Dr Tariq Jagnarine
A breast lump is a localised swelling, protuberance, bulge, or bump on the breast that feels different from the breast tissue around it or the tissue in the same area of the other breast. There are different reasons why breast lumps develop.
While this article can help a person understand if a lump is likely to be cancerous, people should always seek advice for an unexplained breast lump. Some noncancerous lumps need treatment, and breast cancer does not appear in the same way for everyone.
CAUSES
The female breast consists of different types of tissue. The two main types are milk glands, which produce milk, and milk ducts, or tubes, for milk to pass through to reach the nipple. The breast also contains fibrous connective tissue, fatty tissue, nerves, blood vessels, and lymph nodes. Breast tissue composition can vary depending on the function. For example, during breastfeeding, the breasts will change. They will feel and look different. The breasts can also change throughout the monthly cycle. Each part of the breast can react in different ways to changes in body chemistry. These changes impact the sensations and texture of the breast, affecting the development of breast lumps. Possible causes of breast lumps include:
• Cysts
• Abscesses, which can indicate an infection, such as mastitis.
• Fibroadenoma
• Intraductal papillomas
• Fat necrosis
• Lipoma
• Breast cancer
• Gynecomastia, in males, when there is swelling in breast tissue.
Some breast lumps seem to have a distinct border, while others may feel like a general area of thickened tissue. Nipple discharge can occur with some lumps.
Types and symptoms
Breast lumps can develop for many reasons, cancerous and noncancerous. The symptoms may vary, depending on the cause of the lump.
• Noncancerous lumps
The size, feel, and texture of breast lumps can vary considerably. The consistency may help a physician diagnose what kind of a lump it is.
• Breast cysts
A breast cyst is a benign or noncancerous fluid-filled sac in the breast. They commonly affect females aged 30–50 years and are rare after menopause. It may cause no symptoms, or a person may notice:
• Smooth and rubbery lump under the skin
• Pain
• Nipple discharge
It is not clear what causes breast cysts, but they may develop in response to hormones related to menstruation. Cysts can be simple or complex. In both cases, a doctor may suggest removing it by aspiration, a type of surgery. Very rarely, a cyst with solid components that returns after aspiration is linked to underlying breast cancer.
• Abscesses
Abscesses sometimes develop in the breast, especially during breastfeeding. They are noncancerous and usually result from bacterial infections, such as mastitis. A person may notice:
• Lump or mass
• Pain and swelling
• Redness in nearby skin if the skin is pale, or a darkening of darker skin.
• Heat in the area around the abscess
• Discharge from the nipple
• Nausea and vomiting
• Fever
• Swollen lymph glands
Treatment will usually involve:
• Draining the abscess
• Taking antibiotics
• Using nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, to manage pain and inflammation.
If a breast abscess occurs when a person is not breastfeeding, a doctor may do tests to rule out breast cancer.
• Fibroadenoma
A breast fibroadenoma is an unusual growth of glandular tissue in the breast. It is a benign tumour with the following features:
• Round, rubbery solid lump
• Smooth borders
• Painless
Appearing most commonly in females aged 14–35 years, but can occur at any age, fibroadenomas often shrink and disappear over time. However, a person with a large fibroadenoma may wish to have it removed through surgery.
• Intraductal papillomas
Intraductal papillomas are a type of benign tumour. They are wart-like growths that develop in the ducts of the breast. They often:
• form a round or oval mass
• develop under the nipple.
• involve a clear or bloody discharge.
A surgeon can remove intraductal papilloma. They will likely test the tissue to rule out unusual growth that could indicate cancer, a Phyllodes tumour, or other lesions.
• Fat necrosis
Fat necrosis happens when fatty tissue in the breast does not receive enough oxygen. It becomes damaged and breaks down. It can happen after breast reconstruction surgery, trauma, a biopsy, and some medical treatments. There may be:
• Lumps due to oil cysts, which have a solid shell and fat or oil in the centre.
• Change in breast shape.
• Pain in some cases
• Lipoma
A lipoma is a benign, fatty tumour. It will likely be: soft, movable, painless
Lipomas can occur anywhere on the body, including the breast. They do not usually need treatment.
• Cancerous Lumps
A breast cancer lump, or tumour can appear in the breast or underarm. Warning signs include:
• Lump, thickening, or swelling of the breast.
• Skin irritation or dimpling
• Flaky skin on the breast or around the nipple that may be red or darker than the surrounding skin.
• Nipple pain
• Nipple inversion or pulling inward of the nipple.
• Discharge, which may contain blood.
• Changes in the size or shape of the breast
• Pain anywhere in the breast, although there is often no pain
Some people do not notice any symptoms, but following a doctor’s recommendations about screening can help identify breast cancer if it arises. The symptoms of breast cancer can resemble those of other breast lumps. It is a good idea to seek medical advice if any breast changes occur.
Checking for lumps
The American Cancer Society does not recommend self-examination as part of the screening process for breast cancer. However, it is essential to be aware of the breasts and any changes that take place. It is important to be familiar with the breasts. Knowing how the breasts normally feel can help people recognise any problematic changes or lumps.
The following guidelines will help people carry out a self-examination.
• Looking in a mirror, check the size, shape, and colour and look for visible swellings or lumps.
• Raise the arms and repeat step 1.
• Check for any discharge from the nipples that may be watery, milky, yellow, or with blood.
• Feel the breasts with a firm, smooth motion while lying down, including under the arms and down to the ribcage.
• Repeat step 4 while standing or sitting. It may be easier in the shower.
Even though most breast lumps are benign, a person should ask a doctor if they notice anything unusual.
PROCEDURES FOR DIAGNOSIS
If a person seeks medical advice for a breast lump, they may undergo one or more of the following tests:
• Physical examination
• Mammogram
• Breast ultrasound scan
• Breast biopsy to rule out cancer.
• MRI or CT scan to see if changes have occurred elsewhere in the body.
LUMPS IN MALES
Males can also have breast lumps for reasons similar to females. In some cases, the lump may indicate male breast cancer. However, the chance of a lump being cancerous is lower in males. Other reasons a male might have lumpy or enlarged breasts include:
• Gynecomastia, when the breast tissue enlarges due to a health condition or medication use
• Cyst or fluid-filled lump
• Lipoma, or fatty lump
• Adenoma, a benign tumour, although this is less common in males than females
• Subareolar breast abscess, a rare infectious disease in males
• Breast fat necrosis, also rare in males
