Fifty percent of women will experience a noncancerous breast lump at some point in their lives. It is very important to see a healthcare provider for a breast exam and any recommended tests, screenings, or imaging whenever you notice a lump regardless of your age or risk factors for breast cancer. However, just because you have a lump does not always mean it is cancer. There are a plethora of types of benign breast lumps, below are some of the common benign diseases that may be causing the lump you feel.
BREAST CYST
A breast cyst(s) is a painful or painless fluid-filled mass. They are typically smooth, firm, discrete, fluid-filled masses on palpation, however at times they may also present as firm masses. They are related to your hormones and menstrual cycle and therefore are most common in premenopausal women or postmenopausal women on hormone therapy. Ultrasound will help classify the cyst as simple, complicated, or complex. If it is a simple cyst, it is typically left alone however if you have pain, it can be drained. Complicated and complex cysts typically involve a breast biopsy and/or further imaging to confirm that it is a benign finding.
GALACTOCELE
If you are pregnant, lactating, or weaning off of breastfeeding and find a breast mass, it may be due to a clogged milk duct leading to this milk retention cyst. Galactoceles present as cystic and sometimes large typically painless masses containing milky fluid. Ultrasound is the first diagnostic step, however clinical history and aspiration yielding a milky substance confirm the diagnosis. These will typically disappear over time and do not require removal.
FIBROCYSTIC CHANGE
If you notice cyclical breast pain or changes in breast character before your menstrual cycle begins you may have fibrocystic changes in your breasts. You may notice this resolves with your menstrual cycle as these changes are due to your estrogen and progesterone hormone balance. Typically, with fibrocystic changes, there is not a discrete well-defined mass and you may notice more lumpy bumpy, tender, ropy tissue in BOTH breasts.
FIBROADENOMA
Fibroadenomas account for about half of the breast biopsies done. These are solid tumors with glandular and fibrous tissue. They are typically related to your estrogen levels and therefore may increase during pregnancy or under estrogen treatment and will regress after menopause. They are typically well-defined, movable masses on palpation. The first step in diagnosis is an ultrasound, however, a definitive diagnosis is made with a core needle breast biopsy. Typically these are just observed, however, if they are large and bothersome they may be excised.
FAT NECROSIS
Fat necrosis presents as a breast mass that results from trauma. Often times this fat necrosis happens from minor trauma to your breasts that you may not even be able to recall. On physical exam, it feels like a hard lump and therefore it may be worrisome for malignancy and is typically worked up the way breast cancer would be worked up (mammogram, ultrasound, biopsy, MRI). Once it is confirmed that the mass is not cancer it is just observed, and no further action is needed.
INTRADUCTAL PAPILLOMA
This is the most common cause of BENIGN bloody nipple discharge. Though these are considered benign breast lesions, they typically require a biopsy and are often excused to rule out any hidden cancer as they can have areas of atypical or ductal carcinoma in situ (DCIS).
MASTITIS
If you have painful, swollen, and redbreasts you may have a breast infection known as mastitis. This is typically the result of breastfeeding, however less commonly, these symptoms can be the presenting sign of breast cancer known as inflammatory breast cancer and that is why workup is always important. This diagnosis of mastitis is established via cultures, and it is treated with antibiotics. If antibiotics do not resolve symptoms, please speak to your healthcare provider for a further evaluation to rule out inflammatory breast cancer.
Tepas Breast Center recommends that everyone does a monthly self-examination and, whenever you notice any changes in your breasts it is always best to see your healthcare provider so you can make a decision together to establish your personalized plan for evaluation, diagnosis, and follow-up.
Sources:
UpToDate
Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/breast-cysts/symptoms-causes/syc-20370284
