Breast ConditionsDepertment

Breast Disorders

Breast Conditions

Finding a lump in your breast can cause a lot of anxiety. Most breast lumps, particularly in younger women, are not caused by cancer. They may be benign (non-cancerous lumps) infection or cysts. One should consult surgeon immediately after finding breast lump or even if there is suspicion of breast lump.

A normal breast
The breast is connected to muscles on the wall of your chest. It is made up of fatty tissue. Within the fatty tissue are lobules or milk-forming glands. Milk drains from these glands into breast ducts during breast-feeding. Milk then leaves the ducts through your nipple.

The glands and ducts can decrease or increase in number and size. This will depend on whether they are needed. Breast lumps can involve any of these different tissues, or components, that make up your breast.

Self Examination

Every women is advised to do self examination on regular basis to look for breast lump or any changes. If one feels any change from previous examination or a discreet lump then should see surgeon immediately for further evaluation or tests.

One important thing to note is most of lumps suspected or found turns out to be benign one. Tests are advised only if there is suspicion or to rule out serious condition.

Common causes of breast lumps

Normal (physiological) swelling & tenderness

This is also known as fibrocystic change or fibroadenosis. Your breasts change throughout your menstrual cycle each month because of your hormones. At least half of all women who have periods will have some pain, tenderness and lumpiness in their breasts at some time in the month. This is usually most obvious in the week before your period. It quickly goes when your period starts. It is more common in women aged 30-50.

This is a non-cancerous (benign) breast lump that usually occurs in women under the age of 40. These lumps occur as a result of excess growth of the glands and connective tissue in the breasts. They usually feel like round, firm and rubbery lumps. They usually move slightly under the skin when they are pressed. They are not usually painful.

Sometimes they can disappear of their own accord or they can be removed. They tend to go after the menopause.

Breast cysts
A cyst is a fluid-filled lump. Cysts are more common in women approaching menopause, although they can occur at any age. They are usually oval or round lumps that are smooth and firm. They tend to move slightly when pressed. It is common for them to appear within two weeks prior to your period and then go away (resolve) soon after the period.

Treatment of breast cysts typically involves draining the fluid in them.

This is done by using a thin needle inserted into your breast by the doctor. After draining, about 3 in 10 cysts will refill with fluid, but can be drained again.

A lump caused by infection is fairly common in women who are breast-feeding. The ducts that carry the breast milk can become blocked. Germs (bacteria) can enter through cracks in the nipple. This can lead to the development of a collection of pus (abscess) in the breast. Warm compresses, paracetamol and/or antibiotics may be needed. Infection can also cause lumps in women who are not breast-feeding.

Fat necrosis
Injury or trauma to the fatty tissue in your breast can cause a lump. These lumps usually heal and go away of their own accord. However, if they persist then they can be removed.

A lipoma is a fatty growth that develops within the fatty tissue of your breast. It is non-cancerous and usually doesnot need any treatment. However, it can be removed if it is large or causing any symptoms.

Breast cancer
A lipoma is a fatty growth that develops within the fatty tissue of your breast. It is non-cancerous and usually does not need any treatment. However, it can be removed if it is large or causing any symptoms.

Seek help on finding a breast lump

On finding a lump in one of the breasts, one should make an appointment with surgeon as soon as possible. When one sees a doctor, they may start by asking some questions. It is a good idea to think about these questions before your appointment.

Breast investigation
They may want to examine one’s breasts, with one’s arms in the air and then by one’s sides. They may also want to examine one’s breasts when one is sitting and then lying down. They may also want to examine underneath one’s arms to feel for any enlarged lymph glands. If one had had any nipple discharge, one’s doctor may ask one to demonstrate this oneself by asking one to squeeze one’s nipple.

The next step
This will depend on what the doctor finds when they examine the patient. If one is under 30 years old, is still having periods and has only just noticed the lump, one’s doctor may suggest that they return for another examination after their next period.

If uncertain as to the cause of the lump, or if one has a family history of breast problems that they are worried about they may then suggest that one has some further tests.

These can include a mammogram and/or an ultrasound scan of your breast. The breast specialist may also suggest that they take a sample (biopsy) of the lump. There are two common ways of doing this, either by fine needle aspiration or a core biopsy (details below). They are both straightforward procedures. Sometimes ultrasound scanning is done to guide the procedure. The specialist uses the scan to identify exactly where the lump is so that they can take the sample.

What is a mammogram?

