Breast lumps are very common and most women will experience one or more at some time in their lives. However, the vast majority (at least nine out of ten) are benign, i.e. not cancerous. Benign lumps can be caused by cysts (sacs of fluid which build up in the breast tissue) or fibroadenomas (solid growths made up of fibrous and glandular tissue). Breast lumps are defined as any new and unusual sense that tissue in the breast is more solid or organized than it once was.
There are some common causes of lumps:fibroadenomas, cysts. Fibroadenomas are not strictly speaking disease at all but rather a simple overgrowth of the lobules or the leaf of the breast tree. They are most common in women under the age of 30. They move freely within the breast and can be diagnosed by a combination of clinical examination, ultrasound and removing cells by needle aspiration. If a woman has a fibroadenoma, it may not need to be removed. If left alone, at least one in three of these lumps gets smaller or disappears within two years. If she is worried about the lump or it gets bigger, then she can opt to have it removed. Cysts are smooth, mobile lumps and some are large enough to be seen from the outside. They may be painful. They are most common in women between the ages of 40 and 50 but are less common in women who are in their 20s, 30s and 60s. Cysts are a form of ageing of the lobules rather like the way the leaves on the trees become yellow and change during autumn. Cysts can be diagnosed by ultrasound or by inserting a needle into the lump. The fluid removed from cysts varies in colour from yellow to green to blue-black. Only if the fluid is bloodstained will it be sent for tests.
For a woman, it is disconcerting, even frightening, to find a lump in a breast. It is important to remember that the vast majority of breast lumps are noncancerous (benign). They usually are completely harmless and associated with a condition called fibrocystic breasts. This results from a woman's monthly hormone cycles during the childbearing years. Diet also can affect the formation of these uncomfortable lumps and nodules that usually occur in the upper, outer quadrant of one or both breasts. Without examining tissue under a microscope, it is impossible to say positively whether a lump is cancerous or not, but benign conditions have certain characteristics, as do cancerous conditions. Unusual benign breast lesions include: lipoma, adenolipoma, fat necrosis and hematoma, abscess, mastitis, giant hypertrophy, Mondor's disease, galactocele, cyst with parasites, and nodular fasciitis (fibromatosis).
Lipomas are frequently noted in the biopsy specimen, although the xeromammogram appears normal and only demonstrates a fatty breast. It seems logical that some biopsies of normal fatty tissues are reported by pathologists as lipomas. Grossly, lipomas appear as rounded, multilobulated masses of adipose tissue enclosed in a delicate fibrous capsule. As the body accumulates excess fat, lipomas increase in incidence, with 40 to 50 percent occurring in patients from 40 to 60 years of age.
The radiographic characteristics found in the xeromammograms are those of a mass of fat density outlined by a fine, thin capsule, 1mm or less in diameter. The capsulated fat compresses the surrounding breast tissue. Inasmuch as a lipoma is primarily fat, the structures in front or behind the lipoma are easily seen through the mass in the conventional right-angle views.
Infections of the breast are especially common in women who are breastfeeding a baby (lactating). When the skin of the nipple (areola) is injured or cracked, such as occurs with nursing, bacteria can enter the wound and cause infections. In a breastfeeding woman, a hard area commonly thought of a "clogged milk duct" can form. Sometimes, certain treatments (see below) can prevent the painful, hard area from developing into an actual breast infection (mastitis). Infections can either be a deep pocket of pus, in which the infection looks like it is growing down into the breast (an abscess), or a wider area of skin redness that spreads out (cellulitis). Body piercing in the nipple area increases the risk of breast infections that may be particularly difficult to treat.
Careful physical examination is essential to provide a correct diagnosis and to recommend appropriate treatment. The physical findings on breast examination represent a judgment call. The patient often presents with a chief complaint of a lump, which may or may not be confirmed by physical examination. The usual finding is a vague thickening, particularly in the upper outer quadrant. In the mature woman, most of the breast tissue is located in this area and beneath the nipple-areola complex, and it is not surprising that most of the benign changes and cancers are found in these areas. The physical findings may vary, depending on the amount of adipose tissue. In a woman who has recently lost considerable weight, the breasts appear lumpy. The cushion of fatty tissue is absent. This tissue normally feels like tapioca pudding, with small spherical aggregates that have a rather indistinct outline. The physician must carefully evaluate the breast and then decide whether the findings represent a dominant mass or an exaggeration of normal breast tissue associated with fibrocystic changes.