Breast mass

Breast mass
Other names: Breast lump, breast tumor
A breast lump associated with an inverted nipple and skin dimpling. Underlying cause was breast cancer.
SpecialtyGynecology
SymptomsAn area of the breast that feel different than the surrounding tissue[1]
CausesFibrocystic change, fibroadenomas, breast infection, galactoceles, breast cancer[1]
Diagnostic methodExamination, medical imaging, tissue biopsy[2]
TreatmentDepends on the underlying cause[1]
FrequencyCommon[3]

A breast mass, also known as a breast lump, is a localized swellings that feel different from the surrounding tissue.[1] Breast pain, nipple discharge, or skin changes may be present.[1] Concerning findings include masses that are hard, do not move easily, are of an irregular shape, or are firmly attached to surrounding tissue.[2] Other suspicious signs include associated large underarm glands and retracted nipples.[2]

Causes include fibrocystic change, fibroadenomas, breast infection, galactoceles, and breast cancer.[1] Breast cancer makes up about 10% of breast masses.[1] Diagnosis is typically by examination, medical imaging, and tissue biopsy.[2] Tissue biopsy is often by fine needle aspiration biopsy.[4] Repeated examination may be required.[3]

Treatment depends on the underlying cause.[1] It may vary from simple pain medication to surgical removal.[1] Some causes may resolve without treatment.[5] Breast masses are relatively common.[3] It is the most common breast complaint with the women's concern generally being that of cancer.[6][7]

Types

Women seeking evaluation of a breast lump[8]
Finding Percentage
Fibrocystic breast changes40%
No disease30%
Fibroadenoma7%
Other benign mammary dysplasias and neoplasms13%
Breast cancer10%

Cysts and abscesses

A breast cyst is a non-cancerous, fluid-filled sac in the breast. They generally feel smooth or rubbery under the skin and can be quite painful or cause no pain at all. Cysts are caused by the hormones that control the menstrual cycle and are rare in women older than 50.[9]

A sebaceous cyst is a non-cancerous, closed sac or cyst below the skin that is caused by plugged ducts at the site of a hair follicle. Hormone stimulation or injury may cause them to enlarge but if no symptoms are present, medical treatment is not required.[9]

Breast abscesses are non-cancerous pockets of infection within the breast. They can be quite painful and cause the skin over the breast to turn red or feel hot or solid. Abscesses of the breast are most common in women who are breast-feeding.[9]

Growths

Adenomas are non-cancerous abnormal growths of the glandular tissue in the breast. The most common form of these growths, fibroadenomas, occur most frequently in women between the ages of 15 and 30 and in women of African descent. They usually feel round and firm and have smooth borders. Adenomas are not related to breast cancer.[9]

Intraductal papillomas are wart-like growths in the ducts of the breast. These lumps are usually felt just under the nipple and can cause a bloody discharge from the nipple. Women close to menopause may have only one growth, while younger women are more likely to have multiple growths in one or both breasts.[9]

Breast cancer usually feels like a hard or firm lump that is generally irregular in shape and may feel like it is attached to skin or tissue deep inside the breast. Breast cancer is rarely painful and can occur anywhere in the breast or nipple.[9]

Fatty lumps

Fat necrosis is a condition in which the normal fat cells of the breast become round lumps. Symptoms can include pain, firmness, redness, and/or bruising. Fat necrosis usually goes away without treatment but can form permanent scar tissue that may show up as an abnormality on a mammogram.[9]

A lipoma is a non-cancerous lump of fatty tissue that is soft to the touch, usually movable, and is generally painless.[9]

Other

Breast hematomas and seromas may be visible as a local swelling of the breast. Seromas are a common complication of breast surgery. Hematomas can also occur after breast surgery or breast injury or, more rarely, they can occur spontaneously in patients with coagulopathy.

Diagnosis

A fine needle biopsy

Breast lumps are often discovered during a breast self-examination or during a routine check-up. Upon noticing an unusual lump in the breast the best course of action is to schedule an examination with a physician who can best diagnose the type of breast lump and strategy for treatment.

People should make sure that the medical records of any breast-related illnesses are retained, as this facilitates diagnosis in case of recurrence or follow-up.

Treatment

Treatments for breast lumps vary depending on the type of lump. Standard breast cysts and abscesses require drainage for treatment, while sebaceous cysts and fatty lumps are best treated by surgical removal.[9]

Fibroadenoma treatment

Several treatment options currently exist for fibroadenomas: "wait and watch," open surgery and minimally-invasive surgical alternatives.

  • "Waiting and watching" is common for very small fibroadenomas and involves routine check-ups with a physician every 6–12 months.
  • Open surgery has historically been the most common method for removing large fibroadenomas, but has several disadvantages. Surgery often requires general anesthesia and a day in the hospital, and can leave significant scarring at the site of the incision.
  • Minimally-invasive surgical alternatives include biopsy-removal techniques and cryoablation. Biopsy-removal involves using a vacuum-assisted biopsy device to remove the fibroadenoma bit by bit. This procedure can be effective but often does not remove all of the fibroadenoma, resulting in a possible re-growth. In cryoablation, an ultrasound-guided probe is inserted into the fibroadenoma through a small incision in the breast. Extremely cold temperatures are then used to freeze the lesion, which eventually dies and is reabsorbed into the body.

References

  1. 1 2 3 4 5 6 7 8 9 "Breast Masses (Breast Lumps)". Merck Manuals Professional Edition. Archived from the original on 29 October 2018. Retrieved 29 October 2018.
  2. 1 2 3 4 Japp, Alan G.; Robertson, Colin; Wright, Rohana J.; Reed, Matthew J.; Robson, Andrew (2018). "4. Breast lump". Macleod's Clinical Diagnosis (2nd ed.). Elsevier. pp. 46–49. ISBN 978-0-7020-6962-8. Archived from the original on 2022-11-15. Retrieved 2022-11-15.
  3. 1 2 3 Klein, S (1 May 2005). "Evaluation of palpable breast masses". American Family Physician. 71 (9): 1731–8. PMID 15887452.
  4. ↑ Yu, YH; Wei, W; Liu, JL (25 January 2012). "Diagnostic value of fine-needle aspiration biopsy for breast mass: a systematic review and meta-analysis". BMC Cancer. 12: 41. doi:10.1186/1471-2407-12-41. PMC 3283452. PMID 22277164.
  5. ↑ "Breast lumps". NHS. 2017-10-20. Archived from the original on 2018-10-30. Retrieved 29 October 2018.
  6. ↑ Hindle, William H. (2012). Breast Care: A Clinical Guidebook for Women's Primary Health Care Providers. Springer Science & Business Media. p. 12. ISBN 9781461221449. Archived from the original on 2018-10-30. Retrieved 2018-10-29.
  7. ↑ Salzman, B; Fleegle, S; Tully, AS (15 August 2012). "Common breast problems". American Family Physician. 86 (4): 343–9. PMID 22963023.
  8. ↑ Mitchell, Richard Sheppard; Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson (2007). Robbins Basic Pathology (8th ed.). Philadelphia: Saunders. p. 739. ISBN 978-1-4160-2973-1.
  9. 1 2 3 4 5 6 7 8 9 "WebMD: Breast Lump Overview". Archived from the original on 2014-02-14. Retrieved 2009-09-30.
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