Breast Lump: Causes and What Happens Next

What a breast lump feels like

Normal breast tissue is often lumpy or rope-like, especially in the upper outer part near the armpit and in the days before a period. A lump that needs checking feels distinct: you can feel its edges, it stands out from the tissue around it, or it is in one breast but not the same area of the other.

Doctors describe lumps by:

• Size
• Texture: soft, rubbery, firm or hard
• Shape and edges: smooth and round, or irregular
• Mobility: moves easily under the skin, or fixed to the skin or chest wall
• Tenderness
• Change with the menstrual cycle

Common causes of breast lumps

Breast cysts

Cysts are fluid-filled sacs, most common in women aged 35 to 50 and around menopause. They feel smooth, round and mobile, like a grape or water balloon, and are often tender. They can appear suddenly and change with the menstrual cycle. Ultrasound confirms them, and large painful cysts can be drained with a needle.

Fibroadenomas

Fibroadenomas are solid, benign growths of glandular and connective tissue. They are most common in women aged 15 to 35. They feel firm, rubbery, smooth and move easily under the fingers ("breast mouse"). Most stay the same size or shrink, and they do not turn into cancer.

Fibrocystic changes

Many women have fibrocystic breasts: lumpy, tender tissue in both breasts that worsens before periods. This is a normal variation, not a disease.

Infection

Mastitis causes a painful, red, warm area, usually during breastfeeding. An abscess is a collection of pus that forms a tender lump and needs drainage.

Other benign causes

• Fat necrosis: a firm lump after an injury, surgery or radiotherapy, when fatty tissue is damaged.
• Lipoma: a soft, fatty, slow-growing lump.
• Intraductal papilloma: a small growth in a milk duct, often causing clear or bloody nipple discharge.
• Swollen lymph node in the armpit, often from a recent infection or vaccination.
• Galactocele: a milk-filled cyst during or after breastfeeding.

Breast cancer: signs to know

Breast cancer most often appears as a new lump. Features that raise concern:

• Hard, painless and irregular in shape
• Fixed, not moving freely
• Growing over weeks or months
• Skin dimpling or puckering, or skin like orange peel (peau d'orange)
• A nipple that has newly turned inward
• Bloody nipple discharge from one duct
• A swollen lymph node in the armpit or above the collarbone

Pain does not rule cancer out, and a soft lump is not always benign. Cancer risk rises with age, so a new lump after 40 or after menopause is investigated more fully.

Breast lumps in men

Men have breast tissue too. The most common cause of a breast lump in a man is gynecomastia: a soft, rubbery, sometimes tender disc of tissue behind the nipple, often on both sides. It is common in teenage boys and older men, and can be caused by medicines, liver disease, hormone changes or anabolic steroids. Male breast cancer is rare but usually presents as a firm, painless lump off-center from the nipple, sometimes with nipple changes. Any breast lump in a man should be checked.

What happens when you see a doctor

1. History: when you noticed it, whether it changes with your cycle, pain, nipple discharge, breastfeeding, injuries, hormone use, and family history.
2. Clinical breast exam of both breasts and armpits.
3. Imaging: - Ultrasound is the first test for people under 30 and is used for most lumps. It shows whether a lump is a fluid-filled cyst or solid. - Mammogram plus ultrasound for people aged 30 or 40 and over, depending on local guidelines.
4. Biopsy: if imaging shows a solid or suspicious lump, a core needle biopsy takes small samples under local anesthetic, usually guided by ultrasound. This is the only way to confirm whether a lump is cancer.

Many breast clinics offer "triple assessment" (examination, imaging and biopsy) in a single visit. Results usually come within about a week.

Treatment

• Cysts: no treatment unless painful, then needle drainage.
• Fibroadenomas: usually monitored. Removal if large, growing or bothersome.
• Fibrocystic changes: a well-fitting supportive bra, warm or cold compresses, and acetaminophen or ibuprofen at the label dose for tenderness.
• Infection: antibiotics, continued breastfeeding or pumping, and drainage of an abscess.
• Breast cancer: surgery, radiotherapy, chemotherapy, hormone therapy or targeted therapy, depending on the type and stage.

Breast awareness

Get to know how your breasts normally look and feel, at different times of your cycle. Check in the shower or lying down, using the flat pads of your fingers, covering the whole breast up to the collarbone and into the armpit. Look in a mirror for changes in shape, skin or nipples. Follow screening recommendations for mammograms for your age and risk. The US Preventive Services Task Force recommends screening mammograms every 2 years from age 40 to 74 for women at average risk.

Frequently asked questions

Are most breast lumps cancer?

No. Most breast lumps are benign, most often cysts, fibroadenomas or fibrocystic changes. The chance of cancer is lower in younger people and higher after 40 and after menopause. Every new lump should be checked, because imaging and sometimes a biopsy are the only way to be sure.

What does a cancerous breast lump feel like?

Cancerous lumps are often hard, painless, irregular in shape and fixed in place, like a small stone. They may cause skin dimpling, a turned-in nipple or bloody discharge. However, some cancers are soft, round or tender, so the feel of a lump alone cannot rule cancer in or out.

Should I wait until after my period to check a lump?

If you are menstruating and the lump is small and tender, it is reasonable to check it again after your next period, because hormone-related lumps often shrink. If it is still there, see a doctor. Do not wait if the lump is hard, growing, or comes with skin or nipple changes.

Can a painful breast lump be cancer?

It can, but painful lumps are more often cysts, infections or fibrocystic changes. Most breast cancers are painless, but a minority cause discomfort. Any distinct new lump, painful or not, should be examined by a doctor.

Can men get breast lumps?

Yes. The most common cause is gynecomastia, a benign growth of breast tissue behind the nipple, often linked to hormones or medicines. Men can also get breast cancer, usually as a firm painless lump near the nipple. Any breast lump in a man should be checked promptly.