Breast Lumps and Bumps

What are Breast Lumps and Bumps?

Breast lumps and bumps refer to abnormal masses or swellings within breast tissue that can vary in size, shape, and consistency. They are often discovered through physical self-exams, clinical examinations, or imaging techniques like mammography. While the term "lumps and bumps" can refer to a variety of breast changes, these abnormalities can include benign conditions such as cysts, fibroadenomas, or fat necrosis, as well as malignant conditions like breast cancer.


How Do Breast Lumps and Bumps Impact Your Anatomy and Health?

The impact of breast lumps and bumps on anatomy and health depends largely on their underlying cause:

  • Benign Lumps: These typically do not alter the overall health but can sometimes cause discomfort, pain, or anxiety due to uncertainty about their nature. For example, fibroadenomas are solid, non-cancerous lumps that may grow larger over time but do not spread to other tissues. Cysts, which are fluid-filled sacs, might cause pain, especially if they become large.
  • Malignant Lumps: Cancerous lumps, such as those from breast cancer, can significantly impact health. They can invade and destroy surrounding tissue and potentially spread (metastasise) to other parts of the body, leading to severe health complications. The physical changes might include visible distortions in the shape of the breast, nipple discharge, or changes in the skin texture.


Risk Factors for Breast Lumps and Bumps

Anyone with breast tissue is at risk for breast lumps, but the risk is higher in:

  • Women over 40 years of age
  • Individuals with a family history of breast cancer or benign breast conditions
  • Those with genetic mutations such as BRCA1 or BRCA2
  • People with previous breast conditions or cancer
  • Women who started menstruating at an early age or entered menopause at a later age
  • Individuals with dense breast tissue


Causes of Breast Lumps and Bumps

Breast lumps and bumps can arise from a variety of causes, ranging from benign to malignant conditions:

  • Hormonal Fluctuations: Common in women of reproductive age, changes in hormone levels during menstrual cycles can lead to the development of cysts or fibrocystic breast changes, causing the breasts to feel lumpy or tender.
  • Infections: Mastitis, an infection of the breast tissue, often occurs during breastfeeding. It can cause lumps, redness, and swelling.
  • Injuries: Trauma to the breast can lead to fat necrosis or oil cysts, which are lumps formed by damaged fatty tissues.
  • Benign Tumours: Fibroadenomas are common non-cancerous tumours that typically occur in younger women. They are usually firm, smooth, and movable under the skin.
  • Cancer: Breast cancer can present as a lump or thickening in the breast. While many breast lumps are benign, a healthcare professional should evaluate any new, persistent, or changing lump.
  • Other Non-cancerous Conditions: Other benign conditions, such as intraductal papillomas (small wart-like growths in the ducts) and lipomas (fatty lumps), can also cause breast lumps.


Symptoms of Breast Lumps and Bumps

  • A noticeable lump or thickening in the breast or underarm area
  • Change in the size, shape, or contour of the breast
  • Skin changes on the breast, such as dimpling, puckering, or redness
  • Discharge from the nipple, especially if it's bloody
  • Breast pain, although many breast cancers do not cause pain initially


Types of Breast Lumps and Bumps

Sebaceous Cysts

Sebaceous cysts are benign, slow-growing lumps beneath the skin, often filled with keratin or sebum. These cysts commonly occur on the scalp, face, neck, and torso. While generally harmless, they can become inflamed, infected, or cause discomfort, necessitating removal.


Sebaceous cysts can be surgically removed if they become bothersome, infected, or continue to grow. This procedure typically involves a small incision to drain and remove the cyst sac, ensuring it is less likely to recur.


Lipoma

Lipomas are soft, movable under-skin lumps formed from fat tissue. They are typically benign and painless but can occur anywhere on the body. While they generally do not require treatment unless painful or rapidly increasing in size, they can be unsightly or uncomfortable depending on their location.


If necessary, lipomas can be removed surgically under local anaesthesia. This procedure involves making a small incision and carefully extracting the fatty tissue.


Seborrhoeic Keratoses

Seborrhoeic keratoses are common, benign skin growths in middle-aged and elderly individuals. They are typically brown, black, or light tan and have a slightly elevated, waxy, or scaly appearance. They are not cancerous and do not become cancerous.


No treatment is necessary unless the lesions become irritated, itchy, or cosmetically undesirable. Treatments include cryotherapy, curettage, and laser removal.


Fibroadenomas

Fibroadenomas are benign breast tumours commonly found in young women. They are solid, smooth, rubbery, and moveable under the skin. These tumours are noncancerous and can vary in size.


Intraductal Papillomas

Intraductal papillomas are small, benign tumours forming in a breast milk duct. They are most common in women aged 35 to 55. These growths can cause nipple discharge that may be clear or blood-tinged.


Breast Cancer

Breast cancer involves malignant cells forming in the tissues of the breast, potentially leading to tumours. Signs of breast cancer include lumps, changes in breast shape or size, dimpling of the skin, nipple inversion, or redness.


