When to Worry About Breast Lumps

Common Causes of Benign Breast Lumps

Most benign breast lumps and conditions are directly related to your menstrual cycle, fluctuations in your hormones, or the fluid buildup that comes with your monthly period. Other benign breast lumps and conditions may be related to plugged milk ducts, infections, or even breast injuries. The risk for benign breast conditions increases for women who have never had children and those who have a history of irregular menstrual cycles or a family history of breast cancer.

Here are some of the most common benign breast conditions.

Fibrocystic Changes These changes cause a general lumpiness that can be described as “ropy” or “granular,” and they affect at least half of all women. Symptoms of fibrocystic change include tender, fibrous, rubbery tissue; a thickening of tissue; or a round, fluid-filled cyst. These changes, which are related to hormonal fluctuation, may increase as you approach middle age and disappear with menopause. Birth control pills may be recommended to ease symptoms.

Cysts These are round or oval fluid-filled sacs, and they are often tender to the touch, especially as they increase in size. They may come and go with your menstrual period, becoming larger and more tender at the beginning of your period and disappearing at the end. Ultrasound is the best imaging method to determine if a lump is a simple cyst or a complicated cyst, which requires further examination. Large cysts may require needle aspiration to drain the fluid, and the fluid may be sent to a lab for further evaluation if deemed necessary, per the Mayo Clinic.

Fibroadenoma These benign lumps occur primarily in young girls and women in their teens and twenties. They often grow during pregnancy but shrink during menopause, according to StatPearls. They can vary in size from a few millimeters to several inches in diameter and can be very painful. Fibroadenomas are typically round, movable under the skin, and with well-defined edges you can feel. To confirm the diagnosis, your doctor may perform an ultrasound-guided core biopsy, and, if necessary, a surgical removal. If the fibroadenoma shrinks or doesn’t grow over time, you may decide with your doctor to continue to watch the mass closely and not have it surgically removed.

Fat Necrosis This occurs when fatty breast tissue is damaged by an injury to the breast through unintentional trauma to the breast or surgery, such as a breast reduction. It results in firm, poorly defined lumps that can be quite tender to the touch. Fat necrosis often has a suspicious appearance on examination and imaging, so even with a history of injury or trauma to the breast, a core biopsy may be recommended to confirm the diagnosis. It’s more common in women with large breasts, particularly in those with obesity. Sometimes, fat necrosis evolves into an oil cyst, which has a very distinct appearance on a mammogram and is harmless.

Nipple Discharge Sometimes women experience nipple discharge with or without a breast lump. Nipple discharge often varies in color from clear or white to dark green, yellow, or brown. Clear or bloody nipple discharge is often cause for concern and requires further examination and imaging. Nipple discharge that comes from one nipple and not both is also suspicious, according to the Cleveland Clinic, and requires breast imaging.

Mastitis An infection of the milk duct, mastitis can create a lumpy, red, and warm breast, accompanied by fever. It occurs most commonly in women who are breastfeeding, but it can occur in non-breastfeeding women as well. Treatment involves warm compresses and antibiotics. Mastitis in a non-breastfeeding or post-menopausal woman with no history of trauma (or in rare cases, insect bites) is concerning and requires further examination, imaging, and a biopsy.

Other, Less-Common Conditions Some medical conditions cause breast lumps, including hyperplasia, which is an overgrowth of cells in the breast ducts or lobules; adenosis, which causes enlarged lobules; intraductal papilloma, a wart-like growth of gland tissue that grows in the duct; and lipoma, which is a benign fatty tumor.

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Signs of Cancerous Breast Tumors

Though most breast lumps are benign, some do turn out to be cancerous. If a tumor is cancerous, it will continue to grow and invade normal nearby tissue. If it isn’t treated, it can spread to other areas in the body.

Most cancerous breast tumors first appear as single, hard lumps or thickening under the skin. Other signs to watch for include a change in nipple appearance, nipple secretions, nipple tenderness, and dimpling or puckering of the skin.

About half of all cancerous breast lumps appear in the upper, outer quadrant of the breast, extending into the armpit; about 18 percent of breast cancer tumors show up in the nipple area; around 11 percent are found in the lower quadrant; and 6 percent are located in the lower, inner quadrant, according to Stony Brook Cancer Center.

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If You Find a Breast Lump

Most benign breast conditions are treatable, and some will even go away on their own, but it’s best to have your doctor confirm which approach is best for you. All breast lumps should be evaluated by a medical professional, who will help you decide how to proceed. Because of the fluctuations in breast tissue that occur in response to hormonal changes throughout the month, it’s typically a good idea to do a self-exam at the same point every month, such as a few days after the end of your menstrual cycle.

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