What's this lump in my breast?

The many causes, benign and otherwise, of breast lumps.

The other day, I attended a public forum where they taught us how to do a breast self-examination. I did it on myself, and to my alarm, I think I felt a lump on my left breast. I’m very scared. Do I have breast cancer?

Let me assure you that there are plenty of breast lumps that aren't caused by breast cancer. Most breast lumps are harmless and benign. However, any breast lump should be carefully checked by a doctor, and preferably a breast surgeon who can do tests and biopsies on the lump.

What does my breast consist of? I have always thought it was just fat.

Your breast contains primarily lobules or alveoli, which are milk-producing glands. Your breast’s primary function is to produce milk for your baby. Granted, these days that function isn't as utilised since many women tend not to have as many children as they did in the old days.

The milk glands are connected by a series of milk ducts that carry milk to the nipple. These milk glands and ducts look like bunches of grapes inside the tissue of your breasts, and there are about 15 to 20 of them. Sometimes, these milk glands and ducts are organised into clusters, and before your period, you can feel them as little lumps. You need not be afraid of these little lumps. They're normal.

The space between these lobules are filled with fat and connective tissue. But it’s not true that fat forms the largest part of your breast. Your breasts are mostly filled with gland tissue, and that's why they feel firm. The younger you are, the more gland tissue you have. When you get old, they contain more fat, and that's

why your breasts feel softer.

Your breast also contains ligaments to support them. Unfortunately, as you get older, these ligaments stretch over time and your breasts begin to sag. Your breasts do not contain any muscle other than tiny ones in your nipples, so you can’t exercise them into becoming bigger!

The dark part surrounding your nipple is called the areola, which grows and gets darker during pregnancy. The areola contains little bumps called Montgomery glands, which produce oil to lubricate it. Your nipple has tiny openings in it to allow milk to flow.

What are the causes of breast lumps?

There are many. They include infections, injuries (trauma), benign growths and cancerous growths. An infection or inflammation of the breast is called mastitis. This happens especially when you're breastfeeding. If your baby nips at your nipple sharply, or if you get cracks in your nipple for any reason, bacteria can enter this wound and cause infections. The infection can be an abscess (which is a pocket of accumulated pus) or a wider area of skin spread known as cellulitis. These days, another increasing cause of breast infection is nipple piercing.

What about injuries? Are these common?

Not so common, unless you're a very active person and your breasts have been through some rough handling! If your breast is injured in any way, the blood vessels within them can break, causing an area of localised bleeding. This is called a haematoma. Your fat cells can also be damaged, leading to cell death. This is called fat necrosis. Both of these can cause lumps.

What are the benign lumps of the breast?

The most common is called fibroadenoma. These are very common growths. I've had one myself for the past 25 years. They usually manifest in women in their 20s and early 30s, but they can occur when you're younger. Fibroadenomas are painless, most of the time. They're firm, smooth, and can be rubbery or hard. They're well-defined, meaning you can feel their borders and contours. They're usually the size of a marble. They usually enlarge during pregnancy and breastfeeding. The surgeon may advise you to remove them, but the chances of these going on to become cancerous is virtually none.

Then you have breast cysts, which are fluid-filled sacs. These are very common, too, especially if you're over 35. The cysts vary in size during your menstrual cycle and may be tender. Another cause of breast lumps is fibrocystic changes. Here, the breasts feel lumpy and almost grainy. These occur when your breasts are extra-sensitive to fluctuating hormone levels that occur during a menstrual cycle. These lumps and changes can be quite painful.

How can I differentiate these benign lumps from breast cancer?

It can be very difficult, so don’t try. Head immediately to a breast surgeon for an ultrasound and a biopsy. A breast cancer lump is usually painless. Sometimes, there can be nipple discharge or inflammation of the breast skin, depending on the type of breast cancer. So don’t hesitate. Go to the doctor right away.

Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health, computers and entertainment. For further information, e-mail starhealth@thestar.com.my. The information contained in this column is for general educational purposes only. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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