Breast Lump: Causes, Diagnosis and Treatment

A breast lump is a localized swelling or bump in the breast that is different in feel and consistency from the rest of the breast.

Finding a breast lump can be alarming. However, there is no need to worry or panic.

It is important to remember, that most of the breast lumps are benign (meaning non-cancerous), and not of serious consequence. But since a breast lump can also be a sign of cancer, one must seek medical help for any lump or swelling discovered in the breasts.

Normal Variation in Breast Consistency

The female breast is composed of different types of tissue of varying consistency. These include glandular tissue, fatty tissue, and fibrous stroma.  The relative composition of the breast changes with age and function i.e., during pregnancy and breastfeeding. In addition, the breast tissue also responds to the hormonal changes produced during different phases of the menstrual cycle.

Read more about Anatomy of the Breast

Read more about Breast Milk production and Regulation

Breast tissue naturally has a lumpy texture. Some women have lumpier breasts than others. If the lumpiness can be felt throughout the breast and feels similar in both the breasts, then in most of the cases, it is not a cause of worry.

In many women, lumpiness along with pain increases just before the onset of menstruation and decreases after the menstruation is over. These lumps are caused due to the extra fluid accumulated within the breasts under the effect of hormones.

It is important for women to be familiar with their bodies and particularly their breasts. Knowing how the breasts normally feel along with the normal variation that occurs during each menstrual cycle can help in early recognition of significant changes or lumps.

Breast self-exam, which means regularly examining your breasts on your own, is an important way to detect breast lumps. This helps to detect breast cancer in the early stages when it is completely curable.

Read more about Breast Cancer: Risk Factors, Classification, Diagnosis and Treatment

Common Causes of Breast Lumps

Fibrocystic disease

It is a very common condition affecting more than half of all women. It occurs due to an exaggerated response of breast tissue to normal ovarian hormones resulting in the formation of fibrous lumps and small multiple cysts filled with fluid. They are most commonly seen in women between 20-50 years of age and usually disappear after menopause. The size of the lumps and associated pain usually increase before menstruation and decreases after the period ends.

Fibroadenoma

It is a benign tumor of the breast. It is a solid lump composed of fibrous and glandular tissue. Fibroadenomas occur most commonly in women between 15-35 years of age. They are usually painless and freely movable within the breast tissue on palpation (when rolled with pads of the fingers).

Blocked milk ducts

It is a common cause of painful breast lumps found during breastfeeding. Milk is produced by the breast cells from where through the ducts, it travels to the nipple. If the milk is not drained from the breast completely and frequently, it can lead to trapping of the milk within the breast as well as blockage of the duct.

Read more about Breast Lumps During Breastfeeding: Causes, Diagnosis, and Treatment

Read more about Breastfeeding-Benefits, Problems, and Tips for Better Feeding

Mastitis and breast abscess

Mastitis is an inflammation of the breast due to an underlying infection. It causes the breasts to become swollen and painful. It most commonly occurs in women who are breastfeeding. It is important to treat it early to prevent complications. If neglected, it can result in the formation of a breast abscess filled with pus which would need surgical incision and drainage.

Intraductal papillomas

These are wart-like lumps that develop in the milk ducts present in the breast. They are usually situated close to the nipple but can be found elsewhere in the breast. They often produce clear or greenish or bloody discharge from the nipple. They are however benign lumps and not cancerous.

Galactoceles

These are breast cysts that contain milk. They occur during the late stages of pregnancy or during breastfeeding. The lump feels like a smooth, round, moveable sac inside the breast. They are usually small and painless. They tend to resolve on their own with time. If large in size or causing discomfort they may be drained.

Simple breast cysts

These are soft cystic lumps filled with fluid. They can be left as such requiring no treatment or they may be drained using a syringe. They usually don’t recur after they are drained completely.

Fat necrosis

It is a lump of dead or damaged breast tissue. It can occur following injury or trauma, breast surgery or radiation to breast.  It is harmless, painless and doesn’t increase the risk of cancer.

Hamartoma

It is a benign, tumor-like growth composed of variable amounts of fat, fibrous and glandular tissue present in the breast.

Lipoma

It is a benign tumor composed of fatty tissue present within the breast.

Breast cancer

It is the most common cancer in women. In its early stages, it may not cause any symptoms. The most common symptom of breast cancer is a painless hard lump within the breast or the armpit. Other signs and symptoms include dimpling of the skin, inverted nipple, redness or pitting of the skin over the breast (like an orange peel) or scaling and crusting of the skin of the areola or breast.

Clinical Examination of a Breast Lump

A breast lump is usually discovered by a woman while doing breast self-examination or by a health care provider during a physical examination. Annual screening mammography may also help to detect suspicious lumps.

Read more about Screening of Breast Cancer

Clinical examination is the first and foremost step for the diagnosis of a breast lump. A health care professional will examine the swelling and based on the characteristics of the lump will advise which investigations are required.

• A red hot painful swelling is most likely due to blocked duct or mastitis or breast abscess.
• Vague and poorly defined lumps that are associated with pain during menstruation are likely due to fibrocystic disease.
• A  lump that is freely mobile within the breast is likely to be a fibroadenoma.
• Benign tumors will be soft or firm in consistency and will not be fixed to skin or underlying structures.
• Breast cancer is usually hard in consistency, painless and fixed to the underlying structures or overlying skin. It may cause the skin to dimple or to resemble an orange peel.

