Finding a breast lump can be frightening, but a lump is not always a sign of breast cancer. There are various reasons why a lump can develop, and most are not cancerous. According to the support organization Breastcancer.org, 8 out of 10 lumps that occur in the breast are not cancerous. Nevertheless, people should seek medical help if a new lump appears or if an existing lump changes. Often, the lump does not need treatment. However, if a person needs treatment, doctors may recommend surgery. This kind of breast surgery is known as a lumpectomy. In this article, we look at the reasons for the surgery and what patients can expect before, during, and after the procedure.
Risk factors
There are several reasons why a person might need a lumpectomy. Sometimes, a surgeon will carry out a biopsy to test a sample of tissue. At the same time, they might remove a small lump that looks suspicious. If tests confirm the presence of breast cancer, a surgeon will often remove the tumor by doing a lumpectomy. A person who has breast cancer may need chemotherapy, radiation, or medication after undergoing the lumpectomy. This is necessary to treat the cancer and prevent it from returning. The outlook after surgery depends on several factors, including the type of lump that the surgeon finds, and the stage of the cancer if a lump is malignant.
Causes
There are different causes for lumps in the breast. Fortunately, not all of them are cancer. They include: Cysts: These harmless growths in the breast tissue tend to occur with hormonal changes, such as the start of a menstrual period. A surgeon may use a needle to drain the fluid that usually fills a cyst. After draining, it is possible that cysts will reoccur. Fibroadenoma and fibrocystic breasts: These are conditions that involve hardening and thickening of the tissue within the breast. The tissue is usually harmless. Intraductal papillomas: This is when hard, rubbery lumps form in the milk ducts. These are also usually harmless. Benign tumors: These solid growths are not cancerous or dangerous. They can be uncomfortable, and they can sometimes cause leakage from the nipples, depending on their location. Doing a biopsy and examining the cells from the tumor under a microscope is the only way to determine if it is cancerous or benign. Hormonal changes: The breasts change over time and during the menstrual cycle. Lumps may come and go regularly. Checking the breasts at the same time each month can help a person keep track of any change that is unusual. Fatty lumps that develop after a trauma and the use of some medications, are other causes of breast lumps.
When to see a doctor
It is vital for a person to see a doctor to find out which type of lump they have in their breasts. If necessary, it is better for them to begin treatment as early as possible. A doctor may recommend imaging tests, including mammogram, MRI, or ultrasound. These tests can reveal details of the lump and surrounding tissue. Someone who has a low risk for breast cancer may only need to monitor the lump and return periodically to check on it. However, a doctor may recommend either a biopsy or more extensive surgery if there is any chance that the lump may be malignant or if it causes pain.
What happens in a biopsy?
A biopsy involves removing a small amount of the lump to look for its cause. Doing a biopsy is the only way to diagnose breast cancer or other conditions definitively. There are different types of biopsy. These include: Fine needle aspiration biopsy: The doctor inserts a small needle into the lump and removes a few cells for testing. Core needle biopsy: The doctor uses a slightly larger needle to remove three to six small cylinders of tissue from the breast. Specialists then look at the samples under a microscope. Surgical biopsy: A surgeon makes a cut into the breast to remove either a small amount of the abnormal tissue or the entire lump. Removing the entire lump is known as an excisional biopsy. Lymph node biopsy: The doctor takes tissue from the lymph nodes under the arm to check for cancer cells. An excisional biopsy is also known as a breast lump removal or a lumpectomy. A lumpectomy removes only the abnormal tissue and a small amount of surrounding tissue from the breast. It leaves the rest of the breast intact.
Surgical procedures
A surgeon can carry out several types of procedure to remove a breast lump or, in some cases, the entire breast. The surgeon will discuss appropriate options with the patient. The procedure will depend on the size and location of the tumor, breast size, whether or not the cancer has spread, and the wishes of the individual.
