Breast lumps: Types of lumps and what they mean

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Breast lumps: Types of lumps and what they mean

Breast lumps — cysts, cancer, fibroadenomas and other types of breast lumps

Finding a breast lump can be alarming, but it doesn't necessarily mean you have breast cancer. The truth is, a breast lump can result from one of many benign breast conditions. But the possibility also exists that it could be cancer. That's why, when you notice a breast lump or other changes in one of your breasts, such as redness, swelling or skin changes, it's important to see your doctor promptly for evaluation.

Here's a look at types of breast lumps or masses, their causes and what kind of diagnostic or treatment measures might be necessary.

Fibrocystic changes

More than half of all women experience fibrocystic changes — lumpy, thickened tender areas in the breasts — as they get older. Multiplying cells within breast glands and overgrowth of fibrous tissue (fibrosis) in the breasts' supporting tissue cause fibrocystic changes. Large or small cysts can result when such overgrowth blocks ducts and prevents secretions from draining.

Fibrocystic areas of your breasts blend into the surrounding tissue and may move slightly when pressed. You may feel dull pain and a sensation of fullness in the upper, outer part of your breasts. Fibrocystic changes are associated with fluctuations in hormone levels both during your menstrual cycle and as you approach menopause. You may notice increasing lumpiness and tenderness in your breasts as the levels of your reproductive hormones fluctuate during these times. The condition often improves after menopause when levels of estrogen and progesterone drop.

Treatment for fibrocystic changes ranges from lifestyle adjustments to medication. Some research suggests that fibrocystic changes are linked to caffeine consumption, which promotes fluid retention. Your doctor may advise you to cut down on products containing caffeine, such as chocolate, coffee or cola. However, studies show mixed results regarding the effectiveness of limiting caffeine.

Other self-care options include wearing a supportive bra and taking over-the-counter pain relievers, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others). Other medications that have been effective in treating symptoms related to fibrocystic changes include oral contraceptives and danazol, a synthetic drug similar to the male hormone testosterone. However, doctors prescribe danazol only rarely — as in cases of severe breast pain that don't respond to other treatments — because side effects include menstrual irregularities, weight gain, facial hair, acne and hot flashes.

Multiple cysts

Image of multiple breast cysts

Overgrowth of glands and connective tissue (fibrocystic changes) can block ducts and cause cysts.

Cysts

Cysts are fluid-filled sacs caused by dilated ducts. Cysts are oval or round, smooth and firm, and they move slightly when you press them. Women in their 40s who are approaching menopause (perimenopause) often detect them as they experience fluctuating hormone levels. Cysts may come and go. Breast lumps caused by cysts feel hard and tender to the touch. Cysts appear most often during the two weeks before your period and resolve spontaneously after your period. Any associated breast pain usually goes away as the cyst resolves.

Your doctor can't determine from a clinical breast exam alone whether you have a cyst, so you'll need further evaluation. Most likely, your doctor will perform fine-needle aspiration (FNA), a procedure in which your doctor inserts a thin needle into your breast and the suspected cyst and withdraws (aspirates) any fluid. If the fluid withdrawn is yellow or straw colored, your doctor discards the fluid. If the fluid appears bloody, your doctor may send a sample to the lab to check for the presence of cancer cells. FNA usually relieves any pain associated with the cyst.

A breast lump caused by a cyst may resolve on its own. If the breast lump disappears after your doctor removes the fluid, and it doesn't return after six weeks, you won't need any further treatment. If the breast lump doesn't disappear on its own, or it recurs, you may need to have it surgically removed.

Breast cyst

Image of breast cyst

Cysts are fluid-filled sacs caused by dilated ducts. Cysts are oval or round, smooth and firm, and they move slightly when you press them.

Fibroadenomas

Fibroadenomas are round, firm, rubbery masses that arise from excess growth of glandular and connective tissue. These masses can grow to the size of a small plum, but they're benign and usually painless. If you have a fibroadenoma, it may bounce or move slightly when you press the area.

