Breast Lumps

Fibroadenoma

  • AKA “breast mouse” because they are small and mobile
  • Benign tumours of stromal/epithelial breast duct tissue
  • Common in younger patients (<40 years).
  • A smooth, well circumscribed, firm, mobile lump.
  • Usually up to 3cm.
  • Hormone dependent, and regress after menopause.
  • 10% disappear every year.

 

Fibrocystic Breast Disease (Fibroadenosis)

  • Common in women of menstruating age
  • Related to hormonal changes around menstrual cycle
  • Symptoms often occur prior to menstruating (within 10 days) and resolve after wards
  • Benign condition, although can vary in severity and have an effect on quality of life if severe
  • Usually resolves after menopause

Symptoms

  • Bilateral breast lumpiness
  • Bilateral breast pain / tenderness (mastalgia)
  • Fluctuation of breast size

Treatment Options

  • Supportive Clothing
  • NSAIDs
  • Weight Loss
  • Hormonal contraception may make it worse (consider stopping)

 

Breast Cysts

  • A discrete collection of fluid in the breast tissue
  • Most common between ages 30-60.
  • A smooth, well circumscribed, mobile, possibly fluctuant lump
  • Benign
  • Can fluctuate in size over the menstrual cycle
  • Treat conservatively, with needle aspiration or local excision

 

Breast Abscess

  • An acute(usually bacterial) infection of the breast tissue
  • May be associated with fever, pus discharge from the nipple and local erythema, tenderness and heat
  • Treat with antibiotics. May require incision and drainage surgically.

 

Fat Necrosis

  • A lump formed by local degeneration / scarring of fat tissue
  • This is an inflammatory reaction resulting in fibrosis and eventually necrosis
  • Commonly caused by local trauma or breast surgery
  • A firm, irregular, fixed lump. May cause skin dimpling or nipple inversion.
  • Radiologically similar appearance to breast cancer
  • Can be associated with an oil cyst, containing emulsified fat
  • Benign condition
  • May resolve spontaneously
  • Treat conservatively or with surgical excision

 

Lipoma

  • A benign collection of fat
  • A soft, painless and mobile lump up to 20cm in size
  • Benign
  • Treat conservatively with reassurance or with surgical excision

 

Phyllodes Tumour

  • Large, fast growing periductal stromal cell neoplasm.
  • Most common between age 40-50.
  • Can be benign (~50%), borderline (~25%) or malignant (~25%)
  • 1% of breast neoplasms.
  • Requires local excision.

 

Breast Cancer

  • May be hard, irregular, painless, fixed lesions
  • May be tethered to the skin or the chest wall
  • May cause nipple retraction
  • May cause skin dimpling or oedema (peau d’orange)

 

Two Week Wait Referral Criteria (Urgent Cancer Referrals)

  • A discrete lump with fixation, that enlarges and/or with any concerns (e.g. family history)
  • Women over 30 with a persistent breast or axillary lump or focal lumpiness after their menstrual period
  • Previous breast cancer with new suspicious symptoms
  • Skin or nipple changes suggestive of breast cancer
  • Unilateral bloody nipple discharge
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