Breast lump

Definition

Breast lumps in both men and women raise concern for breast cancer, even though most lumps are not cancer.

Alternative Names

Breast mass

Considerations

Both males and females of all ages have normal breast tissue. This tissue responds to hormone changes. Because of this, lumps can come and go.

Breast lumps may appear at any age:

• Both male and female infants may have breast lumps from their mother's estrogen when they are born. The lump will usually go away on its own as the estrogen clears from the baby's body.
• Young girls often develop "breast buds" that appear just before the beginning of puberty. These bumps may be tender. They are common around age 9, but may happen as early as age 6.
• Teenage boys may develop breast enlargement and lumps because of hormone changes in mid-puberty. Although this may be upsetting to boys, the lumps or growth almost always go away on their own over a period of months.

Causes

Lumps in a woman are often caused by fibrocystic changes, fibroadenomas, and cysts.

Fibrocystic changes are painful, lumpy breasts. Fibrocystic breast changes do not increase your risk of breast cancer. Symptoms are usually worse right before your menstrual period, and then improve after your period starts.

Fibroadenomas are noncancerous lumps that feel rubbery. They move easily inside the breast tissue. Like fibrocystic changes, they occur most often during the reproductive years. Usually, they are not tender. Except in rare cases, they do not become cancerous later. A doctor can feel during an exam whether a lump is a fibroadenoma. The only way to be sure, however, is to remove or biopsy the lump.

Cysts are fluid-filled sacs that often feel like soft grapes. These can sometimes be tender, especially just before your menstrual period.

Other causes of breast lumps include:

• Breast cancer
• Injury -- sometimes if your breast is badly bruised, there will be a collection of blood that feels like a lump. These lumps tend to get better on their own in a few days or weeks. If they do not improve, your doctor may have to drain the blood.
• Lipoma -- a collection of fatty tissue
  
• Milk cysts (sacs filled with milk) and infections (mastitis), which may turn into an abscess. These typically occur if you are breastfeeding or have recently given birth.

Home Care

See your health care provider if you have any new lumps or breast changes. Ask about your risk factors for breast cancer, and screening and prevention for breast cancer.

When to Contact a Medical Professional

Call your doctor if:

• The skin on your breast appears dimpled or wrinkled (like the peel of an orange)
• You find a new breast lump during your monthly self-exam
• You have bruising on your breast, but did not experience any injury
• You have nipple discharge, especially if it is bloody or pinkish (blood-tinged)
• Your nipple is inverted (turned inward) but normally is not inverted

Also call if:

• You are a woman, age 20 or older, and want guidance on how to perform a breast self-examination
• You are a woman over age 40 and have not had a mammogram in the past year

What to Expect at Your Office Visit

Your doctor will get a complete history from you, asking about factors that may increase your risk of breast cancer. The health care provider will perform a thorough breast examination. If you don't know how to perform a breast self-examination, ask your health care provider to teach you the proper method.

You may be asked medical history questions such as:

• When and how did you first notice the lump?
• Do you have other symptoms such as pain, nipple discharge, or fever?
• Where is the lump located?
• Do you do breast self-exams, and is this lump a recent change?
• Have you had any type of injury to your breast?
• Are you taking any hormones, medications, or supplements?

Steps your health care provider may take next include:

• Order a mammogram to look for cancer, or a breast ultrasound to see if the lump is solid or a cyst
• Use a needle to draw fluid out of a cyst, which will be examined under a microscope to look for cancer cells
• Order a breast biopsy
• Study any nipple discharge under a microscope 

How a breast lump is treated depends on the cause.

• Solid breast lumps are often removed with surgery.
• Cysts can be drained in the doctor's office. If the fluid removed is clear or greenish, and the lump disappears after it is drained, you do not need further treatment. If the lump does not disappear or comes back, it is usually removed with surgery.
• Breast infections are treated with antibiotics.
• If you are diagnosed with breast cancer, you will discuss your options carefully and thoroughly with your doctor.

References

Warner E. Clinical practice. Breast-cancer screening. N Engl J Med. 2011;365:1025-1032.

Cuzick J, DeCensi A, Arun B, Brown PH, Castiglione M, Dunn B, et al. Preventive therapy for breast cancer: a consensus statement. Lancet Oncol. 2011;12:496-503.

Heisey RE, McCready DR. Office management of a palpable breast lump with aspiration. CMAJ. 2010;182:693-696.

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