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Breast Lumps

(or why are they recommending that I have a breast biopsy)

Breast self examination (BSE) is an exercise that should be performed by women on a regular basis to detect lumps in the breast. Most breast lumps are discovered by women themselves and are usually non cancerous. However, all new breast lumps should be brought tot he attention of your doctor for assessment and to determine if other studies should be performed. BSE may be best performed at the same time of the menstrual cycle or at the same time of the month in the woman without menses.

It may be best to perform this exam in the shower in the morning so that any changes that are felt can be checked out that day. BSE when performed in the wet and soapy state may be easier to detect subtle changes in the texture of the underlying breast tissue. It is hoped that by employing monthly BSE, periodic professional checkups, and mammographic screening, that breast cancer can be detected early and treated more successfully.


Types of breast lumps: Breast lumps may be related to fibrocystic changes in the breast. These changes are most apparent in pre menopausal women and are directly related to hormonal status. Breasts normally swell with l=fluid, most notably during the week before menstruation. At this time, these lumps may be tender and more prominent. Following the menses, these lumps may decrease in size. If these lumps are new, however, they deserve to be checked by your doctor. Fibrocystic changes are the most common cause of breast lumps in pre menopausal women. Associated the these changes are simple cysts that can become quite large (contain several milliliters of greenish-brown fluid) and be tender. These may be detected by ultrasound and/or may be aspirated by your doctor to see if removal of the fluid causes the mass to go away.


Fibroadenomas are rubbery, discrete lumps that occur in women starting in adolescence and progressing into mid life. In older women, these lumps may undergo calcification and present later in life. These are related to estrogen stimulation and are solid tumors containing both fibrous and glandular tissue. They are solid and benign lumps that can grow to be several centimeters in diameter especially in young women.

Unfortunately, breast cancers can mimic all of the benign lesions listed above. The "wives tale" that breast cancers are never tender is not correct. While it is true that most breast cancers are non tender, there are exceptions to this folklore.


Weight loss may result in a change in you breast exam. With a decrease in the overlying fatty layer of the breast, the underlying architecture of the breast may be easier to feel. Previously non palpable (not able to be felt) lumps may now be felt and may need to be checked by your doctor.


Non palpable breast lumps (unable to be felt) are really changes on the mammogram or ultrasound that have a worrisome appearance and suggest a need for careful followup or biopsy. Invasive ways to diagnose breast lumps are many. If lump can be felt, then it can be stuck with a needle to try to get cells for cytology. If this test is positive, then it may save a step in biopsy. If negative, you may still need a more invasive biopsy. Core needle biopsies may be performed with a rapid fire biopsy apparatus that takes a core of tissue. If the suspicious lump cannot be felt, then either a mammographically directed stereotactic biopsy or a needle localized breast biopsy will need to be performed. The stereotactic biopsy takes a core sample through a 4 mm incision and can be performed under local anesthesia without any sedation. A needle localized breast biopsy is performed by first placing a tiny wire through the suspicious lesion in the mammogram suite, and then proceeding to the OR where on open biopsy is performed usually under local with sedation. An open biopsy is usually an excisional biopsy where the entire lump is removed (lumpectomy).


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