Lumps in the breasts

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Breast Lump Removal: Illustrated Series

Causes of breast lumps

Female breast

Normal female breast anatomy

Fibroadenoma

A potentially malignant (cancerous) breast lump may include some of these features:

• A painless lump that is firm or hard, with irregular borders (edges)
• Spontaneous nipple discharge -- usually bloody or straw-colored fluid
• Nipple changes -- retraction (pulling inward), enlargement, or itching
• Breast is no longer symmetrical, compared with what it previously looked like
• Skin changes
  • dimpling, retraction, "orange peel" appearance
  • redness, accentuated veins on breast surface, and eventually skin ulceration
• Bone pain
• Weight loss
• Armpit lump
• Swelling of the arm

Benign fibrocystic changes may range from mild to severe during the menstrual cycle. Symptoms typically peak just before each period and improve immediately after the period. The breast tissue has a dense, "cobblestone" consistency, usually more obvious along the outer edges of the breast. An intermittent (on and off) or persistent sense of breast "fullness" with dull, heavy pain and tenderness is experienced.

Your health care provider will perform a breast exam by feeling the breasts for lumps. Benign fibrocystic changes in both breasts are common. Benign lumps are usually rounded with smooth borders, either rubbery or slightly movable, and not anchored. Nipple discharge occurs only after the nipple is manipulated, is milky looking, and may be expressed from both breasts.

For a potentially cancerous breast lump, there may be spontaneous nipple discharge on one side from a single duct. Lymph nodes in the armpit may be enlarged or tender.

The following tests may be performed:

• A mammogram may help your doctor examine the features of the breast mass.
• Needle aspiration is a test that draws fluid from the breast lump. The fluid may suggest that the lump is a benign cyst. If the lump is a cyst, the lump is less likely to remain after the aspiration test.
• An ultrasound may be performed to see whether the lump is solid or cystic. Cancer is more commonly a solid mass.

A biopsy can confirm or rule out suspected cancer in solid lumps:

• Needle biopsy -- removal of cells for evaluation directly from the mass (can be done in conjunction with needle aspiration procedure)
• Incisional biopsy -- surgical removal of a portion of the mass for evaluation
• Excisional biopsy -- surgical removal of entire mass for evaluation

Review Date: 10/31/2005
Reviewed By: Jeremy Goverman, M.D., Department of Trauma and Critical Care, Massachusetts General Hospital, Boston, MA. Review Provided by VeriMed Healthcare Network.