Breast Lumps and Lumpy Breasts

The term "palpable" is used to define anything that can be felt by the examining fingers of a health care provider or of the woman herself. Such "palpable" findings may be normal or abnormal.

The Lumpy Breast


"Lumpiness" is a term frequently used to describe the palpable texture of the breast in many normal women. This is usually due to prominent normal milk glands, ducts and the fibrous supporting tissue which surrounds these structures. This "lumpiness" may vary from fine irregularities to more coarse and nodular alterations in breast texture and is most prominent in the upper outer areas of the breast. Such findings are frequently cyclical, changing during the menstrual cycle as normal breast tissue reacts and responds to the fluctuating influence of normal female hormones (estrogen and progesterone).

Such lumpiness may be associated with cyclical pain or discomfort.

For many years women with lumpy breasts have been diagnosed with "fibrocystic disease". This term is both unfortunate and erroneous. Most of these women do not have cysts and any condition affecting at least half of normal women should not be considered a "disease". Mammograms and ultrasound examinations of areas of lumpiness are most often normal. There is no effective treatment and none is needed for this essentially normal variation in breast texture.

We urge all women to learn and regularly practice breast self-examinations so that they can become familiar with the texture and cyclic variation of their own breasts. Monthly breast self-examination provides women with the opportunity for early detection of a breast "lump", which may be a life-saving discovery. The Breast Health Center offers personalized training in breast self-examination (BSE) by our breast health nurse .

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The Breast Lump

A breast lump, as distinct from the "lumpiness" previously discussed will feel different especially to the woman practicing regular breast self-examination. Lumps are frequently not a subtle finding. They usually feel more discrete and stand out from the surrounding tissue. Lumps may be of any size and shape, may be fixed or movable and may vary in degree of firmness. They are more easily felt if they are close to the skin. Lumps which persist unchanged during one or two menstrual cycles require further investigation.

Many clinical doctors will, in their office, insert a thin needle into a breast lump for diagnosis. If the lump is a fluid-filled cyst this procedure can both diagnose and treat the lump by removing the cyst fluid causing the lump to disappear. If no fluid is extracted the needle contents can be sent for laboratory analysis (fine needle aspiration cytology).

Breast ultrasound can both find lumps and distinguish between fluid-filled cysts
and solid lumps (see Breast Health Center pamphlet "About Breast Cysts"). When a woman is referred to the Breast Health Center with an undiagnosed breast lump an ultrasound examination will usually be performed.

For young women in whom a mammogram may not be appropriate, the ultrasound examination may be the only test needed. Older women may benefit from both a mammogram and an ultrasound examination.

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What Ultrasound and Mammograms May Show

Mammograms may show the lump in question and provide some clues as to its nature. A metallic BB is taped to the skin of the breast over the lump to assist this evaluation and special mammogram views are taken of the area in question. More importantly, however, the mammogram allows assessment of tissue elsewhere in both breasts for detection of abnormalities which are non-palpable. Breast ultrasound is frequently more informative than mammography in breast lump evaluation. If ultrasound shows a simple cyst, no further diagnosis or treatment is usually necessary.

Some complex cysts and solid lumps have overlapping ultrasound features and require further investigation by removal of tissue for laboratory analysis. If the area is well demonstrated using ultrasound or mammography these images can be used to allow a Breast Health Center radiologist to precisely guide a needle into the lump removing slivers or cores of tissue for microscopic analysis. Alternatively, the entire lump can be removed at a surgical operation.
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The Palpable Lump With a Normal Mammogram and Ultrasound

Sometimes a palpable lump cannot be seen on either the mammogram or the ultrasound images. This suggests that the lump is a benign process and may represent a "pseudo lump" formed by normal breast tissue.

Occasionally, however, a real breast lump may not be seen with either mammograms or ultrasound. Although these normal imaging tests are reassuring, continued monitoring of the palpable area by the woman herself and by her doctor is essential. Examination by a breast surgeon is recommended for any persistent or enlarging lump despite normal mammograms and ultrasound tests.

Needle biopsy guided by palpation may provide useful information when a concerning lump is felt but mammogram and ultrasound tests are normal. Your doctor may perform this test or refer you to a breast surgeon for this procedure.

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