Breast Lumps-Don’t Panic and Don’t Neglect

October 29, 2024

By: Dr. Surajit Bhattacharya, MBBS, M.S (General Surgery), M.Ch (Plastic Surgery)

Understanding Breast Lumps: Causes, Types, and When to Seek Medical Attention

You’re in the shower, checking your breasts, and suddenly your hands freeze – you’ve found a lump! What should you do now? First, don’t panic and remember this important fact: 80% of lumps found in the breast are benign, meaning they do not destroy tissues, do not metastasize to distant organs, and have a very low potential to develop into a malignant and cancerous tumor.
If you are under 40, it’s likely there’s no reason to worry, and if you regularly undergo mammography screenings, as long as the results are negative, the chances are quite good that it’s not a cancerous lump. Still, with all this information, it’s hard not to worry when finding a lump in the breast – what is it and why does it happen, what distinguishes a cancerous lump from a benign one, and will the lump disappear on its own? I ofen am in the receiving end of all these questions from my patients and will try to answer all these questions now.

What does a lump in the breast feel like?

Different lumps have different textures, and even two lumps of the same type can feel somewhat different from each other. A cyst, for example, feels somewhat like a small water balloon in the breast, or it can be more firm – somewhat like a grape. On the other hand, a lump caused by breast inflammation (mastitis) may have a more pointed shape and feel warm to the touch. Other types of lumps can look like dimples in the skin, and some can even cause the nipple to retract inward. Ultimately, the person who needs to examine the lump after you find it is your doctor, who will know how to diagnose it correctly and send you for tests to help identify it. Please do not try to exchange notes with your friends who have had breast lumps. Your condition can be very different and so will be your management.

Common Signs of Benign Breast Lumps

The breast is composed of fat, blood vessels, fibrous connective tissues, and glands, and it also has a complex system that produces milk, including milk lobules and ducts that lead to the nipple. This anatomy itself is full of lumps in various places, and what complicates it further is that just like you, your breasts are also aging and from menarche through pregnancy, lactation, repeat pregnancy to finally menopause its size, shape and feel keeps on changing. So, when looking for a lump in the breast, the following signs should be considered
• Size of the lump
• Mobility of the lump
• What type of edges the lump has
• Whether the lump is painful and does it pain only on some days or always
• Whether you have any nipple discharge staining your bra
• Are there any lumps in axilla (underarm) too?

A benign breast lump is usually one where you can clearly feel its edges and diagnose its shape, and it can also move slightly within the breast. This is actually the first thing that distinguishes it from a cancerous tumor, as a cancerous tumor does not have these characteristics. However, this is not a hard and fast rule because a cancerous tumor too, in its early stages, can move within the breast. The size of the lump can range from the size of a pea to the size of a golf ball, and it should “roll” between your fingers and not penetrate deeper into the breast tissues. Another difference is that a cancerous lump usually does not cause pain, while a benign lump does, though there are exceptions. For example, a relatively rare form of breast cancer called “inflammatory breast cancer” can cause pain, tenderness, and a burning sensation in the breast. This is because this cancer can spread to the skin and lymph tissues in the chest, and the pain is felt from these tissues.

How to know the type of lump

The only way to know what type of lump it is through a medical examination and sunsequent investigations. Depending on your age, medical history, family history of breast disease, and physical exam findings, you may be referred for a mammogram, ultrasound, FNAC (Fine Needle Aspiration Cytology) or biopsy. It is important to note that not every lump requires advanced tests, at least not immediately. If you have, for example, a fluid-filled cyst during your menstrual cycle, your doctor will likely want to re-examine your breast after the cycle to see if the cyst has disappeared. If it has, the doctor will know that the lump was benign and related to the hormonal changes your body experiences during the cycle.

Benign Breast Lumps

Most benign breast lumps are related to the menstrual cycle and hormonal changes, or fluid accumulation that comes with the cycle. Other benign lumps are related to blocked milk ducts, infection, or even breast injury. The likelihood of developing a benign breast lump increases with hormonal imbalances in your body or if there is a family history of benign breast lumps or breast cancer. Here are 7 conditions that cause benign breast lumps that are not cancerous:

Fibroadenoma

These lumps usually develop in young women during their teenage years or twenties and during pregnancy, and they shrink during menopause. Their size ranges from a few millimeters to several centimeters and they can be very painful. The lump is usually round and well-defined, and it can move under the skin. To confirm the diagnosis, the doctor will perform a biopsy guided by ultrasound, and if necessary, surgical removal. If the lump shrinks or does not grow over time, the doctor may decide to just monitor it without removing it.

