Breast Lump: Causes, Evaluation, and Treatment

When you feel a lump in your breast, it’s understandable to be concerned.

But there’s likely no need to panic.

There are many reasons why there might be a lump in your breast, and most times, they are benign, or harmless.

So, when should you be concerned? 

In this article, I’ll discuss possible breast lump causes and treatment options.

I’ll also explain signs to look out for when doing self-checks.

Finally, I’ll explore when to see a medical professional and provide a guide to preparing for a mammogram. 

Breast Lump Possible Causes

Breast tissues respond to hormonal changes in both people with and without vaginas. It is possible to experience lumps at any age.

Even infants can experience breast lumps due to exposure to estrogen produced by their parent, but they resolve as the estrogen clears off.

There are a variety of conditions that can cause a breast lump, and while some are harmless, a few others are severe. 

Benign Causes

Benign lumps are more common than cancerous lumps.

They are usually smoother at the edges and, although they may be hard, can move around slightly when pushed on.

Lumps with benign causes typically do not require treatment.

Benign lumps include:

Fibroadenoma: A fibroadenoma is a hard, rubbery mass in the breast that can easily move around when touched. It is painless, has a well-defined shape, and ranges in size. It is noncancerous and is often found in people with vaginas during their reproductive years. A doctor may require a mammogram or ultrasound to know if the lump looks like a fibroadenoma. Still, only a needle biopsy or removing the whole lump can confirm the suspicion. 

Lipoma: A lipoma is a collection of fat cells. It can occur in different parts of the body, including the breast. The lump is typically soft, painless and movable when pushed on. It might become painful if it pushes against another body structure, for example, a nerve.

Cyst: A cyst is a fluid-filled sac. It is usually round and movable and may feel tender to the touch. It is noncancerous, and it is possible to have more than one breast cyst at a time. Cysts occur in people with vaginas in their reproductive years but tend to disappear during menopause unless the person with a vagina is getting hormonal replacement therapy. There can be a simple cyst, a complicated cyst or a complex cyst, but an ultrasound can differentiate between them.

Fibrocystic changes: Fibrocystic changes involve lumps in the breast that may be associated with pain. They are noncancerous and are typically considered normal. These changes are strongly associated with fluctuation in hormonal levels, particularly estrogen, so pain and soreness may increase before and during the menstrual period. 

Mastitis: Mastitis is an infection of the breast that commonly happens when breastfeeding. It can cause a lump in the breast and other symptoms such as pain in the area, redness and swelling of the breast, a burning sensation in the affected area, and flu-like symptoms such as fatigue and fever. If left untreated, it can lead to a breast abscess.

Intraductal papilloma: An intraductal papilloma is located inside the milk duct, and while it is noncancerous and typically painless, it may cause clear or bloody nipple discharge. It may be found in one or both breasts. A single papilloma in the breast does not increase the risk of breast cancer, but multiple papilloma increases the risk slightly.

Traumatic fat necrosis: Trauma to the breast can lead to tissue death, called necrosis. In fat necrosis, dead fatty tissues form a firm round lump. The tissue damage can happen in any area of the breast and may occur during a biopsy, surgery, or an accident. The site of the lump may look red and, on rare occasions, dimpled. 

Gynecomastia: Gynecomastia is a condition of enlarged breast tissues in people without vaginas that may cause a breast lump. The lump may be tender to touch and will move if pushed. Gynecomastia is caused by an imbalance in the hormones estrogen and testosterone.

It happens commonly in people without vaginas who are:

• Newborn and have been exposed to estrogen from their mother
• Going through puberty and are experiencing the fluctuations of estrogen and testosterone
• Over age 50 and experiencing low testosterone levels

Some conditions associated with gynecomastia include:

• Klinefelter syndrome
• Testicular trauma
• Congenital orchitis
• Kallman syndrome
• Renal failure 
• Hyperthyroidism
• Malnutrition

Some drugs may also cause gynecomastia. 

More Serious Causes

Other breast lumps require immediate medical attention, and they include:

Breast abscess: A breast abscess is a breast infection complication from conditions like mastitis. It typically occurs in people with vaginas who are breastfeeding. Pus collects under the skin or breast tissue and the lump is usually painful. The affected area is usually red, swollen, and warm. There may be discharge from the affected area, usually not the nipple. A breast abscess would typically require antibiotic treatment. If that doesn’t work, your healthcare provider may perform a procedure to drain the abscess.

Breast cancer: Breast cancer first appears as a lump or thickening in the breast. The lump is usually hard, irregular in shape, unilateral, and immovable. Most lumps don’t cause pain, but some do. Breast cancer cells can spread to other body parts if not detected early. The first area of spread is usually the lymph nodes under the arm and then the other organs in the body. Treatment is effective with a survival probability of 90% or higher on average for at least five years after an initial diagnosis in high income countries, but early detection is crucial.