Types of surgery
A lumpectomy is when most of the breast tissue stays in place. In some cases, a more invasive intervention is necessary. If doctors suspect cancer, a surgeon will remove lymph nodes that are close to the breast tumor to look for any evidence that cancer has spread. When the surgeon removes a cancerous tumor, they must be sure that they have removed all the cancer cells. The surgeon will initially take a small amount of tissue that surrounds the tumor, known as the margin, for examination under a microscope. If there are no cancer cells in the margin, this is considered a healthy or clear margin. If there are cancer cells in the margin, further surgery may be necessary to remove the rest of the cancer. A mastectomy is the complete removal of the breast, nipple, and all of the breast tissue. There are different types of mastectomies, which include removing the breast tissue but preserving the skin overlying the breast and/or preserving the nipple The surgeon may carry out reconstructive surgery to create a new breast, either at the same time or a later date after a mastectomy.
What to expect
A lumpectomy is usually an outpatient procedure. It can take place either in the hospital or an outpatient surgical center. If a mastectomy is necessary, it will usually take place in the hospital, because the procedure and recovery are more complex. Patients who use certain medications, such as aspirin and other blood thinners, may need to stop taking these before surgery in order to reduce the risk of bleeding. A doctor will advise if this is necessary. Patients should not eat or drink for at least 8 to 12 hours before surgery, and they should make arrangements for a ride home. If the lump is difficult to locate within the breast tissue, a radiologist may need to place a marker in the lump and a thin guide wire, leading from the surface of the breast into the lump. This makes it easier for the surgeon to find the lump during surgery. Typically, the person will meet with the surgeon a few days to a week before they have one of these procedures, so they can discuss any additional instructions that may be necessary.
During surgery
Depending on the surgery, the medical team may use a local or general anesthesia. The surgeon will usually operate with an electric knife that reduces the risk of bleeding. They typically make a curved incision in the breast. Sometimes, they will fit a drainage tube to remove any excess fluid that might build up in the place where the lump was after the surgery. Following the procedure, the surgeon will stitch the incision and apply a dressing.
Risks
As with all surgical procedures, breast lump removal can carry some risks. These risks may include: - bleeding - infection - pain - swelling - scar tissue - change in appearance of the breast
Recovery
Recovery will depend on the type of procedure. The surgeon will give detailed instructions on how and when a person should have a follow-up appointment for further care. The doctor may give the individual a prescription for some pain medication and instructions about caring for the dressing and follow-up appointments. Sometimes, the drainage tube remains in place until the follow-up appointment. Depending on the extent of the procedure, aftercare may include: - resting - taking sponge-baths instead of showers while stitches are still in place - wearing a support bra or sports bra - arm exercises that the surgeon may recommend Meanwhile, patients should look out for increasing pain, swelling, redness, and other signs of infection. If they notice these, they should contact their doctor as soon as possible. There may be some itching and sensitivity as the nerves grow back after surgery. This may go away in time, or a person may become used to the different feeling. After removing the breast tissue, the surgeon will send it to a pathologist, who will examine it under a microscope to confirm the diagnosis. The doctor will share this information after receiving the results. They will discuss what the results mean and what will happen next.
Screening
It is not always possible to detect a lump or other changes in the early stages of breast cancer. For this reason, it is important to consider screening. The American College of Physicians recommend asking a doctor about routine screening from the age of 40 years. They also recommend routine screening every 2 years for women ages 50–74 with an average risk of breast cancer. Other authorities, such as the American Cancer Society, make different recommendations. Individuals should ask their doctor to figure out which option is the best for them.
Takeaway
Although it can be frightening to find a lump in the breast, the cause is often not cancer. However, anyone who finds a lump should see a doctor promptly to obtain an accurate diagnosis, and start early treatment if necessary. Screening can help people find changes in the early stages of breast cancer, when there is a strong chance of treating it effectively. Have you noticed a lump that was not there before? Did you feel any change at all on your breast and the surrounding area? Talk to us at Sydney Breast Associates, and we’ll help you with any concerns you have about breast lumps or cancer.
