Breast Lumps

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Introduction | Fine Needle Biopsy | Incisional Biopsy | Open Breast Biopsy

A breast lump is a growth of tissue that develops in the breast. The growth usually feels different from the surrounding tissue and may feel more prominent. The skin on the breast may become red with dimples or pitting as a result of the growth, while the nipple may experience inversion or abnormal discharge and pain. Some breast lumps may indicate breast cancer.

A breast lump can develop from any of the following:

  • Breast cancer
  • Injury or trauma to the breast
  • Breast cysts
  • Milk cyst (galactocele)
  • Fibrocystic breasts
  • Fibroadenoma
  • Lipoma
  • Hamartoma
  • Intraductal papilloma
  • Mastitis

Cysts

Cysts are round sacs of fluid caused by dilated ducts. They are smooth and firm and move slightly when pressed. They develop often in women who are approaching menopause and are experiencing fluctuations in hormone level. A fine-needle aspiration procedure is typically performed to relieve any pain associated with the cyst, as well as determine if further testing is needed for cancer suspicions. Cysts can develop into breast lumps, which are hard and round. The lumps sometimes disappear on their own after draining the fluids, but surgical removal is often necessary to permanently remove them if they do not disappear.

Fibrocystic changes

Fibrocystic changes are lumpy, thickened tender areas in the breasts that develop with age as cells multiply in the breast’s supporting tissue due to hormone fluctuations. These areas blend into the surrounding breast tissue but may move slightly been pressed. They can cause the upper part of the breasts to feel full and tender, and cysts can develop as a result of the cell overgrowth. Fibrocystic changes usually improve after menopause when hormone levels become more consistent. Treatment for fibrocystic changes can include wearing a supportive bra, taking over-the-counter pain relievers, and limiting caffeine consumption.

Fibroadenomas

Fibroadenomas are round, firm, usually painless benign masses that develop from excess growth of glandular and connective tissue. They are greatly affected by hormone changes and can develop in women of all ages. A biopsy, in addition to mammography and ultrasound, is usually needed to diagnosis a fibroadenoma. Surgical removal can permanently eliminate the lump, although lumps may disappear by themselves.

Breast infection (mastitis)

A breast infection known as mastitis can develop from bacteria that enter breast tissue during breast-feeding. The infection can cause a lump of thickened skin if you develop an abscess, one of the possible complications of mastitis. Periductal mastitis occurs when the milk ducts become inflamed, causing scarring and widening of the milk ducts. This may lead to lumps, pain, and nipple discharge or retraction. Treatment options include antibiotics for mild forms of infection, as well as surgery for advanced infections.

Trauma or injury to the breast

Trauma or injury to the breast from an accident or surgical procedure can lead to fat necrosis. Fat necrosis usually develops as a firm, round lump of scar tissue that moves when pressed. The lump is sometimes painful and may need to be tested for cancer, although this is rare. Surgical removal of the mass can be considered if the mass does not resolve on its own.

Phyllodes tumor

A phyllodes tumor is a painless breast lump within the connective tissue of the breast. These tumors are rarely cancerous. Benign phyllodes tumors grow rapidly and may become so large that it is mistaken for a fibroadenoma. Treatment usually involves surgical removal.

Intraductal papilloma

An intraductal papilloma is a small, noncancerous growth in a milk duct. It can produce a lump near the edge of the nipple that causes spontaneous, often bloody discharge from the nipple. Treatment usually involves surgical removal and further testing for cancer.

Breast cancer

A cancerous breast lump is typically painless, hard and irregularly shaped. It feels different from surrounding breast tissue. If the lump is attached to underlying muscle, it may not move when pressed. The breast skin may be dimpled or red. Additional signs include random clear or bloody nipple discharge, a change in breast shape, skin pitting, and nipple indentation.

Diagnosis

Fine-needle aspiration

A fine-needle aspiration procedure uses a thin needle to extract the fluids in the breast lump for evaluation. If the fluid does not contain blood, the lump is most likely a benign cyst that will later disappear. If the lump contains bloody fluid, the fluid will be sent to a lab for further analysis and testing for cancer. If the lump does not contain any fluid, further testing will still be required to check for cancer.

Ultrasound

Ultrasound uses sound waves to produce images of the breast lump. If the lump is painful, ultrasound will be used to guide a fine-needle aspiration procedure, which can relieve the pain. If the lump is painless and confirmed to be benign, aspiration is most likely not necessary. If ultrasound shows that the lump is solid, a breast biopsy may be done for further testing.

Mammogram

A diagnostic mammogram is a special kind of x-ray that provides views of the breast at higher magnification from several angles and focuses on the area where the lump is located. A mammogram may be done in conjunction with ultrasound to form a diagnosis, depending on the patient’s age since younger patients typically require ultrasound for denser breasts. If cancer is suspected, a needle biopsy and surgery may be necessary.

Magnetic resonance imaging

Magnetic resonance imaging (MRI) is an imaging test that uses magnetic energy rather than X-ray. An MRI can be used if clinical breast exams reveal specific areas of concern that other diagnostic tests did not detect. However, an MRI takes longer to perform than other imaging tests and can be difficult to read, making diagnosis more complicated. It also requires the injection of an intravenous dye in order to differentiate between areas of blood supply.

Breast biopsy

If the breast lump is solid, one of the following biopsy procedures may be used:

  • Fine-needle aspiration biopsy – A needle is used to collect a tissue sample; performed in the office
  • Core needle biopsy – A larger needle is used to extract a small, solid core of tissue; performed in the office.
  • Stereotactic biopsy – Uses stereo images (images of an area from multiple angles) and mammography to locate an abnormal area that appears on an imaging test but not detected with ultrasound or clinical exams. A sample of breast tissue is then removed using a needle.
  • Vacuum-assisted biopsy – A small cut is made in the skin so that a hollow probe connected to a vacuum can be inserted to remove tissue from an abnormal area.
  • Surgical biopsy – The entire lump plus some of the surrounding tissue are extracted for analysis. If the lump is too large to be easily removed, a portion of the lump is removed instead.

Treatment

If the breast lump is determined to be cancerous, a treatment plan will be made depending on the type of cancer and its stage. Options include surgery, radiation, chemotherapy and hormone therapy. If the breast lump is not cancerous, the patient may choose to have it removed for the peace of mind or monitore the lump area for a period of time. Any changes in the breast following evaluation must immediately be reported to your doctor. If diagnosis does not provide the adequate results, you may be referred to a surgeon or other specialist for further consultation.

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