Treatments

Treatment of a breast lump depends on the cause and whether it is benign or malignant.

For benign causes, there is usually no need for treatment unless it causes discomfort.

On the other hand, for serious causes, medical attention is needed.

The treatment options for possible breast lump causes are as follows:

Fibroadenoma: A fibroadenoma is harmless and may decrease in size or go away without treatment. If the fibroadenoma is large and causes the person discomfort, a doctor may recommend a biopsy and surgical intervention.

Lipoma: There may be no need for treatment since lipomas are typically harmless and painless. If the lipoma is large and growing, the doctor may recommend surgery.

Breast cyst: A doctor may recommend draining the cyst, but there is a high chance of recurrence.

Fibrocystic changes: Your healthcare provider will likely not recommend any treatment if there is no discomfort or pain. In the case of mild discomfort, the doctor will recommend over the counter pain relief medicines.

Mastitis: To treat mastitis, a doctor will usually prescribe antibiotics. The type and dosage of the antibiotics will depend on the type of bacteria causing the infection. Antibiotics are usually taken for 7-14 days. Make sure to finish your dose or speak to your prescribing doctor before discontinuing the medicine. 

Intraductal papilloma: A doctor will typically recommend surgery where they remove the papilloma and the affected part of the milk duct.

Traumatic fat necrosis: Traumatic fat necrosis typically does not require any treatment as your body will break down the lump in a few months. Your doctor may prescribe a pain reliever for pain and will monitor the lump for changes.

Gynecomastia: Gynecomastia in newborns does not need treatment as the breast size will decrease as the estrogen exposure from their mother clears. The same applies to gynecomastia during puberty which tends to resolve in less than a year. If a medication causes gynecomastia, the breast size will usually revert when you stop the medication. If a condition causes it, treatment of the condition should resolve the lump. In the case where it persists, surgery is an option.

Breast abscess: A breast abscess will typically require surgical incision and drainage. If the abscess is smaller than 3 cm, the doctor may consider needle aspiration and prescribe oral antibiotics, although there is the risk it will recur.

Breast cancer: If the diagnosis is cancer, your doctor will discuss all treatment options with you. Surgery, chemotherapy, hormonal therapy, biologic therapy, and radiation are all possible treatments depending on the tumor profile.

Diagnosis

To diagnose the lump correctly, your doctor will require a complete history from you.

Some of the details your doctor may need include:

• When you first noticed the lump
• How you noticed the lump
• If you experience other symptoms such as nipple discharge or pain
• If you have had any injury to your breast
• If you are taking hormones or other supplements
• Any known Family History of breast CA

Signs to Look Out For

Some of the signs to look out for when you notice a lump are:

• If the lump is in both breasts and underarm
• Nipple discharge, e.g., clear or bloody discharge 
• Skin changes, e.g., reddened, bruised, or thickened

Breast Lumps: Men vs. Women

People with vaginas are often advised to perform breast self-examinations but they’re not the only ones who should be doing self-checks.

People without vaginas also have breast tissue, as well. 

However, it is true that breast lumps are more common in people with vaginas, with over 25% of them experiencing a lump in their lifetime.

Gynecomastia is a breast lump condition that happens to people with penises.

Breast cancer is also possible in people without vaginas, with about 1 out of 100 breast cancer cases diagnosed in the United States found in people with penises.

Mammograms Guide

A mammogram is an x-ray of the breast used to screen for breast cancer and diagnose suspicious changes in breast tissue. 

To ensure the ease and accuracy of the mammogram:

• Schedule your test about a week after your period if pre-menopause. Breast tenderness before and during menstrual periods may increase the discomfort of the process.

• Take your previous mammogram images, although some facilities can arrange to get them.

• Avoid deodorants, antiperspirants, and lotions under your arm and on your breast. The particles in these products may distort your images.

The United States Preventive Services Task Force (USPSTF) recommends that people with vaginas between 50-74 years old who are at average risk for breast cancer get a mammogram every two years.

Younger women and those with a family history or increased risk of breast cancer should discuss when to start with their healthcare provider.

When to See a Medical Professional 

Due to the possibility of lumps being a symptom of breast cancer, a medical professional should examine any breast lump.

If you feel a new breast lump during a self-examination that doesn’t disappear after your period, see your healthcare provider for a proper diagnosis.

If you’re unsure how to perform a self-examination, ask your doctor for guidance.

A doctor will typically start with a physical examination and may then order mammography or ultrasound imaging. 

How K Health Can Help 

Have you felt a new lump under your breast or underarm? You may need to speak to a doctor. Did you know you can get affordable primary care with the K Health app?

Download K Health to check your symptoms, explore conditions and treatments, and, if needed, text with a clinician in minutes. K Health’s AI-powered app is based on 20 years of clinical data.