Mastitis

Mastitis is an inflammation of breast tissue that often involves an infection. It is most commonly seen in breastfeeding women but can occur in any woman. Symptoms include breast pain, swelling, warmth, redness, and fever.


Stages of Breast Lumps and Bumps

The "stages" of breast lumps primarily apply to malignant lumps (cancer), as benign lumps do not have a staging system. Breast cancer stages range from 0 to IV:

  • Stage 0: Known as ductal carcinoma in situ (DCIS), the cancer cells are confined to the ducts and have not invaded surrounding tissue.
  • Stage I: Early-stage invasive breast cancer where the tumour is up to 2 cm and has not spread outside the breast.
  • Stage II: Divided into IIA and IIB, this stage includes larger tumours (2 cm to 5 cm) or those that have spread to a few nearby lymph nodes.
  • Stage III: Known as locally advanced breast cancer. This stage may involve tumours larger than 5 cm, extensive cancer spread to several nearby lymph nodes, and/or significant involvement of skin or chest wall.
  • Stage IV: Metastatic breast cancer, where the cancer has spread to distant parts of the body such as bones, liver, lung, or brain.


Diagnosis of Breast Lumps and Bumps

The diagnosis of breast lumps involves several steps to determine the nature of the lump and whether it's benign or malignant:

  • Clinical Breast Exam (CBE): A doctor examines the breasts and underarms for lumps or other changes.
  • Imaging Tests:
  • Mammography
  • Ultrasound
  • MRI
  • Biopsy:
  • Fine Needle Aspiration (FNA)
  • Core Needle Biopsy
  • Surgical Biopsy
  • Laboratory Tests: If cancer is suspected, additional tests may be performed on the biopsy sample to determine the type of cancer and the presence of hormone receptors or other markers.


Treatment of Breast Lumps and Bumps

Treatment depends on the type, size, and location of the lump, as well as the patient's overall health:

  • Benign Lumps:
  • Small, benign lumps without symptoms might be monitored over time with regular follow-up exams.
  • Hormonal treatments or anti-inflammatory medications can be used if the lump causes discomfort.
  • Surgical removal may be recommended if a benign lump is large or causing significant symptoms.
  • Malignant Lumps (Breast Cancer):
  • Surgery: Options include lumpectomy (removing the lump) or mastectomy (removing part or all of the breast).
  • Radiation Therapy: Often used after surgery to eliminate any remaining cancer cells.
  • Chemotherapy: Used to kill cancer cells, often before (neoadjuvant) or after (adjuvant) surgery.
  • Hormone Therapy: For tumours that are hormone receptor-positive.
  • Targeted Therapy: Drugs specifically target cancer cells with certain characteristics, such as HER2-positive cancers.


What if Breast Lumps and Bumps are Untreated?

  • Benign Lumps: While they generally do not pose a serious health risk, they can sometimes grow larger and become uncomfortable or painful. Regular monitoring is necessary to catch any changes early.
  • Malignant Lumps (Breast Cancer): Untreated breast cancer can progress and spread to other parts of the body (metastasis), significantly reducing the likelihood of successful treatment and recovery. The prognosis worsens considerably with advanced stages of cancer.


Foreign Body Removal

Foreign body removal is a common procedure required when an object becomes embedded within the body’s tissues. This can occur due to accidents, injuries, or other incidents where materials like splinters, glass, metal, or other debris penetrate the skin. Effective and timely removal is essential to prevent infection and other complications. 


Reasons for Foreign Body Removal

Foreign bodies need to be removed to prevent:

  • Infection, as the foreign material can introduce bacteria into the body.
  • Inflammation and pain caused by the body’s immune response to a foreign object.
  • Long-term complications such as granuloma formation or migration of the object deeper into tissues.
  • Potential toxicity, especially with certain metals or chemical-containing objects.


Symptoms Indicating the Need for Removal

The presence of a foreign body may be indicated by:

  • Visible objects in the skin
  • Pain or discomfort at the site of entry
  • Swelling, redness, or warmth around the affected area
  • Pus or discharge, suggesting an infection


The removal technique depends on the type and location of the foreign body. Minor surgical procedures under local anaesthesia can be required, especially for deeply embedded or hazardous materials like glass or metal.


Wound Assessment

Wound assessment is critical in determining the appropriate treatment and ensuring proper healing, especially in chronic or infected wounds. It involves evaluating the wound size, depth, type of tissue involved, and signs of infection.


Management may include cleaning, debridement, and the use of appropriate dressings and antibiotics if infection is present. Advanced wounds might require more specialised treatments, such as negative pressure wound therapy or skin grafts.


Ingrown Toenails

Ingrown toenails occur when the edge of a toenail grows into the surrounding skin, causing pain, redness, and swelling. They are commonly seen in the big toes and can result from improper nail trimming, tight footwear, or injury.


Treatment options include soaking the foot to soften the nail, placing cotton under the affected nail to separate it from the skin, or, in more severe cases, partial or complete nail removal to prevent further ingrowth and infection.

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