Fibroadenomas respond to hormonal changes and tend to enlarge during pregnancy and shrink after menopause. Women of any age may have them, but they're usually detected in women in their 20s or 30s. Your doctor can't tell from a clinical breast exam alone whether a breast lump is a fibroadenoma. Mammography and ultrasound may help with the diagnosis, but the only way to be certain of a fibroadenoma is to take a sample of tissue for lab analysis (biopsy). Your doctor may also recommend surgery to remove the lump completely.

Fibroadenomas sometimes disappear spontaneously. But your doctor may recommend surgical removal if a fibroadenoma persists, gets larger or you're anxious about it.

Fibroadenoma

Image of fibroadenoma

Fibroadenomas are benign masses that are usually painless and move slightly when you press the area.

Breast infection (mastitis)

Mastitis is a breast infection most often caused by bacteria that enter breast tissue during breast-feeding. You may feel a breast lump or area of thickened skin if you develop an abscess, one of the possible complications of mastitis.

Postmenopausal women may develop periductal mastitis. In this condition, milk ducts become inflamed, especially near the dark skin surrounding the nipple (areola). This can lead to scarring and widening of the milk ducts and could cause signs and symptoms such as a breast lump, pain, nipple discharge and nipple retraction. Doctors aren't sure what causes periductal mastitis.

Treatment for mild forms of mastitis includes antibiotics. However, if the antibiotics don't control the infection, or if the mastitis is severe, you may need surgery to remove the mass. Among older women, mastitis that isn't associated with pregnancy or that doesn't respond to antibiotics needs to be evaluated to make sure it isn't inflammatory breast cancer.

Trauma or injury to the breast (fat necrosis)

Trauma or other injury to the breast — such as after surgery or an accident — can lead to a condition known as fat necrosis. Fat necrosis often results in a lump of scar tissue that's firm, round and movable. If the injury is old, the breast lump may be painless. If the injury is recent, you may experience pain and bruising in the overlying skin. Breast lumps caused by fat necrosis often resolve spontaneously. However, if this doesn't happen, follow up with your doctor to make sure the breast lump isn't cancerous (malignant).

Because a cancerous lump may have features similar to a breast lump caused by fat necrosis, your doctor may order imaging tests, such as ultrasound, mammography or both. If the breast lump persists, your doctor may eventually recommend surgery to remove the mass.

Phyllodes tumor

A phyllodes tumor develops as a painless breast lump within the connective tissue of your breast. In rare instances, some phyllodes tumors are cancerous, but most are benign. Benign phyllodes tumors grow rapidly and may become very large.

Often it's difficult for your doctor to distinguish between a phyllodes tumor and a fibroadenoma — even after imaging tests and a needle biopsy. However, phyllodes tumors are much less common than fibroadenomas. Rapid growth of the mass may signal to your doctor that your breast lump is a phyllodes tumor.

Treating a phyllodes tumor usually involves surgery to remove the mass. After surgical removal, recurrence of the tumor remains a possibility.

Intraductal papilloma

An intraductal papilloma — a small, noncancerous growth in a milk duct — can cause a small breast lump that you feel behind and near the edge of your nipple (areola). An intraductal papilloma may also cause discharge from your nipple, either spontaneously or when you press on the breast lump. The discharge is often bloody. Your doctor may order imaging tests, such as mammography or ultrasound, to help make a diagnosis. Treatment usually involves surgery to remove the affected duct and examination of the tissue to check for cancer.

Breast cancer

A cancerous (malignant) breast lump is often painless, hard and irregularly shaped. It feels different from surrounding breast tissue. If the breast lump is attached to underlying muscle, it may not move when you press on it. Overlying skin on your breast may be dimpled or red.

Other signs include:

  • A spontaneous clear or bloody discharge from your nipple
  • Retraction or indentation of your nipple
  • A change in the size or contours of your breast
  • Any flattening or indentation of the skin over your breast
  • Pitting of the skin over your breast, like the skin of an orange

Treatment depends on the type of cancer, its stage and the appearance of cancer cells under the microscope. Options include surgery, radiation, chemotherapy and hormone therapy. Detecting breast cancer in its earliest possible stage — by having regular mammograms and clinical breast exams — gives you the best chance for successful treatment.

Last Updated: 05/17/2006
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