Breast Lump or Mass: Causes and What to Do

What a breast lump might be

Benign causes in more detail

Fibrocystic breast changes

Fibrocystic breast disease is so common it is considered a normal variation. Hormone changes through the cycle make breast tissue lumpy and tender, mainly in the upper outer areas, in the days before a period. It does not raise cancer risk in most people.

Cysts

Fluid-filled sacs that are most common in the 40s, before menopause. They can appear within days and feel like a grape or water balloon. Ultrasound confirms them. Painful cysts can be drained with a fine needle.

Fibroadenomas

Solid, benign lumps of glandular and fibrous tissue, most common in teenagers and young women. They are painless and slip around under the fingers. Most stay the same or shrink. Large or growing ones may be removed. A rare, fast-growing relative is the phyllodes tumor, which is removed surgically.

Breast infection

Mastitis most often affects breastfeeding women. A tender lump with redness and fever can be a blocked duct, mastitis or an abscess. Keep breastfeeding or expressing from the affected side unless told otherwise.

Other benign lumps

Intraductal papillomas (often with clear or bloody discharge from one duct), lipomas, sclerosing adenosis and swollen lymph nodes in the armpit after infections or vaccinations (including COVID-19 vaccines).

Breast cancer warning signs

Breast cancer is the most common cancer in women, affecting about 1 in 8 women in the US over a lifetime, and it also occurs in men. Features that raise concern:

• a hard, painless lump with irregular edges
• a lump that is fixed and does not move
• dimpling or puckering of the skin
• skin redness, thickening or an orange-peel texture
• a nipple that has newly turned inward
• bloody or spontaneous discharge from one nipple
• a scaly, crusting rash on the nipple (Paget's disease)
• a lump or swelling in the armpit
• change in breast size or shape

Pain does not rule cancer in or out. Most breast pain is hormonal and not cancer, but a painful lump still needs checking.

Breast lumps in men

Breast enlargement in men is usually gynecomastia: a rubbery, often tender disc of tissue directly behind the nipple, on one or both sides, common in puberty and older age and with some medicines. Male breast cancer is rare but usually appears as a firm, painless lump off-center from the nipple, sometimes with nipple changes. Men should get any breast lump checked.

What happens at the appointment

1. History: when you noticed it, whether it changes with your cycle, pain, discharge, family history of breast or ovarian cancer, hormone use and pregnancy or breastfeeding.
2. Clinical breast examination of both breasts and armpits.
3. Imaging: - Ultrasound: first test under about age 30, and alongside mammography in older women. Tells solid from cystic. - Mammogram: usually for those 30 and over. - MRI: in selected cases, such as high genetic risk.
4. Biopsy: a core needle biopsy, usually guided by ultrasound, gives a definite answer for solid lumps that are not clearly benign.

Results are often described with a BI-RADS score from 0 to 6, which indicates how likely the finding is to be cancer and what should happen next.

Many breast clinics offer "triple assessment" (examination, imaging and biopsy) in a single visit.

Treatment

• Fibrocystic changes: a supportive bra, reducing caffeine if it helps you, and acetaminophen (paracetamol) or ibuprofen as needed, following the label dose.
• Cysts: no treatment unless painful, when they can be drained.
• Fibroadenomas: usually monitored. Removed if large, growing or bothersome.
• Infection: antibiotics compatible with breastfeeding, and drainage for abscesses.
• Cancer: surgery, often with radiotherapy, hormone therapy, chemotherapy or targeted therapy depending on the type and stage.

Being breast aware

There is no single right way to examine your breasts. What matters is knowing how your breasts normally look and feel, so you notice changes. Check the whole breast, up to the collarbone and into the armpit. Follow screening mammogram recommendations for your age and risk. US Preventive Services Task Force guidance recommends screening every 2 years from age 40 to 74 for average-risk women.

Frequently asked questions

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. But some are soft, round or tender, so feel alone cannot tell. Any new lump needs an exam and imaging to be sure.

Should I worry about a painful breast lump?

Painful lumps are more often cysts, fibrocystic changes or infection than cancer. Still, pain does not rule out cancer, so any new lump should be checked. A painful, red, hot breast with fever needs prompt care for possible mastitis or abscess.

Can a breast lump go away on its own?

Yes. Cyclical lumpiness and some cysts shrink after a period, and lumps from minor infection or injury can resolve. If a lump is still there after your next period, or you are past menopause, get it checked rather than waiting.

How fast should I see a doctor about a breast lump?

Book an appointment within a week or two of noticing a new lump. Seek care sooner for a hard, fixed lump, skin or nipple changes, bloody discharge, an armpit lump, or a red, swollen breast.

Can men get breast lumps?

Yes. Most are gynecomastia, a benign rubbery swelling behind the nipple. Men can also get breast cancer, usually as a firm, painless lump. Any breast lump in a man should be assessed by a doctor.