A mammogram is essentially an X-ray of one’s breasts. A person trained in taking X-rays (a radiographer) will ask one to remove the top and bra. The mammogram is generally done with one standing up. Each breast is pressed between two X-ray plates. This may feel a little uncomfortable but the discomfort should only last for a few minutes. Two images of each breast are taken in different positions.

Knowing about an ultrasound scan of the breast

An ultrasound scan of the breast uses the same technique as an ultrasound scan that women have when they are pregnant. It is a painless test which uses sound waves to create images of structures inside you, in this case the inside of one’s breast. Again, one will be asked to remove one’s top and bra. Some gel will be spread on to the breast. The radiologist will then move the scanning probe over the surface of one’s breast. The high-frequency sound waves allow them to produce an image of one’s breast. They should be able to see any lumps in the breast.

One may have both an ultrasound scan and a mammogram. Women under the age of 35 may only have an ultrasound scan. This is because it is difficult to get a clear picture of younger women’s breasts using a mammogram.

Some women have a magnetic resonance imaging (MRI) scan. This can show different detail of the breast tissue than a mammogram or an ultrasound test.

Fine needle aspiration

Fine needle aspiration cytology (FNAC) is a procedure where a small, fine needle, with a syringe connected to it is used to take a sample of breast cells from the lump. This sample is then sent to the laboratory and is examined under a microscope. It is usually a quick procedure and may be a little uncomfortable. Local anaesthetic is not usually used, as this would mean using two needles (a needle to give the local anaesthetic first) instead of just one.

Your breast may feel a little sore for a short period afterwards. It may take one to two weeks for the results, or sometimes longer depending on the clinic. The results can show if the lump is cancerous or non-cancerous (benign). Sometimes not enough cells are present in the sample to give a definite answer. In this case you will need further tests.

What is a core biopsy?

For a core biopsy, a larger needle is used to take a sample of tissue from one’s breast lump. One will usually be given a local anaesthetic to numb the area before the biopsy is taken. A small cut may be made in the skin. More than one biopsy may be taken. The tissue that is taken is sent to the laboratory and is examined under a microscope.

One may need to wear a dressing on the area afterwards and one’s breast may feel a little sore. Painkillers usually help the soreness. One may have some bruising in the area of the biopsy. Again, the results can show if the lump is cancerous or non-cancerous (benign).

Breast cancer screening

If one is between 50 and 70 years old, one is advise to have regular breast cancer screening using mammography. If mammogram is normal once it should not be repeated for minimum 3 years.

Breast cancer

The detection of a lump in the breast causes understandable fear of a cancer diagnosis. Careful examination will increase the chance of correct diagnosis. It is important that referrals are appropriate and that information and discussion accompany this assessment.

Breast cancer is by far the most common cancer in women. Sometimes there are cases found in men too, the male female ratio being 1:144

Liable aspects for malignancy
• Previous history of breast cancer.
• Family history of breast cancer in a first-degree relative.
• A number of genetic mutations are implicated. The BRCA1, BRCA2 and TP53 mutations carry very high risk but only around 5% of women diagnosed with breast cancer carry a relevant genetic mutation on their chromosomes.
• Between 6% and 19% of women will have a family history but this may be due to chance, shared environmental or lifestyle risk factors, or increased genetic susceptibility.
• Risk increases with age. I≤5% of cases present before age the age of 35, ≤25% before the age of 50
• Never having borne a child or first child after the age of 30.
• Not having breast-fed (breast-feeding is protective).
• Early menarche and late menopause.
• Continuous combined HRT increases risk.
• Radiation to chest (even quite small doses).
• Being overweight after the menopause.
• High alcohol intake – may increase risk in a dose-related manner.
• Breast-feeding and physical activity may reduce risk.
• Breast augmentation is not generally associated with increased risk. Type of implant used may be important. There are also concerns that implants may slow detection and therefore adversely affect survival; however, research has been inconclusive

Presenting symptoms of breast cancer:
Breast lump. Most patients present having felt a lump – usually painless but may be painful in some.
Nipple change – eg, inversion, change in shape or a scaling rash.
Nipple discharge.
Bloodstained discharge from nipple – intraduct carcinoma may present in this way.
Skin contour changes.
Axillary lumps – lymph nodes.
Breast pain/mastalgia. Alone this is an uncommon presentation.
Symptoms of metastatic disease – bone pains/fractures, symptoms of lung, liver or brain metastases. (Unusual at presentation.)
Asymptomatic but picked up at routine mammography screen