A palpable breast lump is a distinct mass or area of thickening felt within the breast tissue. While finding a lump can be concerning, many are benign, meaning non-cancerous. This article explains what breast lumps feel like, when to seek medical attention, and how they are investigated.
What a Palpable Lump Feels Like
A breast lump is a distinct mass or area of thickening that feels different from surrounding tissue. Its texture varies, from soft and squishy to firm and hard, or even rubbery, rope-like, or bumpy.
Lumps range in size from a pea to a golf ball, and may be movable or fixed. Normal breast tissue can feel lumpy or uneven, with textures changing due to hormonal fluctuations. A new or distinct lump that differs from your usual breast texture warrants attention.
Common Reasons for Breast Lumps
Breast lumps stem from various conditions, most of which are benign.
Benign Causes
Cysts
Cysts are fluid-filled sacs that commonly occur in the breast, particularly in individuals between 35 and 50 years old, or those nearing menopause. These typically feel smooth, round or oval, and movable, often becoming larger and more tender before a menstrual period due to hormonal changes. Simple cysts are entirely fluid-filled and are almost always non-cancerous.
Fibroadenomas
Fibroadenomas are solid, non-cancerous tumors composed of glandular and connective tissue, frequently found in women between 15 and 35 years old. These lumps are usually firm, rubbery, and easily movable, often described as feeling like a marble under the skin. They typically do not cause pain, though some may become tender before a period or grow larger during pregnancy.
Fibrocystic changes
Fibrocystic changes are a common condition where breast tissue feels generally lumpy, dense, or ropelike. This lumpiness and tenderness often relate to hormonal fluctuations during the menstrual cycle, worsening before a period and improving afterward. Over half of women experience fibrocystic changes at some point in their lives, most commonly between ages 20 and 50.
Infections or abscesses
Infections or abscesses in the breast, known as mastitis, can cause painful, swollen, warm, and red lumps, sometimes accompanied by fever or flu-like symptoms. These conditions often arise from bacteria entering breast tissue, sometimes through cracked nipples or blocked milk ducts, and are more common in breastfeeding individuals. An abscess is a collection of pus that can form if untreated.
Fat necrosis
Fat necrosis occurs when fatty breast tissue is damaged, leading to the formation of painless, firm, round lumps. This can happen after trauma, surgery, or even a bruise to the breast. The damaged fat cells release oily content, sometimes forming an oil cyst, which can harden over time.
Malignant Causes (Breast Cancer)
Breast cancer can present as a lump that feels hard, has irregular or angular edges, and may be fixed in place rather than movable. While most cancerous lumps are painless, some may cause discomfort. Other signs of breast cancer can include changes in breast size or shape, dimpling or puckering of the skin, redness, scaling, or nipple changes like inversion or discharge. Only a healthcare provider can definitively determine if a lump is cancerous through diagnostic tests.
When to Consult a Doctor
Any new or concerning breast lump warrants evaluation by a healthcare professional.
Seek medical attention for a lump that is new, firm, fixed, or does not resolve within 4 to 6 weeks, or if it changes in size or feel. Other concerning signs include:
- Changes in breast size or shape.
- Skin changes like dimpling, puckering, redness, or scaling on the breast or nipple.
- Nipple discharge, especially if bloody or clear and sudden.
- Persistent or severe breast pain.
How Doctors Investigate Breast Lumps
Healthcare providers follow a systematic process to investigate breast lumps, beginning with a physical examination.
A clinical breast exam (CBE)
A clinical breast exam (CBE) involves the doctor visually inspecting and manually feeling the breasts, underarms, and collarbone area. The doctor notes the lump’s size, shape, texture, and mobility, and observes for skin changes or nipple issues like inversion or discharge. This initial assessment helps guide the subsequent diagnostic steps.
Imaging tests
After the clinical exam, imaging tests are ordered to get a clearer picture of the lump. A mammogram uses low-dose X-rays to create images of the breast tissue, helping to identify very small lumps that may not be felt during an exam. An ultrasound uses sound waves to produce images of the breast’s interior, which is particularly useful for differentiating between fluid-filled cysts and solid masses. For more detailed images, especially in cases of dense breast tissue or unclear mammogram/ultrasound results, a breast MRI (Magnetic Resonance Imaging) may be used, which employs a magnetic field and radio waves without X-rays.
Biopsy
If imaging tests are inconclusive or suggest a solid mass, a biopsy is typically performed to obtain a definitive diagnosis. This procedure involves taking a tissue sample from the lump for microscopic analysis. Common types include fine-needle aspiration, which uses a thin needle to withdraw fluid or cells, often used for cysts. A core needle biopsy uses a larger needle to remove small cylinders of tissue, often guided by ultrasound or mammography. In some instances, a surgical biopsy may be performed to remove part or all of the lump for examination.