Cyst

This lump is round or oval and filled with fluid. It is soft to the touch and will be softer as it gets larger. A cyst may come and go with the menstrual cycle, usually becoming larger and softer at the beginning of the cycle and disappearing by the end. An ultrasound is the best way to determine if the lump is a simple cyst or a more complex one that requires further testing. If it is a large cyst, it may need to be drained of fluid, which can be sent to a lab for further testing if the doctor deems it necessary.
Fibrocystic Breast Changes

Breast tissue may change over time, which happens in 30-60% of women, and at least 50% of women of childbearing age. Some studies even suggest the prevalence is higher – between 70-90%. The lump is characterized by a granular or smooth texture that moves freely in the breast, and additional symptoms may include tenderness, fibrous or rubber-like tissues, or a round fluid-filled cyst. Fibrocystic changes are related to hormonal changes, so they increase as menopause approaches but disappear during it. The doctor may recommend birth control pills to reduce the symptoms associated with this condition.

Nipple Discharge

Nipple discharge can accompany breast lumps, and the discharge itself can have various colors, including white, dark green, yellow, brown, or even clear. If the discharge is clear or contains blood, it is usually a sign that should raise a red flag and requires examination and imaging. Sudden discharge from one nipple alone is suspicious and requires a mammogram. If, on the other hand, the discharge comes from several ducts in the same nipple, it is not a cause for concern, unlike discharge from just one duct, which requires examination.

Mastitis

This inflammation is caused by an infection in the milk ducts, resulting in a lump in the breast accompanied by redness and warmth, as well as a high fever. It mainly occurs in breastfeeding women but can happen independently of breastfeeding and even in women who have passed menopause. Treatment includes cooling with ice, pain relievers, and antibiotics since the infection is bacterial.

Breast Abscess

Mostly seen in lactating women, this is an extremely painful condition accompanied with high fever. This usually needs high end antibiotics, analgesics and anti-inflammatory drugs, surgical drainage and stopping of lactation. The child has to be switched to top feed by the attending pediatrician.

Fat Necrosis

This occurs when breast fat tissue is damaged due to injury or post-surgery, such as breast reduction surgery. It results in a hard lump with an undefined shape that is quite sensitive to touch. Sometimes, such a lump can develop into a fatty cyst, which can be identified by a mammogram and is harmless.

Other Causes

There are various other medical conditions that can cause benign breast lumps, including
• Hyperplasia: An increase in the amount of organic tissue in the breast due to trauma, chronic inflammation, or hormonal change.
• Adenosis: Growth of the milk lobules in the breast.
• Intraductal Papilloma: A growth resembling a polyp developing in the breast ducts.
• Lipoma: A benign fatty tumor.

How to Know if a Lump Might Be Cancerous?

Although most breast lumps are benign, some indeed turn out to be cancerous. If a cancerous lump is not treated, it continues to grow and invade the healthy tissues nearby and can eventually reach other parts of the body. Therefore, it is always advisable to check lumps found in the breasts with a doctor as soon as they are noticed. Do not be afraid if the doctor refers you for additional tests, such as mammography, MRI, or ultrasound – additional tests do not automatically indicate a cancerous lump, and their purpose is to simply provide more information to the doctor.
Most cancerous lumps begin as single, hard lumps, and additional signs include:
• Changes in the appearance of the nipple
• Nipple discharge
• Nipple tenderness
• Puckered skin fixed to the lump
• Dimpling or bumps on the skin – like an orange peel (Peau-de-orange)
About half of the lumps appear in the upper part of the breast and the outer part, spreading toward the armpit. About 18% of lumps appear in the nipple area, about 11% in the lower part of the breast, and about 6% in the inner lower part.

What to Do If You Find a Lump?

First, don’t panic! Most benign lumps can be treated, and some will even disappear on their own, but it is always recommended to see a doctor to diagnose the lump. The doctor will decide how to proceed and whether additional tests or treatments are needed. Since many lumps change due to hormonal changes, it is advisable to examine the breast at different times throughout the month, such as before the menstrual cycle, during it, after it ends, and at the beginning.

Breast Self Examination

Breast self-exam, or regularly examining your breasts on your own, can be an important way to find breast cancer early, when it’s more likely to be treated successfully. This self examination schedule has two parts – look and feel and click this hyperlink to understand how to exactly do it: https://www.moffitt.org/cancers/breast-cancer/faqs/how-to-do-a-self-breast-exam/

Dr. Surajit Bhattacharya holds an MBBS, an M.S. in general surgery, and an M.Ch in plastic surgery from King George’s Medical College, Lucknow, India. He furthered his expertise with advanced training in Microsurgery from Bernard O’Brien Institute of Microsurgery, Melbourne, Australia, and Cranial Surgery from the Australian Cranio-Facial Unit, Adelaide, Australia. He is the Senior Consultant in Plastic Surgery at Sahara Hospital and Ajanta Hospital in Lucknow.