A breast lump is a common problem in women and girls. Although very rare, men can also develop lumps in the breast. While the majority of lumps in women are benign, in males, even if the occurrence is very low, chances of malignancy are high. The lump may be painful or painless, of short or long duration (even years), only felt by hands or may be grossly visible and may be benign or malignant depending on the cause. It can be unilateral or bilateral. Women should take care of this lump by consulting a doctor from the beginning. Ignoring this lump may cause enlargement, complications, or may also delay the diagnosis of an underlying malignancy. Both breasts should be evaluated as a bilateral disease is not uncommon.
Causes of Lump in Breast:
There are a variety of causes for developing a lump in the breast. Some of the common causes are infection, trauma, cyst, fat necrosis, fibrocystic disease, and tumors (benign/malignant).
Some of the common causes of breast lump include:
- Infection: One of the common causes of a breast lump. Infection is also a reason for bulging. Infection followed by a collection of pus (Abscess) causes diffuse enlargement of the breast.
- Fibrocystic disease: It occurs due to the development of a fibrous cyst in the breast. It is non-cancerous and causes lumps. It is an abnormality of normal cyclical changes in the breast.
- Fibroadenoma: It is a small, painless, mobile, and rubbery lump of the breast, also called breast mouse due to free mobility within the breast. It is also non-cancerous. The lumps developed because of swelling in the fibrous and glandular tissue. These are common at a young age and may be single or multiple. Bilateral occurrence is also common. It may be present for years without any problems.
- Breast cyst: This type of cyst forms a closed sac-like structure containing fluid collection. The patient can feel like an abnormal pocket of fluid is deposited in the breast and make them feel uncomfortable while seeing or touching the swollen areas. A cyst is sometimes dangerous as it may be a malignant cyst.
- Breast cancer: It gives rise to palpable or visible lump in the breast, which may enlarge to a huge size. It may produce swelling and ulceration of overlying skin. It is generally painless throughout its course. It always requires surgery for treatment with an exception when it is diagnosed at a very late stage. At the later stages, the prognosis is very bad.
- Others: Traumatic fat necrosis, Hematoma, Phylloides tumor, etc. are some other causes causing a lump in the breast.
Sign and Symptoms of Lump in the Breast:
Anyone including man and women have to face the following types of symptoms for a lump in the breast:
- Without any problem – Asymptomatic
- The feeling of breast heaviness or generalized discomfort
- Small palpable lumps and irregular swellings
- Visible bulging in some specific area of the breast
- Thickening of the breast in the underarm area
- Change can be noticed in the size or shape of the breast
- Dimpling of breast skin in the affected region of the breast
- The nipple of the breast may go inward
- Nipple discharge
- Swellings in the axilla
Investigations: Clinical examination is the first thing a surgeon will do for characterizing the lump. Some of the investigations required are:
- Ultrasonography: It is generally the first line of investigation.
- Mammogram: It is done to rule out or to diagnose a malignant lump. May not be required in every case of a breast lump.
- Biopsy: Core biopsy or FNAC is performed for tissue diagnosis. It is very useful for diagnosing malignancy.
- BRCA1 / BACA2 gene detection: BRCA1 or BRCA2 genes are responsible for causing cancer. It is done to know the familial nature of the disease. If this gene is present, then there are maximum chances for developing breast cancer. In this stage, surgery is the only option for a cure.
- MRI: Not done routinely. It is required in special cases.
Treatment for Lump in the Breast:
A breast lump should be evaluated as early as possible and then treated as required. Treatment for the lump is most necessary, but the patient should confirm it from the doctor. After the detection of the lump, the doctor can suggest what type of therapy can give the cure. Some of the treatment measures are as follows:
- Medical Treatment: It is prescribed only in the treatment of infectious diseases.
- Draining out: If there is an abscess (collection of pus), large hematoma (collection of blood) it requires surgical drainage to remove the pus.
- Breast tumors: There is no medical treatment for proven breast tumors. Small benign tumors may not require any treatment at all. Large benign and malignant tumors always require surgery for treatment. Surgery may involve either removal of the lump only or removal of the whole breast and axillary tissue along with lump.
- Radiotherapy/Chemotherapy: They are given as an adjunct to surgery to reduce tumor size before surgery or to reduce the likelihood of recurrent disease. They have a very limited role in the late stages of the disease.
Dr. Pranay Gourav, Consultant – General Surgery, Narayana Multispeciality Hospital, Barasat