Breast lumps are defined as any new and unusual sense that tissue in the breast is more solid or organized than it once was.
For a woman, it is disconcerting, even frightening, to find a lump in a breast. It is important to remember that the vast majority of breast lumps are noncancerous (benign). They usually are completely harmless and associated with a condition called fibrocystic breasts. This results from a woman's monthly hormone cycles during the childbearing years.
Diet also can affect the formation of these uncomfortable lumps and nodules that usually occur in the upper, outer quadrant of one or both breasts.
Without examining tissue under a microscope, it is impossible to say positively whether a lump is cancerous or not, but benign conditions have certain characteristics, as do cancerous conditions.
As a rule:
- Benign breast masses or lumps have a definable outline and can be easily moved within the breast. Lumps that feel tender and are most noticeable before menstruation are generally benign.
- Cancer breast masses are usually single, firm and have indistinct borders. They are hard to move within the breast and feel as if they are attached to other tissues.
- Cancerous lumps generally are not painful. Dimpling of the breast skin, a recent retraction of the nipple, and bloody nipple discharge suggest cancer.
Unusual benign breast lesions include: lipoma, adenolipoma, fatnecrosis and hematoma, abscess, mastitis, giant hypertrophy, Mondor's disease, galactocele, cyst with parasites, and nodular fasciitis (fibromatosis).
Lipomas are frequently noted in the biopsy specimen, although the xeromammogram appears normal and only demonstrates a fatty breast. It seems logical that some biopsies of normal fatty tissues are reported by pathologists as lipomas. Grossly, lipomas appear as rounded, multilobulated masses of adipose tissue enclosed in a delicate fibrous capsule. As the body accumulates excess fat, lipomas increase in incidence, with 40 to 50 percent occurring in patients from 40 to 60 years of age.
The radiographic characteristics found in the xeromammograms are those of a mass of fat density outlined by a fine, thin capsule, 1mm or less in diameter. The capsulated fat compresses the surrounding breast tissue. Inasmuch as a lipoma is primarily fat, the structures in front or behind the lipoma are easily seen through the mass in the conventional right-angle views.
Careful physical examination is essential to provide a correct diagnosis and to recommend appropriate treatment. The physical findings on breast examination represent a judgment call. The patient often presents with a chief complaint of a lump, which may or may not be confirmed by physical examination.
The usual finding is a vague thickening, particularly in the upper outer quadrant. In the mature woman, most of the breast tissue is located in this area and beneath the nipple-areola complex, and it is not surprising that most of the benign changes and cancers are found in these areas.
The physical findings may vary, depending on the amount of adipose tissue. In a woman who has recently lost considerable weight, the breasts appear lumpy. The cushion of fatty tissue is absent. This tissue normally feels like tapioca pudding, with small spherical aggregates that have a rather indistinct outline.
The physician must carefully evaluate the breast and then decide whether the findings represent a dominant mass or an exaggeration of normal breast tissue associated with fibrocystic changes.