasound or mammogram you may need a biopsy of the lump to rule out a cancer.

 

Treatment

Breast lump caused by hormonal fluctuation do not need further treatment other than symptomatic treatment with painkillers. Vitamin E and evening primrose oil may alleviate pain associated with fibrocystic changes. Breast lump caused infection is treated with appropriate antibiotics. A breast abscess needs surgical drainage. Breast lump caused by cyst is treated by draining the fluid from the sac, Breast cancer is treated with surgery, chemotherapy and radiation therapy.

 

When to seek medical care?

A breast lump in premenopausal women can be monitored for a  month or two to see if changes or resolves because of hormonal fluctuation with menstruation. Immediate medical care should be sought if:

  • The lump is hard and fixed to the breast tissue.
  • There is discharge from the nipple such as pus or blood.
  • Lump is associated with fever
  • You feel enlarged lymph nodes under your armpits.
  • There is inversion or retraction of the nipple.
  • You notices changes in the breast skin like dimpling, redness or crusting.

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