Breast lump
Breast mass; Breast nodule; Breast tumor
A breast lump is swelling, growth, or mass in the breast.
Breast lumps in both men and women raise concern for breast cancer, even though most lumps are not cancer.
The female breast is either of two mammary glands (organs of milk secretion) on the chest.
Less than one-fourth of all breast lumps are found to be cancerous, but benign breast disease can be difficult to distinguish from cancer. Consequently, all breast lumps should be checked by a health care professional.
Fibrocystic breast disease is a common and benign change within the breast characterized by a dense irregular and bumpy consistency in the breast tissue. Mammography or biopsy may be needed to rule out other disorders.
A fibroadenoma is a non-cancerous benign lump that is found in breast tissue. When felt under the skin, the lump may feel rubbery and easily moveable within the breast tissue. Fibroadenomas are commonly found in young women during their reproductive years.
The female breast is composed mainly of fatty tissue interspersed with fibrous or connective tissue. The circular region around the nipple is often a different color or pigmented. This region is called the areola.
There are many possible causes for lumps in the breast. Most breast lumps are benign, as in fibroadenoma, a condition that affects mostly women under age 30. Breast abscesses are usually incidental to breastfeeding.
A core needle biopsy of the breast is a procedure to remove samples of tissue from a lump or suspicious area of the breast and evaluate it for breast cancer. Core needle biopsy uses a long, hollow needle to take several core samples of tissue, usually using ultrasound or mammographic guidance. The samples are then sent to a lab for analysis.
Considerations
Both males and females of all ages have normal breast tissue. This tissue responds to hormone changes. Because of this, lumps can come and go.
Breast lumps may appear at any age:
- Both male and female infants may have breast lumps from their mother's estrogen when they are born. The lump will most often go away on its own as the estrogen clears from the baby's body.
- Young girls often develop "breast buds," which appear just before the beginning of puberty. These bumps may be tender. They are common around age 9, but may happen as early as age 6.
- Teenage boys may develop breast enlargement and lumps because of hormone changes in mid-puberty. Although this may be upsetting to boys, the lumps or growth almost always go away on their own over a period of months.
Causes
Lumps in a woman are most often either fibroadenomas or cysts, or just normal variations in breast tissue known as fibrocystic changes.
Fibrocystic changes are painful, lumpy breasts. This is a benign condition that does not increase your risk for breast cancer. Symptoms are most often worse right before your menstrual period, and then improve after your period starts.
Fibroadenomas are noncancerous lumps that feel rubbery.
- They move easily inside the breast tissue and are usually not tender. They occur most often during the reproductive years.
- These lumps do not have cancer or become cancerous except in rare cases.
- A health care provider may sometimes suspect a lump is a fibroadenoma based on an exam. Also, an ultrasound and a mammogram can often provide information to determine if a lump looks like a fibroadenoma.
- The only way to be sure, however, is to have a needle biopsy or remove the whole lump.
Cysts are fluid-filled sacs that often feel like soft grapes. These can sometimes be tender, often just before your menstrual period. Ultrasound can determine if a lump is a cyst. It can also reveal whether it is a simple, complicated, or complex cyst.
- Simple cysts are just sacs filled with fluid. They do not need to be removed and may go away on their own. If a simple cyst is growing or causing pain, it can be aspirated.
- A complicated cyst has a little bit of debris in the fluid and can either be watched with ultrasound or the fluid can be drained.
- A complex cyst looks more worrisome on ultrasound. Your provider may recommend either a follow up ultrasound or a needle biopsy. Depending on the results, the cyst may be monitored with ultrasound exams or removed surgically.
Other causes of breast lumps include:
- Breast cancer.
- Injury. Blood may collect and feel like a lump called a hematoma if your breast gets badly bruised. These lumps tend to get better on their own in a few days or weeks. If they do not improve, your provider may have to drain the blood.
- Lipoma. This is a collection of fatty tissue.
- Milk cysts (sacs filled with milk). These cysts can occur with breastfeeding.
- Breast abscess. These typically occur if you are breastfeeding or have recently given birth, but can also occur in women who are not breastfeeding.
Home Care
See your provider if you have any new lumps or breast changes. Ask about your risk factors for breast cancer, and screening and prevention for breast cancer.
When to Contact a Medical Professional
Call your provider if:
- The skin on your breast appears dimpled or wrinkled (like the peel of an orange).
- You find a new breast lump during self-exam.
- You have bruising on your breast but did not experience any injury.
- You have nipple discharge, especially if it is bloody, clear like water, or pinkish (blood-tinged).
- Your nipple is inverted (turned inward) but normally is not inverted.
Also call if:
- You are a woman, age 20 or older, and want guidance on how to perform a breast self-exam.
