Breast cancer is every woman’s first concern when she finds a lump.
But there are many types of common benign (noncancerous) lumps that can form in the breast tissue, including fibroadenomas, cysts and papillomas.
We talked with UNC Health breast surgical oncologist Barbara Dull, MD, to learn more about different types of benign breast conditions, how they manifest and what to do if you find a mysterious lump. (Step one: Try not to panic.)
“Sometimes, a lump is normal breast tissue, particularly in young women who might feel lobules of dense tissue,” Dr. Dull says.
She explains three other common types of benign lumps.
As many as 10 percent of women will find a fibroadenoma in their breasts during their lifetime, Dr. Dull says. “Fibroadenomas end up being the most common solid masses or lumps that we find in women between the ages of 15 and 35.”
These benign masses are typically round or oval-shaped, have distinct borders, can be moved easily within the breast tissue, and do not typically cause pain. Some stay the same size for years, while others grow and change shape over time.
The exact cause of these growths is unknown. However, many doctors believe that fibroadenomas are linked to an increase in estrogen, because they tend to pop up soon after puberty or after a woman starts a hormonal method of birth control.
If a patient finds a lump through self-examination or during a routine breast exam at the gynecologist, her doctor may order an ultrasound. Ultrasounds are typically used for young patients because their breast tissue is denser and a mammogram would not be as effective.
“If it looks like a classic fibroadenoma, meaning it’s rounded and oval-like and there is nothing suspicious about it, we give patients the option of observation, where we repeat ultrasounds every six months for up to two years to see if anything changes,” Dr. Dull says.
If necessary, a core needle biopsy can provide a definitive diagnosis. This is when a long needle is inserted into the mass to collect a small bit of tissue. Local anesthetic is used. If the biopsy confirms it to be a fibroadenoma, some women will choose to leave the mass alone.
Other patients prefer to have the mass removed through a procedure called an excisional breast biopsy. During the surgical procedure, typically done under IV sedation, the surgeon makes a small incision and removes the entire mass from the breast tissue. The mass is then tested to ensure that it is not cancerous.
If a fibroadenoma is growing, it’s best to remove it sooner rather than later, Dr. Dull says.
“The largest fibroadenoma that I had to remove was a little over 12 centimeters in length,” Dr. Dull says. “That’s what we want to avoid. If it is continuing to enlarge, we want to remove it before it changes the appearance of the breast.”
If the cysts have a normal appearance but become painful or uncomfortable, a doctor can drain, or aspirate, the fluid from the cyst.
“Women will often come in for examination if it’s enlarging and filling up with more and more fluid, if it’s close to the skin’s surface, or it becomes painful,” Dr. Dull says.
For most patients, aspiration takes care of the problem. In very few cases, some patients must come in for repeat aspirations as their cysts continue to fill up and cause pain.
If the fluid is bloody (not clear, yellow, green or light brown) the doctor may send the fluid to the lab to look for cancer cells.
Papillomas are a type of solid mass that can form inside the milk duct, usually near the nipple. These generally benign growths might cause symptoms such as clear or bloody nipple discharge and pain.
“We routinely see papillomas because they are the most common cause of women having nipple discharge,” Dr. Dull says.
Most often, papillomas are so small and deep that they may only be detected through an ultrasound or a mammogram. However, if symptoms or an imaging test cannot provide a proper diagnosis, surgeons may perform a breast biopsy to confirm whether it is a papilloma or not.
Physicians generally recommend surgical excision if the papillomas are palpable, large in size, causing symptoms such as nipple discharge or show concerning findings on a core needle biopsy, such as atypical cells.
What to Do If You Find a Lump
Make sure that you are doing a breast self-exam monthly. For women who are pre-menopausal, do it at the same time of month. The tissue can feel different depending on where you are in your menstrual cycle, Dr. Dull says.
If you notice a change in your breast that persists for a week or two, see your OB-GYN or primary care provider. It’s probably nothing, but it’s important to find out.
“We would rather go through this process to examine it than to miss something,” Dr. Dull says.
If you’re concerned about a new lump, talk to your doctor. If you need a doctor, find one near you.