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 commonest breast lumps occurring under the age of 35 years are
fibroadenomas and fibrocystic disease.
• The commonest 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 orfibrocystic disease).
Differential diagnosis
Swelling of the whole breast
Bilateral
• Pregnancy, lactation.
• Idiopathic hypertrophy.
• Drug induced (e.g. stilboestrol, cimetidine).
Unilateral
• Enlargement in the newborn.
• Puberty.
Localized swellings in the breast
Mast itis! breast abscess
• During lactation: red, hot, tender lump, systemic upset.
• Tuberculous abscess: chronic, ‘cold’, recurrent, discharging
sinus.
Cysts
• Galactocele: commoner 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: wide surgical excision (10% are
malignant).
Malignant include:
• Carcinoma
early: ill defined, hard, irregular, skin tethering late: spreading fixity, ulceration, fungation, ‘peau d’orange’.
Swellings behind the breast
• Rib deformities, chondroma, costochondritis (Tietze’s disease).
KEY INVESTIGATIONS
• ENAC: tumours, fibroadenoma, fibrocystic disease, fat necrosis, mastitis.
• Ultrasound: fibroadenoma, cysts, tumours (best for young women/
dense breasts).
• Mammography: tumours, cysts, fibrocystic disease, fat necrosis.
• Biopsy (‘Trucut/open surgical): usually provides definitive
histology (may be radiologically guided if lump is small or
impalpable—detected by mammography as part of breast screening
programme).