Investigations of a Breast Lump

Image Credit: https://cancercentrelondon.co.uk

Mammogram

Mammography uses low dose x-rays to examine the breasts. The breasts are exposed to a small amount of ionizing radiation and pictures of the inside of the breasts from different angles are obtained. It is the most effective non-invasive test to detect breast cancer.

Breast ultrasound

Ultrasound uses high-frequency sound waves to obtain pictures of the inside of the breasts. It is non-invasive and free of harmful radiation. It can capture images of areas of the breast that are difficult to see with mammography. It can distinguish between fluid-filled (cystic) and solid breast lumps. During pregnancy and lactation, ultrasound is considered superior to mammography because the hormone-induced changes in breast tissue cause an increase in the density of breast tissue making interpretation of mammograms difficult.

Breast MRI (Magnetic Resonance Imaging)

MRI uses a powerful magnetic field, radiofrequency pulses and a computer to produce images of the inside of the breasts. A contrast material is injected through a vein into the body before obtaining the images. MRI can be used to diagnose breast lumps in select high-risk patients, in cases of dense breast tissue or when findings of mammogram and ultrasound are not conclusive.

Read more about MRI in Breast Cancer- Indications and Procedure

Fine needle aspiration cytology (FNAC)

In this procedure, a fine needle is inserted into the lump and some material is aspirated. This material is then spread on a glass slide, stained with appropriate stains and examined under a microscope.

The procedure may be performed under the guidance of ultrasound.

In most of the cases, FNAC is able to categorize the lump as infectious, benign or cancerous. It is also a quick, relatively painless, non-invasive, outdoor procedure. The results are available within a few hours and can help to relieve the patient’s anxiety quickly.

Biopsy

Sometimes, when the results are inconclusive on FNAC, a biopsy may have to be performed to be sure that the lump is not cancerous. It is a small surgical procedure carried out under local anesthesia. A small piece of the breast lump is removed (and after a series of steps including processing, fixation, and staining) it is examined under a microscope. It is the best method to confirm whether cancer is present or not. However, the processing and other steps involved make it a lengthy procedure. The results are available in about 3-4 days.

A breast biopsy can be of various types

Core needle biopsy: A needle larger than that used for FNAC and having a special tip is used to remove a tiny sample of breast tissue.

Stereotactic biopsy: Mammography is used to precisely identify the suspicious area and then that area is biopsied.

Vacuum-assisted biopsy: A probe with a vacuum is inserted through a small incision in the skin and a sample of breast tissue is removed. It is performed under imaging guidance (ultrasound or mammogram or MRI).

Surgical biopsy: A small cut is made in the skin and part or whole of the lump is removed.

• Incisional biopsy: Only a part of the lump is removed.
• Excisional biopsy: The entire lump is removed. It is also called lumpectomy. If the lump turns out to be non-cancerous, it also serves as the only treatment required.

Treatment of Breast Lumps

Treatment of a breast lump depends on the cause. Moreover, not all breast lumps need to be treated.

Fibrocystic disease

Most women with fibrocystic breast disease don’t require invasive treatment. Home treatment is usually sufficient to relieve associated pain and discomfort.

Over-the-counter analgesics like nonsteroidal anti-inflammatory drugs (NSAIDs) (eg,  ibuprofen) and acetaminophen may be used to relieve pain and discomfort. Evening primrose oil supplements may help to reduce breast pain by changing the balance of fatty acids in the body. Since fibrocystic disease occurs due to the effect of hormones, oral contraceptives may help by lowering the levels of cycle-related hormones.

Blocked ducts

The mainstay of treatment is to empty the breasts frequently either by regular breastfeeding or by using a breast pump. Gentle breast massage and applying warm compresses also help to resolve a blocked duct.

Read more about Breast Pumps-Types, Working, Uses and Selection Tips

Mastitis

In the case of mastitis, antibiotics and anti-inflammatory medication are required.

Read more about Mastitis: Causes, Prevention, and Treatment

Breast abscess

Breast abscess needs to be surgically drained to remove pus and debris, followed by antibiotic administration.

Simple breast cysts

The cysts can be drained causing them to collapse. In case the cysts recur, they may be further investigated to rule out any associated cancer.

Galactocele

A galactocele can be left as such to allow it to resolve on its own. If causing discomfort or infection, it may be drained.

Benign tumors

In the case of benign tumors like fibroadenoma, lipoma, hamartoma, papilloma, etc, the lump may be excised. Very small lumps (less than 2-3 cm in size ) however, don’t require treatment and may be left as such.

Breast cancer

Treatment depends on the stage of cancer. Staging is done on the basis of the size of the tumor, invasive or noninvasive nature of the tumor,  lymph nodes involvement and spread of cancer to nearby or distant organs (called metastasis)

Read more about Staging of Breast Cancer

Read more about Metastasis or Metastatic Disease

The various treatment modalities include surgery (lumpectomy meaning removal of the lump or mastectomy meaning the removal of the breast), chemotherapy and radiotherapy.