Definition
A breast lump is defined as any palpable mass in the breast. A breast lump is the most common presentation of both benign and malignant breast disease. Enlargement of the whole breast can occur either uni- or bilaterally, but this is not strictly a breast lump.
Key Points
- The most common breast lumps occurring under the age of 35 years are fibroadenomas and fibrocystic disease.
- The most common breast lumps occurring over the age of 50 years are carcinomas and cysts.
- Pain is more characteristic of infection/inflammation than tumours.
- Skin/chest wall tethering is more characteristic of tumours than benign disease.
- Multiple lesions are usually benign (cysts or fibrocystic disease).
Differential Diagnosis
Swelling of the Whole Breast (Mammoplasia)
Bilateral
- Pregnancy, lactation.
- Idiopathic hypertrophy.
- Drug induced (e.g. diethylstilbestrol, antidepressants).
- Gynaecomastia in males.
Unilateral
- Enlargement in the newborn.
- Puberty.
- Gynaecomastia in males.
Localized Swellings in the Breast
Mastitis/Breast Abscess
- During lactation: red, hot, tender lump, systemic upset.
- Tuberculous abscess: chronic, ‘cold’, recurrent, discharging sinus.
Cysts
- Galactocele: more common postpartum, tender but not inflamed, milky contents.
- Fibrocystic disease: irregular, ill defined, often tender.
Solid Lumps
Benign include:
- Fibroadenoma: discrete, firm, well defined, regular, highly mobile.
- Fat necrosis: irregular, ill defined, hard, ?skin tethering.
- Lipoma: well defined, soft, non-tender, fairly mobile.
- Cystosarcoma phylloides: usually large tumour (5 cm), firm, mobile, well circumscribed, non-tender breast mass. (rare, 1% of breast tumours, 10% are malignant).
Malignant include:
- Carcinoma
early: ill defined, hard, irregular, skin tethering
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