Breast health

Breast lumps

Some breast lumps are harmless, while others can be painful and/or dangerous. Breast lumps can occur at all ages and for a number of different reasons, including infection, injury, benign (non-cancerous) growths, and cancer. While, according to the Mayo clinic, 85 percent of breast lumps are benign¹, this does not mean that a breast lump should be ignored. On the contrary, every breast lump should be evaluated by a doctor to determine whether it is cancerous.

Infections and breast lumps

Breast infections are particularly common among women who are breastfeeding. When the skin of the nipple (called the areola) is injured or cracked, bacteria can enter the injured area and cause infection. In a breastfeeding woman, this can result in a hard area commonly called a "clogged milk duct." This painful, hard area can develop into an infection known as mastisis. An infection can take the form of either a deep pocket of pus in which the infection looks like an abscess growing down into the breast or a wider area of cellulitis—red skin that spreads out. Body piercing in the nipple area increases the risk of breast infections that may be particularly difficult to treat. The good news, however, is that treatments do exist and that they can prevent painful, hard areas from developing into mastisis.²

Injuries and breast lumps

Injury to breast tissue or to nearby nerves can create a lump. When a breast is injured by trauma, tiny blood vessels can rupture, resulting in localized bleeding under a bruise. This bleeding, known as a hemotoma, can be felt as a lump. Injury can also lead to a condition called necrosis in which fat cells in the breast tissue are damaged as a result of trauma to the breast. Breast lumps associated with a significant trauma are not cancerous and are usually treated with warm compresses, non-prescription pain medication, and in some instances, antibiotics.³

Benign growths that cause breast lumps

Fibroadenomas

Very common breast growths, particularly among women between 30 and 35, fibroadenomas are benign, solid, firm tumors that arise from glandular and connective tissues. A woman may have several such growths. Often round, rubbery, and firm to the touch, they are usually painless or only slightly tender. Fibroadenomas can enlarge during pregnancy and shrink after menopause. Usually found in women under 40, fibroadenomas are more common among black women.⁴

Breast cysts

Also benign, breast cysts are fluid-filled sacs within the breast tissue, often caused by a dilated milk duct. They may be tender to the touch and may move slightly when pressed. Breast cysts may be tiny or large, and their presence may be related to the menstrual cycle, appearing before a woman's period and disappearing afterward. Breast cysts often grow larger during the menstrual cycle. Like fibroadenomas, breast cysts are also very common, particularly in women over 35 because of natural hormonal fluctuations that occur as a woman approaches menopause. Breast cysts generally disappear after menopause.⁵

Fibrocystic breast changes

It's believed that nearly half of all women experience fibrocystic breast changes with their period. Breasts that are lumpy with many irregularities that feel almost grainy are said to be fibrocystic. Fibrocystic changes also include feelings of tenderness in the breast tissue, areas of thickening, presence of cysts, and tenderness or pain. Fibrocystic breasts are believed to occur because a woman's breasts are particularly sensitive to fluctuating hormone levels. Symptoms usually disappear or subside after menstruation, and the condition usually disappears after menopause.⁶

What types of lumps might suggest cancer?

You may wonder what types of lumps might suggest breast cancer. Breast lumps that are painless and that cannot be moved (see Breast Self Examination) may well signal cancer. Other symptoms of breast cancer include clear or bloody discharge from the nipple, dimpling or puckering of the skin around the nipple, and inflammation of the skin of the breast.

While many women worry that breast pain may be a sign of cancer, you should know that only about 6 percent of women with breast cancer have breast pain: breast cancer typically causes no pain in the breast.⁷

Nipple discharge that occurs without the nipple's being touched can be the result of benign growths such as intraductal papillomas or ecstasia. Intraductal papillomas are non-cancerous growths that protrude into the milk ducts. Ecstasia are dilated areas of milk ducts. In addition, nipple discharge can also be caused by breast cancer, and any nipple discharge, therefore, should be evaluated by a doctor.⁸

Skin changes on the breast, including redness and warmth, can also be indicative of breast cancer. A rare form of breast cancer, Paget's disease of the breast is characterized by these signs of inflammation. Most inflammation or rashes, however, are not due to cancer, but instead, are caused by benign conditions such as nipple eczema or fungus infections. Nevertheless, any breast rashes should be evaluated by a doctor. Areas that are especially red and scaly—particularly if they are persistent or accompanied by nipple discharge—are often biopsied to rule out cancer.⁹

Whether a particular breast lump is cancerous depends on a number of factors, including mammogram and ultrasound results, as well as past medical history. However, the only way to be certain a breast lump is not cancerous is to undergo a breast biopsy. There are several different ways in which a biopsy may be performed, and the technique used depends whether the lump can be felt and the woman's overall health. If the lump cannot be felt, a biopsy may be performed in conjunction with a mammogram or ultrasound.¹⁰

Treatment of breast lumps

Mastisis

Mastisis in a breastfeeding woman is typically treated with warm compresses and antibiotics. The breast is massaged during heat treatment, whose purpose is to open up the milk ducts. Once heat treatment is complete, either nursing or using a breast pump to express milk can help relieve swelling and pain. Either of these is an important part of treatment because it helps decrease the risk of the infection's progressing. Nursing>, therefore, should continue during mastisis because it is a key part of treatment. If, however, nursing, massage, and heat are ineffective or the area looks red, consult with your doctor to determine whether antibiotics should be prescribed. Without proper treatment, mastisis can progress quickly and develop into a severe infection.¹¹

Regardless whether a woman is pregnant, she should see her doctor if, with treatment, the affected area does not return to normal. A doctor can exclude or diagnose other types of unusual infections.¹²

Cellulitis

Cellulitis is treated with antibiotics and frequent follow-up visits to the doctor are necessary.

Abscess

Because antibiotics alone cannot adequately treat an abscess, an abscess of the breast often needs to be drained by a doctor.

Fibroadenomas

Because they are difficult to distinguish from cancer until they are removed, fibroadenomas are usually removed.

Mastodynia

A common problem, breast pain (or mastodynia) is often concluded to be a normal condition as long as no mass can be felt. Often believed to be caused by natural hormonal fluctuations, mastodynia may be more severe around the time of a woman's menstrual cycle. If pain is particularly severe and interferes with a woman's life, oral contraceptives or other medications may provide relief.¹³

Fibrocystic breast changes

Fibrocystic breast changes require neither medications nor surgery: a baseline mammogram may be all that's necessary, unless a new lump arises. If a new lump develops, mammography and possibly a breast ultrasound are necessary.¹⁴

Breast cancer

Breast cancer, the most common cancer among women, requires urgent treatment and the choice of treatment depends on the type of cancer, its size, and its location. Early detection of breast cancer is vital, since it increases the chances of successful treatment and survival. Women are therefore encouraged to become familiar with their own breasts — knowing how they look and feel and understanding the normal changes that occur at different times during the menstrual cycle. Be sure to read more about breast cancer and breast health in this section.

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1. Suspicious Breast Lumps. Mayo Foundation for Medical Education and Research. (2001–2004)
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   Breast Lumps in Women. MedicineNet, Inc. (1996–2004)
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   Suspicious Breast Lumps. Mayo Foundation for Medical Education and Research. (2001–2004)
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   Breast Lumps in Women. MedicineNet, Inc. (1996–2004)
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