Health Library Breast ProblemsFrom Healthwise

Breast lumps or changes are a common health worry for most women. Women may have many kinds of breast lumps and other breast changes throughout their lives, including changes that occur with menstrual periods, pregnancy, and aging. Most breast lumps and breast changes are normal.

See a picture of the breast anatomy.

Common, noncancerous (benign) breast changes include:

• Sacs filled with fluids (cysts).
• Generalized breast lumpiness.
• Painless, movable, and firm round lumps (fibroadenomas).
• Damaged fatty tissue (fat necrosis).
• Growths inside the ducts (intraductal papillomas).
• Enlargement of lymph nodes in the breast.
• Breast pain (mastalgia).
• Breast infections (mastitis) or abscesses.
• Nipple discharge.
• Inflamed blood vessels (thrombophlebitis).

Breast development is the first sign of puberty in young girls. Usually, breasts begin as small, tender bumps under one or both nipples that will get bigger over the next few years. It is not unusual for one breast to be larger than the other or for one side to develop before the other. A girl may worry that a lump under the nipple is abnormal or a sign of a serious medical problem when it is a part of normal breast development.

In men, enlargement of male breast tissue (gynecomastia) is a noncancerous breast change. During puberty, young men commonly have smooth, round lumps or "breast buds" under the nipple. These develop because of rapid changes in hormone levels. They are not dangerous and usually disappear in a few months.

Many women with breast pain or breast lumps worry about breast cancer. The incidence of breast cancer in the United States has gradually increased during the past 30 years and is the second leading cause of cancer deaths in women. Breast cancer represents approximately 30% of new cancer diagnosed in women. Approximately 1 man gets breast cancer for every 100 cases of breast cancer in women.

The earlier breast cancer is detected, the more easily and successfully it can be treated.

There are 2 methods of early detection:

• Clinical breast examination (CBE). During your routine physical examination, your doctor may do a clinical breast examination. During a CBE, your doctor will carefully feel your breasts and under your arms to check for lumps or other unusual changes.
• Mammogram. A mammogram is an X-ray of the breast that can often find tumors that are too small for you or your doctor to feel. Most women should begin having mammograms at the age of 40. If you are younger than age 40 and have risk factors for breast cancer, talk with your doctor about starting screening before age 40.

Breast self-examination (BSE) involves checking your breasts for lumps or changes while standing and lying in different positions and while looking at your breasts in a mirror. Once you know what your breasts normally look and feel like, any new lump or change in appearance should be evaluated by a doctor. Most breast problems or changes are not caused by cancer. However, BSE should not be used in place of clinical breast examination and mammography. Studies have not shown that BSE alone reduces the number of deaths from breast cancer.

One of the biggest risk factors for breast cancer is age. Breast cancer is a common disease in women older than 50. At least 1 out of every 8 women in the United States will develop breast cancer if she lives long enough. The chance that a woman will develop breast cancer by age 30 is about 1 in 250. The risk that a woman will develop breast cancer by age 40 is about 1 in 70.¹

Early breast cancer is often seen on a mammogram before there are any symptoms. The most common symptom of breast cancer is a painless lump. However, sometimes painful lumps are cancerous. Other symptoms of breast cancer include:

• A lump or thickening in the breast or armpit that is new or unusual.
• A change in the size or shape of the breast.
• Skin changes, such as a dimple or pucker in the skin of the breast.
• Discharge or bleeding from the nipple that comes out without squeezing the nipple (spontaneous discharge).
• A change in the nipple.
• Scaling or crusting of the nipple.
• A change in the color or feel of the skin of the breast or the darker area around the nipple (areola).
• A breast lump in a man.

Treatment of a breast problem depends on the cause of the problem.

Review the Check Your Symptoms section to determine if and when you need to see a doctor.

