On discovery of a lump in the breast, the procedure to be followed, till diagnosis is achieved, remains the same for all lumps. On examination, there are certain characteristics about lumps which can direct the attending physician towards the nature of the lump.
Certain other common lumps are as follows:
- Breast Cysts
- Sebaceous cysts
- Mastitis, which can be specific or non specific
- Traumatic Fat Necrosis
Fibroadenomas are benign lumps of the breast usually seen in younger patients. They may be single or multiple and are usually painless. Sometimes a patient may present with a large fibroadenoma which occupies almost the entire breast. This is known as a Giant fibroadenoma. Once a lump is confirmed to be a fibroadenoma, it may be left alone and observed. It does not regress or disappear on its own or by any medication, but it does not harm and hence can be safely left alone.
Giant fibroadenomas should be surgically excised as, they grow they tend to compress normal breast tissue, causing its pressure atrophy.
Breast Cysts occur commonly in the last decade of reproductive life. Since they may present as a hard lump, they can cause panic as they mimic a cancerous lump. They may be multiple and bilateral. They may cause pain due to the tension in the cyst or due to infection. Diagnosis can be confirmed by ultrasound. An aspiration will empty the cyst and resolve it completely. A word of caution here, they may recur but can be re-aspirated. If on aspiration, there are any solid remnants seen inside the cyst, then these need to be biopsied by a core needle biopsy to rule out malignancy.
Sebaceous cysts are superficial lumps seen on the breast which are actually lumps in the subdermal layer and not in the breast tissue itself. They may slowly increase in size, but more importantly, these cysts may get infected. Once infected, they cause a lot of pain and there will be an increase in the size of the cyst with surrounding redness. These cysts should be surgically excised.
Any infection or inflammation of the breast tissue may cause swelling, pain, and fever. This mastitis may be specific or nonspecific.
Nonspecific mastitis will respond to antibiotics and anti-inflammatory medication and some local treatment.
Specific forms of mastitis include:
- Granulomatous non-tuberculous
Tuberculous granulomatous mastitis may present as an irregular lump or may present as an abscess without any pain. It requires investigations in the form of a biopsy for histopathology and culture. The treatment is usually antituberculous medication, but sometimes surgery may be required especially in case of painful or recurrent abscesses.
Granulomatous non-tuberculous mastitis is a condition in which patients may have recurrent episodes of infection with or without pus formation in the breast. It mimics tuberculosis, but the biopsies and culture of the tissues do not prove it to be tuberculosis. Treatment is by judicious use of antibiotics, anti-inflammatory medication and surgery. Sometimes, multiple surgeries may be required and sometimes, steroids may be added for the treatment. A word of caution, this condition is also known to recur due to unexplained reasons.
Lactational Mastitis is linked to Pregnancy issues
These may be related to pregnancy and lactation. There will be associated pain and fever. A sonography will confirm the diagnosis. If detected early, treatment is a judicious combination of antibiotics, anti-inflammatory medications, and local treatment. Sometimes surgical management in the form of aspiration of the abscess or incision and drainage is required.
Galactocoele is a condition seen in lactating women or dating from lactation, whereby a lump is felt in the breast which may not be painful. A sonography shows the presence of collected milk, without any infection. It may be left alone if it is not painful or it may be aspirated, but chances are that it may refill. In long-standing cases, the walls tend to calcify.
Haematomas are the collection of blood in the localized part of the breast which may happen following an injury to the breast. Besides the lump which may be painful, there may be associated bruising on the breast. Any history of trauma will hint at the diagnosis which can be confirmed by a sonography. The management depends on the patient’s symptomatology and size of the haematoma.
Traumatic Fat Necrosis
Traumatic Fat Necrosis is a condition which is seen following blunt trauma to the breast. The delicate fatty tissue of the breast is injured because of the trauma and it undergoes some necrotic changes. These changes are in stages and sometimes they may present in the form of an irregular lump, which may be firm to hard in consistency and may be painless, mimicking cancer. An excision biopsy will confirm the diagnosis.