There are many types of breast lumps and not all are cancers. Around 80-85% of lumps are non-cancer lumps. This means that only 15-20% breast lumps are cancerous. This article will discuss how we differentiate among all the lumps and which are the commonly seen lumps.
Lumps due to hormonal changes:
There is usually no need for any treatment, but you have to be sure that there is no other reason for breast lumps in young boys and girls. Please consult your doctor. Most of the time, reassurance is all what is needed. But your doctor may get an ultrasound done, if necessary. Persistent enlargement of one or both breasts in boys is termed as Gynaecomastia and may require surgical treatment. Persistent enlargement of breasts in young girls around puberty with rapid growth is termed Gigantomastia and may require surgical treatment .
Fibroadenoma or a breast mouse:
These are commonly seen lumps in young women in their 20s and 30s. They can be single or multiple, in one breast or both breasts. They are generally painless and freely movable in the breast tissue and slip under the finger. Hence they are called as “Breast Mouse/Mice”.
It is not known what causes these lumps to develop. Sometimes, these lumps are very big, measuring more than 4-5 cms, in which case they are called Giant Fibroadenomas. These are non-cancerous lumps. Many times they dissolve on their own but can grow to a large size during pregnancy and breast feeding.
Fibroadenoma can be diagnosed on clinical examination by your doctor but ultrasound is often done to rule out any other condition such as cysts. Your doctor may plan for a surgery to remove it. Once removed it is sent to the laboratory to be checked under the microscope (histopathological examination).
Breast cysts
Breast cysts are extremely common. They appear in the 30s to 40s age group. These cysts are nothing but fluid filled sacs mostly affecting both breasts. There are multiple tiny cysts which are commonly seen when you do a breast ultrasound. Occasionally these cysts become big and you can feel it as a lump.
Once the ultrasound confirms it to be a cyst, a simple needle can suck out the fluid and your lump will disappear within seconds. This procedure is called as Fine needle aspiration or FNA. If the fluid is blood stained, it needs to be checked and that is called as Fine needle aspiration cytology or FNAC. If the cysts are small and you can’t feel it, there is no need for any surgical procedure.
Fibro-cystic breast change
As the name suggests, there is formation of fibrosis and cysts in the breasts. Earlier this condition was called Fibrocystic breast disease but now it is no more considered as a disease and it is merely a change in the breasts as almost 50% women get this during their lifetime.
In this condition a woman experiences pain, lumps or thickened areas and may be even a nipple discharge of brown, greenish colored liquid. It may affect one or both breasts. The symptoms may worsen just before your period or your pain may be persistent throughout.
It is diagnosed clinically but often an ultrasound or mammogram is done. If the cysts are large, you may have FNAC done. If the area shows a very lumpy feel, your doctor may ask you to undergo breast lump biopsy, to confirm the diagnosis.
The exact cause of this condition in not known but may be related to a hormone, oestrogen which is produced by your ovaries.
Treatment:
If you are experiencing mild pain, you need not have any medication at all.
Galactocele
These lumps are balloon like sacs filled with milk. They are painless but if infected can cause pain. They are seen during or after breast feeding. This is because of the milk duct getting blocked and not emptying the milk out through the nipple. Simple aspiration or sucking out the milk with a needle and syringe do wonders and your galactocele will disappear at once.
Sometimes the galactocele will get infected and cause pain. This infected milk or pus can be sucked out and sent for testing and antibiotics can be started accordingly.
Intra-ductal papilloma
These lumps are tiny wart like masses which are formed within the breast ducts (milk ducts). They are generally found just below the nipple areola. They present with symptoms such as bloody or blood stained nipple discharge. The lump may not be felt depending upon the size. Women are scared of it because it causesa bloody nipple. The papilloma can be seen in a single duct or there can be multiple ducts showing papilloma. This condition has a slightly increased risk of developing breast cancer. These papillomas generally show atypical hyperplasia on histopathological examination which is considered as a pre-malignant condition.
Ultrasound of the breast can show the intra-ductal papilloma. A core biopsy can be done to confirm the diagnosis. But the definitive treatment is removal of the lump with the affected milk duct. The name of the surgery is Microdochectomy.
Hematoma/ Fat necrosis
Any injury to the breast can lead to bleeding within the breast tissue. You may feel this as a very painful lump. Usually the history of an injury is sufficient to make a diagnosis and an ultrasound confirms it.
If blood is still fluid, it can be sucked out with needle and syringe. But sometimes it can get infected and forms an abscess.
A severe blow may lead to a part of the fat to become damaged or dead. It can form a lump. This is called as fat necrosis. Sometimes fat necrosis is seen to develop after breast surgery and radiation.
Phyllodes tumour
It is named Phyllodes means “leaflike” as this tumour grows in a leaflike pattern. These are rare tumors in the breast amounting to only 0.5-1% of all breast tumours. These are benign tumours in the breast. Only 10% are malignant and spread to other body parts via blood stream. They mimic large fibroadenoma.
It is diagnosed as any other lump. Initially a complete clinical examination, Mammogram and ultrasound are done followed by a core biopsy. The treatment is complete surgical removal of the tumour.