Understanding Breast Lumps
Normal breast tissue under the skin has a uniformly soft, dough-like consistency throughout the breast except immediately around the nipple area. The normal breast of a mature woman may feel nodular or fibrous. The nipple usually has a slightly firmer consistency, but is symmetrical and smooth.
Breast lumps are unusual clumps, bumps, bulges, mounds or masses of tissue located anywhere in one or both breasts, even in the tissue that extends up towards the region under the arm, known as the axilla.
The look and feel of breast lumps vary by:
- Size — pea-size to plum-size or larger
- Shape — may be round with regular, smooth borders or have an irregular shape with ill-defined borders
- Feel — may be painless or painful to touch
- Location — can be densely attached and fixed to the underlying chest wall or can be mobile and more superficial towards the surface of the skin
- Color/texture — puckering, dimpling, or unusually pink or red appearance of skin around the lump.
Keep in mind, breast tissue changes throughout a woman's life cycle, so that what is normal for your breasts will vary with age and phase of life, and with menstrual cycle as hormone levels vary with time of month, or may be affected by medications such as birth-control hormones or menopausal-hormone supplements.
During the reproductive years your breasts may increase slightly in size or swell and become tender or sensitive just before your menstrual period. These symptoms typically disappear as menstrual bleeding winds down. If you are using hormones for birth control then the symptoms may vary on a monthly basis or persist from day to day until your body adjusts to the type of hormones you're using. Symptoms of tenderness or pain occasionally persist or become bothersome enough that changing the amount or type of hormone is recommended, or hormone use may be discontinued.
During pregnancy your breasts become noticeably more swollen and tender and the texture may be more nodular as the glandular units fill with milk secretions.
After pregnancy and during breast-feeding your breast tissue will swell even more than before delivery. The milk secretions tend to peak all at once, about two to four days after you deliver your baby. When the "milk comes in" so does the firmness, tenderness or increased sensitivity, and the nipples may leak milk, even just by rubbing against your clothing. The baby suckles and drains the breast of its milk during breast-feeding, resulting in a softened, less tender breast.
During or post-menopause your breasts will tend to be softer throughout and less nodular, less upright and less full, especially if you aren't taking estrogen hormone therapy. When taking such estrogen therapy, the breasts of some women can revert to premenopausal consistency and appearance.
Most benign breast conditions do not increase the risk of developing breast cancer. Below are some common benign breast conditions that can cause lumps:
Benign breast conditions that can cause lumps
- Cyclic breast changes
- Swelling, tenderness or pain just before or during menstruation
- May include the presence of one or more lumps
- Symptoms of swelling, pain, lumpiness disappear by the end of the menstrual period
- Fibrocystic changes, also known as general lumpiness or benign breast disease
- Very common, especially in women ages 30 to 50 years old
- Changes usually go away after menopause
- Fluid-filled, usually well-defined area in the breast
- Occur most often during ages 35-50 years
- Smaller ones may disappear; larger ones may need to be drained by inserting a fine needle to withdraw the fluid
- Usually solid, firm and round
- Usually painless
- May feel rubbery
- More common during late teens and early 20s
- Twice as frequent in African-American women
- Fatty necrosis
- Usually painless, round and firm
- Often formed after an injury to the breast, with bruising followed by disintegration of fatty tissue in the area
- Often mistaken for cancer; often requires removal or biopsy to thoroughly exclude possible cancer
- Sclerosing adenosis
- Excessive growth of breast lobules
- Often painful, but pain not related to menstrual periods
- May be confused for cancer; often biopsied or surgically removed to thoroughly exclude possible cancer
- Most commonly seen after delivery with breast-feeding, known as "postpartum mastitis"
- Usually due to blockage and inflammation of a breast duct, trapping breast milk and allowing growth of bacteria leading to infection
- Area usually red, warm, tender and lumpy
- Low- or high-grade fever may be present, with or without chills
- Often treated with antibiotics, surgery usually not necessary
- Mammary-duct ectasia
- Most often seen during menopausal years
- Blockage and inflammation of a duct near the nipple
- Can be painful, with green to gray nipple discharge
- Often treated with antibiotics, although surgical removal of the duct may be necessary
Your health-care provider will ask you about your general health; medical history, including your age and pregnancy history; your family history; and past and current use of medications. He or she then will perform a thorough exam of your breasts and nearby lymph nodes to locate and identify the lump.
If the lump is unusual in shape or size, unrelated to menstrual cycles, or is a persistent lump from the previous menstrual cycle, then you will most likely be scheduled for a mammogram, breast ultrasound or both to identify the lump, surrounding breast tissue and lymph nodes. Mammograms usually are taken of each breast, but diagnostic mammograms may be needed to focus on the lump or view other suspicious areas of the breast.
Biopsy, taking a sample of tissue, is usually advised for solid lumps. Biopsy can be excisional or incisional, needle, or localization.
Excisional biopsy is surgically removing the entire lump. Small lumps are usually removed this way by a breast surgeon as an outpatient or day-surgery procedure.
Incisional biopsy is surgically removing a small sample or piece of the lump. Large lumps are usually sampled this way, also as an outpatient or day-surgery procedure by a breast surgeon.
Needle biopsy is when a needle is inserted into a lump and material is withdrawn with suction from a syringe. The needle can be a fine needle (very thin), or can be a core needle, a larger needle with a cutting edge to remove a nugget of tissue.
Localization biopsy is when a mammogram, ultrasound, or three-dimensional X-ray is used to help identify the precise location of a lump, usually when the lump is too small or situated too deeply in the breast tissue to feel through the skin.
Removing a sample and thoroughly examining this breast-lump tissue is the only sure way to know if a breast lump, especially a solid breast lump, is cancer.
Contact your health-care provider right away and arrange to be seen if one or both breasts are found to have lump(s) that have any of the following characteristics:
- New or unusual
- Unrelated to a menstrual cycle or don't disappear after the next menstrual period
- Firm, hard or solid
- Irregularly shaped or have irregular borders
- Fixed or firmly attached to the chest wall
- Dimpling or puckering the skin over the lump
- Associated with irritated or reddened skin
When breast lumps aren't benign they are said to be cancerous or malignant. The diagnosis of breast cancer is confirmed by thoroughly evaluating a sample of breast tissue obtained by needle aspiration or surgical biopsy. Physical features of breast lumps that may suggest breast cancer include:
- Firm, hard or solid tissue
- Irregular borders
- May be fixed or firmly attached to the chest wall
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