Breast Masses

Approximately one in every eight women (12.5%) will develop breast cancer at some time in their life. Unfortunately there is no known way to prevent breast cancer. Early detection is the best way of treating breast cancer. Screening for breast cancer should include routine self breast examinations, examination by a health care professional and mammograms. Consult with your doctor as to when to begin these and how frequent to perform these.

More than 90 percent of breast masses are identified by women themselves. The majority of these are not cancerous (benign). The breasts are composed of mammary glands (clusters of glands that produce milk during pregnancy and breast-feeding) which drain at the nipple, fibrous tissue that encases and supports the breast and fatty tissue. Lymph nodes (small kidney shaped glands that act like filters) are located in the armpit (axilla) and occasionally throughout the breast. The breast is constantly changing under the effects of the female hormones, estrogen and progesterone. Because of this, some masses may change during the menstrual cycle or throughout life.

Diagram of breast tissueFibrocystic "disease", or lumpy-bumpy breasts, is the most common source for breast masses and is responsible for approximately 80% of breast operations. Simple cysts (fluid filled sac), fibroadenoma (a solid breast mass composed of fibrous and glandular tissue and papillomas (wart-like growths in the inner lining of the ducts near the nipple) are other examples of benign breast masses.

Cancerous (malignant) breast masses are usually single, hard and painless. Unlike benign breast masses, malignant lesions continue to grow in an unpredictable fashion. Risk factors for the development of breast cancer include a previous history of breast cancer or a history of breast cancer in a first-degree relative. If you give birth for the first time after the age of 30 or if you never give birth, your risk for the development is also higher. The use of birth control pills and hormones may also increase your risk for breast cancer.

Occasionally masses may not be palpated but identified only on mammogram. Abnormal areas of calcium deposits may also be seen on mammogram that may increase the suspicion for breast cancer.

Although uncommon, about 1% of all breast cancers can occur in males. The evaluation of a male breast mass should be the same as for a female breast mass.

Once a lesion of the breast is identified, you should talk to you doctor. There are many options for managing breast lesions.

  • Observation – your doctor may feel that the lesion is not suspicious and should be watched. In this case a repeat mammogram to look at the lesion may be indicated in a few months.

  • Needle Biopsy – Your doctor may place a needle in the lesion to remove fluid (if it is a cyst) or to take out some cells (if it is solid). This material will be sent to the hospital to be looked at by the pathologist under a microscope to see if cancer cells are present.

  • Incisional Biopsy – If the mass is very large a small piece of the lesion may be removed to see if cancer cells are present.

  • Excisional Biopsy – removing the entire lesion. This may be done in a number of ways. They are often done in the hospital on an outpatient basis.

  • Open Biopsy – the surgeon will make an incision to completely remove the lesion

  • Needle Localization Biopsy – a small wire will be placed by the radiology department which will help your surgeon identify where the lesion is in your breast.

  • Stereotactic Biopsy – using a special mammogram table and a computer, the lesion is  identified and removed using a large needle that is attached to a vacuum device.

After a biopsy is done, most people resume normal activity the following day. Your doctor will have you make a follow-up appointment to discuss the findings of the tissue removed. Most lesions removed do not show any cancer. Occasionally precancerous lesions or lesions that would increase your risk for developing breast cancer may be identified. In this situation your doctor may recommend additional surgery.

Scarring will occur after biopsy. Your doctor will more than likely recommend a repeat mammogram of the breast where the surgery was preformed a few months after surgery to have a new baseline for the scarring that will occur after surgery.

If cancer is identified on your biopsy, you doctor will provide you will all the options available for the treatment of your breast cancer. The treatment of breast cancer can be complicated and confusing. Many doctors may be involved in your care. These may include your primary care physician, breast surgeon, plastic surgeon, medical oncologist, radiation oncologist, physical and occupational therapist and possibly a cancer care coordinator.

The content on this site is intended for informational purposes only and is not intended as medical advice.

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