Breast Lumps

What are Breast Lumps?

The majority of the breast lumps are benign in nature, however they should always be investigated.

Types of Benign Breast Conditions

Benign breast problems are of several types; but in general, they are classified according to the predominant symptom as

• Lumps
• Pain
• Nipple problems
• Infection of the breast

Causes of Breast Lumps

Localised Nodularity

If you have a lump in your breast, localised nodularity is a common finding reflecting the presence of lumpy or nodular breast tissue. These areas of localised nodularity are the usual causes of a benign breast lump.

It is generally noticed in the upper outer quadrants of the breasts.

Localized nodularity is just a physiological change; most women who have been previously diagnosed with "fibrocystic disease" may have had nodular breast tissue.

The cause of a breast lump may vary based on your age. Some lumps can be caused by:

• Fibroadenomas
• Cysts

About Fibroadenomas

Fibroadenomas are harmless lumps of glandular and fibrous tissue. Fibroadenomas do not increase the risk of breast cancer.

Typically, fibroadenoma develops from a lobule and later the glandular tissue and ducts grow over the lobule, forming a solid lump.

Fibroadenoma may vary in size from a few millimetres to five or more centimetres in diameter. Most palpable fibroadenomas are of 1-3 cm in size and are called simple fibroadenomas and some can grow to more than 5 cm and are called giant fibroadenomas.

How Common are Fibroadenomas?

About one in six (15%) women have fibroadenoma at some time in their life. Fibroadenomas occupy 12% of all the symptomatic breast masses; most common in women aged 20 to 40 and with peak incidence in 21-25 year age group.

In women over the age of 50 years, fibroadenoma occurs in less than 5% of the population.

Causes of Fibroadenomas

Although, the exact cause of fibroadenomas is unknown, effect of hormonal changes during period and pregnancy are suggestive.

Fibroadenomas can be solitary or multiple, palpable or impalpable.

Diagnosis of Fibroadenomas

Triple Testing is a combination of

1. clinical examination
2. imaging, and
3. biopsy

Imaging for Fibroadenomas

Fibroadenomas can be detectable as a lump by

• Palpation
• Mammogram
• Breast ultrasound

Any suspected fibroadenoma either palpable or impalpable that shows atypical features on clinical or imaging assessment requires pathological diagnosis by

• fine needle aspiration biopsy
• core biopsy, or
• surgical excision

Treatment of Breast Lumps and Fibroadenoma

After diagnosis, breast lumps and fibroadenomas can often be managed with clinical and imaging surveillance alone. Occasionally surgery is required to remove the lump.

It is entirely the women’s choice whether to have the fibroadenoma removed if it is stable, but mostly women will not go for removal unless the lump is large or symptomatic.

What are Breast Cysts?

Cysts are fluid entrapments in the breast tissue.

Cysts appears as lumps that are smooth, soft to firm, mobile, and sometimes tender and often of sudden onset.

Cysts are harmless.

Patients should be assured that a benign cyst does not significantly increase their risk of breast cancer.

Who is Affected by Breast Cysts?

Breast Cysts are common in women in the age group of 35-50. They usually cease with menopause, but are common in women taking Hormone Replacement Therapy (HRT).

Approximately 7% of women may have a palpable cyst at some point of their lives.

Diagnosis of Breast Cysts

Breast cysts can be impalpable, asymptomatic and are usually identified by an incidental finding on routine imaging.

On ultrasound, cysts appear as well-defined round or oval anechoic (black) lesions.

Atypical cysts though asymptomatic may require aspiration under the guidance of ultrasound and a sample will be sent for cytological assessment.

Typical breast cysts are not cancerous, and cysts do not increase breast cancer risk. Asymptomatic cysts with typical features of a benign cyst do not require treatment.

Draining Breast Cysts

The cystic fluid can be drained using a fine needle. Cyst fluid can vary in colour and consistency. The fluid can be clear or coloured- yellow, green, orange, or black.

Treatment of Symptomatic Cysts

Women with symptomatic cysts (causing significant discomfort) can be considered for aspiration to provide symptomatic relief, either under clinical or ultrasound guidance.

A palpable lump that has the typical features of a simple cyst on ultrasound does not require aspiration to confirm the diagnosis.

Surgery is rarely recommended for treating cysts.

Fat Necrosis

Fat necrosis occurs due to trauma (sudden injury) or a specific injury to the breast. Breasts are made up of lobules, ducts, glandular, fibrous, and fatty tissue.

The damaged area of breast tissue can lead to a lump formation known as fat necrosis. Necrosis refers to cell death. The damage to the fatty breast tissue commonly occurs following breast surgery, including breast reduction and breast reconstruction, or radiotherapy to the breast.

Most women diagnosed with fat necrosis have no history of any specific injury at all.

Fat necrosis appears like a firm painless lump, but some women may have tenderness or even pain. The skin around the lump may look red, bruised, or occasionally dimpled.

At times fat necrosis, can cause the nipple to retract inwards. Although fat necrosis is benign, it can sometimes look like breast cancer. These lumps of breast tissue may appear as malignant breast tumours on mammograms and other imaging studies.

Therefore, for a proper diagnosis full triple assessment is required.

Fat necrosis often resolves on its own. If the lump does not disappear over time, or increases in size, a small surgery may be recommended to remove the lump. Fat necrosis can be observed in women of any age. It is a benign breast condition and does not increase breast cancer risk.