Benign breast lumps

A breast lump is a hard swelling or bump that feels different from the rest of the breast. Sometimes, it's a feeling of fullness in the breast. Although most breast lumps develop in women, men may also develop lumps and swelling of breast tissue.


Anatomy
The breasts are made of lobules, ducts and stroma. Lobules are the glands that produce milk, and the ducts connect the lobules to the nipple. Stroma is the fatty tissue and support structure that surrounds the lobules and ducts. Blood and lymphatic vessels are also found in the breasts. The lymphatic vessels carry lymph, a clear fluid that helps fight infection and removes tissue waste products. Changes in any of these elements may cause breast lumps or other abnormalities.
Breast tissue begins to develop six weeks after conception. For girls, one of the first signs of puberty is the growth of breast tissue. Hormonal changes cause the development of tissue under the nipple, known as a breast bud. This may feel like a small lump and be itchy or uncomfortable. One breast often develops before another or at a different rate, which may cause concern for some girls. Many boys experience similar symptoms during puberty. Boys may need to be reassured that these symptoms are normal and will eventually disappear.


Causes/associated factors
At any age, finding a lump in your breast can be frightening. Fortunately, most breast lumps are benign (noncancerous). In spite of the optimistic odds, however, it's important to consult your doctor whenever you notice a breast lump that's unusual, new or doesn't go away after your next menstrual period.
Although different types of breast lumps may have separate risk factors, common risk factors include:

age (You may face a higher risk of various types of benign breast conditions as you age.)
increased weight or breast size
African-American race (For unknown reasons, fibroadenomas -- described below -- occur twice as often in African-American women than women of other races.)
family history of benign breast conditions

Common types of benign breast lumps
Fibroadenomas
A fibroadenoma is a benign tumor made of fibrous and glandular tissues. The lump is usually marble-shaped or rounded, and movable under the skin. Some fibroadenomas are too small to be felt, while others are many inches wide. A fibroadenoma nearly always appears as one tumor, but in some cases, multiple tumors develop in one or both breasts. The lump doesn't change shape during the menstrual cycle, but often enlarges during pregnancy. Fibroadenomas occur most often in adolescents and women in their 20s. After menopause, hormone replacement therapy may cause fibroadenomas.

Simple cysts
Simple cysts are pockets of fluid that may develop within the breast. Some simple cysts are too small to be felt, while others are many inches wide. The cysts typically become larger and more tender before each menstrual period and regress when your period begins. If they don't go away, consult your doctor. They're usually diagnosed with ultrasound (using sound waves to create pictures of internal body parts), which can help the doctor differentiate a solid mass from a fluid-filled one. Simple cysts occur most often in women between ages 35 and 50.

Fat necrosis
Fat necrosis lumps (related to the death of fatty tissue) are hard, round and painless. The skin around the necrosis may appear red or bruised. Fat necrosis is common in women who are obese or have large breasts. The lumps may appear after breast surgery or radiation to the breast, or during the healing process after the breast's fatty tissue has been injured -- by a bruise or blow, for example.

Fibrocystic changes
Hormonal changes often cause breast swelling, tenderness, lumps or pain, especially before and sometimes during your period. For up to half of all women, the symptoms are quite pronounced and result in generalized lumpiness and breast pain. The same hormonal fluctuations can cause the symptoms to come and go each month. The lumps often appear and disappear rapidly, and multiple lumps in one or both breasts are common. Formerly called fibrocystic breast disease, the condition is now known as fibrocystic breast changes.

Gynecomastia
Gynecomastia is the development of breast tissue in males in one or both breasts. Again, during puberty some boys experience normal swelling of the breast tissue, which typically resolves on its own. In some cases, however, breast swelling during adolescence may be caused by hyperthyroidism, a tumor or a chronic disease, such as kidney or heart failure. For men, breast swelling may be caused by medication, including hormones, digitalis, certain diuretics, cimetidine (Tagamet, for example) and androstenedione (a precursor of the male hormone testosterone sometimes taken as a supplement by body builders). Cirrhosis of the liver and abuse of illegal substances such as marijuana may also lead to gynecomastia.


Signs/symptoms
Consult your doctor for a breast exam if you experience any of the following symptoms:
one or more lumps in your breast, armpit or upper chest (whether they're painful or not)
nipple discharge
a newly inverted nipple (when the nipple turns in)
skin puckering or dimpling on your breast
skin swelling or thickening on your breast
an unusual change in the size of one breast
any other unusual breast changes
breast pain
nipple itching

Diagnosis
The doctor will review your medical history and do a physical exam. Diagnostic tests may also be needed, such as:
mammography (an X-ray of the breast)
ultrasound (using sound waves to create images of internal body parts)
needle aspiration (withdrawing fluid with a fine needle for further examination)
breast biopsy (taking a tissue sample for further examination)
for men, blood tests to measure hormone levels

Treatment
Treatment depends on the cause. Aside from regular exams, sometimes the best treatment is none at all. Many lumps go away on their own.
Cysts can usually be drained with a fine needle.

For gynecomastia, stopping the medication or treating the underlying condition that causes it may be the only treatment needed. Sometimes more aggressive treatment is needed. Gynecomastia related to cirrhosis and certain congenital conditions may be treated with medication or surgery to remove the breast tissue.

Fibroadenomas and other benign tumors may be surgically removed if they're large or uncomfortable.


Complications
Complications from most benign breast lumps are minimal. The most common is an increase in size or pain. Prompt medical evaluation can help distinguish benign breast lumps from breast cancer.

Pregnancy-specific information
Hormone-induced changes related to pregnancy can cause many breast changes. For example, fibroadenomas often enlarge during pregnancy, and other changes can make it more difficult to detect lumps. Consult your doctor if you notice a lump in your breast or any other symptoms.

Senior-specific information
Breast cancer rates increase with age. Although benign lumps are common near menopause, breast cancer must be identified or ruled out. Seek prompt medical evaluation for any breast changes, including lumps, that develop later in life.

Prevention
Women

Breast self-exam: Although many medical organizations still endorse the monthly self-breast exam, its usefulness is in question. Recent studies have shown that monthly breast self-exams don't appear to decrease the number of deaths due to breast cancer. The U.S. Preventive Services Task Force recently cited an association between breast self-exam and an increase in benign breast lump biopsies. They state that no evidence exists to recommend either for or against doing a breast self-exam, but they can't rule out that other potential benefits may exist.

Clinical breast exam: It's important to see your doctor for clinical breast exams. Some health professionals recommend clinical breast exams every two to three years between ages 20 and 39 and every year beginning at age 40. The U.S. Preventive Services Task Force concluded that there's insufficient evidence to recommend for or against routine clinical breast examination alone to screen for breast cancer.

Mammogram: The debate on the timing of mammography continues. Some health care professionals recommend regular mammograms every one to two years beginning at age 40 and annually beginning at age 50. The U.S. Preventive Services Task Force recommends mammograms every one to two years, with or without clinical breast exams, for women age 40 and older.

Based on your age and other risk factors, decide with your doctor how often to do breast self-exams and have clinical breast exams and mammogram screenings. See your doctor if you notice any of the symptoms described above -- regardless of when you had your last mammogram or clinical breast exam.

Men
Because breast cancer in males is rare, routine mammograms aren't recommended for men. Be sure to see your doctor about any changes in your breasts, however.