- You are a woman over age 40 and have not had a mammogram in the past year.
What to Expect at Your Office Visit
Your provider will get a complete history from you. You will be asked about your factors that may increase the risk for breast cancer. The provider will perform a thorough breast exam. If you don't know how to perform a breast self-exam, ask your provider to teach you the proper method.
You may be asked medical history questions such as:
- When and how did you first notice the lump?
- Do you have other symptoms such as pain, nipple discharge, or fever?
- Where is the lump located?
- Do you do breast self-exams, and is this lump a recent change?
- Have you had any type of injury to your breast?
- Are you taking any hormones, medicines, or supplements?
Steps your provider may take next include:
- Order a mammogram to look for cancer, or a breast ultrasound to see if the lump is solid or a cyst.
- Use a needle to draw fluid out of a cyst. The fluid is usually discarded and does not need to be examined under a microscope.
- Order a needle biopsy which is often done by a radiologist.
How a breast lump is treated depends on the cause.
- Solid breast lumps are usually biopsied with a needle by the radiologist. Depending upon the situation, they might be removed with surgery. They can also be monitored over time by the provider.
- Cysts can be drained in the provider's office. If the lump disappears after it is drained, you do not need further treatment. If the lump does not disappear or comes back, you might need to be rechecked with exam and imaging.
- Breast infections are treated with antibiotics. Sometimes a breast abscess needs to be drained with a needle or surgically drained.
- If you are diagnosed with breast cancer, you will discuss your options carefully and thoroughly with your provider.
If you're a woman, your doctor or gynecologist may have recommended that you examine your breasts every month to check for lumps. You might be wondering, why do I need to do a breast self-exam? Or, you might ask, how do I examine my breasts, and what exactly am I looking for? Well, let's talk about why, and how to examine your breasts. Why examine your breasts? Well, for one thing, it helps you get an idea of how they normally feel. Then if there's ever a problem, you'll be familiar enough with your breasts to spot it. For example, a lump on your breast could be a sign of breast cancer. Finding that lump could allow you to get checked out with a mammogram earlier than you might have done if you didn't do breast self exams. But, this is a two edged sword. Many expert groups no longer recommend routine breast self examination because the consequences of over treatment of benign or normal lumps may outweigh the benefits of early detection. Lumps lead to extra mammograms, which often lead to biopsies, and the biopsies turn out to be benign, or normal, in more than 90% of cases. But, not always. Some expert groups simply recommend breast self awareness. Ultimately, the choice is yours. If you are going to do breast self exam, the best day to do a self exam is about 3 to 5 days after your period ends. Your breasts are naturally less lumpy right after your period, so there's less of a chance that you'll mistake a normal bump for an abnormal growth. If you've already gone through menopause and your periods have stopped, just do your exam on the same day every month. Mark it on your calendar so you won't forget. To do the exam, lie on your back, as it's easier to feel any lumps or changes when you're lying down. First, put your right hand behind your head. Then, using the middle fingers on your left hand, gently but firmly press down, circling your entire breast. Make sure you cover the whole right breast. Squeeze your nipple gently. See if any fluid comes out. Now, sit up, and feel around your armpit. When you're done with the right breast, repeat the whole check on the left side. Next, stand in front of a mirror. With your arms down at your sides, look at both breasts. Check the shape of each breast. Look for any changes in the skin, like dimpling or puckering. Also see if your nipples now turn inward. Now, do the exact same check again with your arms over your head. After you've done a few breast self-exams, you'll become familiar with the look and shape of your breasts. At each exam, you're looking for anything different, like new bumps, changes in the texture of your skin, or discharge from your nipple. If you do notice that something has changed, don't panic, it could mean many different things. But, call your doctor as soon as you can so you can find out what's caused the change, and, if necessary, get it treated.
References
Davidson NE. Breast cancer and benign breast disorders. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 188.
Gilmore RC, Lang JR. Benign breast disease. In: Cameron AM, Cameron JL, eds. Current Surgical Therapy. 13th ed. Philadelphia, PA: Elsevier; 2020:657-660.
Henry NL, Shah PD, Haider I, Freer PE, et al. Cancer of the breast. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff's Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 88.
Klimberg VS, Hunt KK. Diseases of the breast. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. Philadelphia, PA: Elsevier; 2022:chap 35.
Kern K. Delayed diagnosis of symptomatic breast cancer. In: Bland KI, Copeland EM, Klimberg VS, Gradishar WJ, eds. The Breast: Comprehensive Management of Benign and Malignant Disorders. 5th ed. Philadelphia, PA: Elsevier; 2018:chap 86.
Version Info
Last reviewed on: 11/6/2021
Reviewed by: Debra G. Wechter, MD, FACS, General Surgery Practice Specializing in Breast Cancer, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
