Breast Lumps and Lumpy Breasts
The term "palpable" is used to define anything that can be felt by the health care provider or the woman herself. Such "palpable" findings may be normal or abnormal.
The Lumpy Breast
"Lumpiness" is a term commonly used to describe the texture of the breast in many women. The lumpiness is usually due to normal structures in the breast. These structures are most noticeable in the upper-outer area of the breast, but may be felt in any area of the breast. Such findings are often cyclical, which means they change during the menstrual cycle along with the changing levels of female hormones (estrogen and progesterone).
Such lumpiness may be associated with breast pain.
At least half of all women are affected by lumpy breasts at some time in their lives. For many years, women with lumpy breasts have been diagnosed with "fibrocystic disease." This term is misleading because mammograms and ultrasounds of lumpy breasts usually show normal results. There is no effective treatment and none is needed for these normal changes in breast texture.
We recommend that all women become familiar with the normal texture and cyclical changes of their own breasts. Breast self-examination (BSE) is a way for women to learn how their breasts normally feel so they can report any unusual changes to their doctor. The Breast Health Center offers personalized training in breast self-examination.
The Breast Lump
A breast lump, as distinct from the "lumpiness" discussed above, will feel different especially to the woman doing the breast self-examination. Lumps will usually stand out from the surrounding tissue. They may be of any size and shape, may be fixed or movable and may be different in firmness. They are more easily felt if they are close to the skin. Lumps which remain unchanged during one or two menstrual cycles require further investigation. In their office, many doctors can insert a thin needle into a breast lump called a fine needle aspiration biopsy to find out what it is. If the lump is a fluid-filled cyst, this procedure can both diagnose and treat the lump by removing the cyst fluid and causing the lump to disappear. If no fluid is taken out, the needle contents can be sent to the laboratory for analysis (fine needle aspiration cytology).
Breast ultrasound can both find lumps and distinguish between fluid-filled cysts and solid lumps. When a woman is referred to the Breast Health Center with an undiagnosed breast lump, an ultrasound examination will usually be done.
For many young women a mammogram may not be appropriate, so an ultrasound may be the only test needed. Older women may benefit from both a mammogram and an ultrasound.
What Ultrasound and Mammograms May Show
Mammograms may show the lump in question and provide more information about its nature. A metallic BB is taped to the skin of the breast over the lump and special mammogram views are taken of the area to help the doctor look at that particular spot. More importantly, the mammogram allows the doctor to look closely at all the tissue in the breast to find any abnormal areas that can not be felt. Breast ultrasound often gives more information than a mammogram when evaluating a breast lump. If an ultrasound shows a simple cyst, no further diagnosis or treatment is usually necessary.
Sometimes complex cysts and solid lumps are hard to identify on an ultrasound image. These require further testing by removing a small amount of tissue for laboratory analysis. If the area can be seen clearly with a mammogram or ultrasound, the radiologist uses these images to guide a needle into the lump and remove small pieces of tissue for analysis. The entire lump can also be removed with a surgical operation.
The Palpable Lump With a Normal Mammogram and Ultrasound
Sometimes a palpable lump can not be seen on either the mammogram or ultrasound. This suggests that the lump may be a "pseudo lump" formed by normal breast tissue. However, on occasion, a real breast lump may also not be seen with either mammograms or ultrasound. Although these normal tests are reassuring, it is important for the woman and her doctor to continue to monitor the lump.
Examination by a breast surgeon is recommended for any lump that does not disappear or gets larger despite normal mammograms and ultrasound tests.
Needle biopsy guided by palpation (touch) may give useful information when a breast 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.