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

	Yes	Do you have symptoms of a breast infection?
When to See a Doctor See significance of symptoms of a breast infection if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have diabetes? Yes Do you have a disease or take medicine that causes problems with your immune system? Yes Are you breast-feeding? Yes Do you have pain, swelling, redness, or warmth in or around a breast? Yes Do you have red streaks extending from a breast? Yes Are your nipples cracked and bleeding? Yes Do you have drainage of pus from the nipple or another area of the breast? Yes Do you know or think you have a fever? Yes Do you have swollen lymph nodes in the neck or armpit? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Have you had mild pain and swelling with redness less than 1 in. (2.5 cm) in or around a breast for 1 week or longer? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you still have symptoms of a breast infection after taking antibiotics for 3 or 4 days?
When to See a Doctor See significance of a breast infection that is not improving with treatment if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have diabetes? Yes Do you have a disease or take medicine that causes problems with your immune system? Call your health professional today if you answer "Yes" to any of the following questions. Yes Have you been treated for a breast infection and your symptoms have not improved after 3 to 4 days of treatment? Yes Have your symptoms returned after completing treatment with antibiotics for a breast infection? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have breast pain that is not related to your menstrual cycle?
When to See a Doctor See significance of breast pain if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have severe breast pain? Yes Do you have moderate breast pain? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Have you had mild breast pain for 2 weeks or longer? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Do you have breast pain that comes and goes? Yes Do you have breast pain that occurs regularly with your menstrual cycles, and home treatment has not relieved your pain? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you think your breast problem may be caused by a medicine?
When to See a Doctor See significance of medicines causing breast problems if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: If your answer to one of the questions below is "Yes": Call the doctor who prescribed the medicine today. He or she can determine whether you should stop taking the medicine or take a different one. An appointment may or may not be needed. If you are taking a nonprescription medicine, stop taking the medicine. Call your doctor if you feel you need to keep taking the medicine or if you need help to control your symptoms after you stop the medicine. Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have breast tenderness that you think may be caused by a medicine? Yes Do you have nipple discharge that you think may be caused by a medicine? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have a lump in your breast or change in the size or shape of a breast?
When to See a Doctor See significance of a lump or change in the size or shape of a breast if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: Women: If you are still having menstrual periods, it may be appropriate to wait through one menstrual cycle to see whether your breast changes return to normal. Men: It is very common for young men entering puberty to have smooth, round lumps or "breast buds" under the nipple. These occur because of rapid changes in hormone levels (gynecomastia). These lumps are not dangerous and usually disappear in a few months. You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Do you have a lump or thickening in the breast or armpit? Yes Do you have a change in the size or shape of your breast? Yes Are you a man who has found a breast lump? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have any other breast problem?
When to See a Doctor See significance of other breast problems if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Do you have skin changes, such as dimpling or puckering of the skin of the breast? Yes Do you have nipple discharge that comes out without squeezing the nipple (spontaneous discharge)? Yes Do you have bloody nipple discharge? Yes Do you have a change in the color or feel of the skin of the breast or the darker area around the nipple (areola)? Yes Do you have a nipple that is drawn inward (retraction or inversion)? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

Breast self-exams are a simple way for you to learn what your breasts normally feel like. During a breast self-exam, you examine your own breasts to look and feel for changes from one month to the next. You will learn how your breasts feel and what is normal for you so that you can spot any changes early. For more information about how to do a breast self-exam, see the topic Breast Self-Examination.

Alternative medicines or supplements may help relieve breast tenderness, discomfort, or pain (mastalgia). As with all alternative medicines and supplements, it is important to follow the directions on the label. Do not exceed the maximum recommended dose. If you are or could be pregnant, talk with your doctor before taking any medicine or supplement.

• Evening primrose. Some studies have shown that when taken on a regular schedule, evening primrose relieves breast pain. For more information, see the topic Fibrocystic Breasts.
• Magnesium. Some studies have shown that magnesium reduces mild premenstrual symptoms of fluid retention, which may be the cause of premenstrual breast tenderness. For more information, see the topic Fibrocystic Breasts.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment:

• A change in a breast develops, such as:
  • A lump or thickening in the breast or armpit that is new or unusual and does not go away after your monthly period.
  • A change in the size or shape of your breast.
  • Skin changes, such as a dimple or pucker in the skin of the breast.
  • Discharge or bleeding from the nipple that comes out without squeezing the nipple.
  • A change in the shape of a nipple (retraction or inversion of a nipple).
  • A change in the color or feel of the skin of the breast or the darker area around the nipple (areola).
• A breast lump develops in a man.
• Symptoms of a breast infection develop.
• A breast infection does not improve after 3 to 4 days of medical treatment.
• Symptoms of a breast infection return after medical treatment.
• Symptoms become more severe or more frequent.

To prevent breast tenderness, discomfort, or pain (mastalgia), follow these tips:

• Wear a sports bra during exercise. A sports bra may prevent breast discomfort, pain, and injury during exercise or sports. It is important that the sports bra fit properly. It should keep the breasts almost motionless and allow them to move together with the chest, not separately. It is important to replace your sports bra as the material stretches and become less supportive. A sports bra may need to be replaced every 6 months if it is used regularly.
• Limit your salt intake. High salt intake may cause fluid retention. Fluid retention may be the cause of premenstrual breast tenderness.

To prevent nipple irritation during exercise:

• Cover your nipple with a small bandage or a dab of petroleum jelly before you exercise.
• Wear a sports bra that fits you properly. Avoid sports bras that are lined with cotton.
• Avoid exercising in cold temperatures.
• Wear a vest or jacket made from fabric that blocks the wind.

To prepare for your appointment, see the topic Making the Most of Your Appointment

You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

• What symptoms do you have?
• How long have you had your symptoms? Do your breast changes occur at the same time each month?
• What is your age and general health?
• Do you have menstrual periods? Are your periods regular?
• Are you pregnant?
• Have you had children? Did you breast-feed? Are you currently breast-feeding?
• Have you had a breast infection (mastitis) or a blocked milk duct in the past?
• What prescription and nonprescription medicines are you taking?
• Have you ever been diagnosed with breast lumps or had any fluid or cysts drained from your breasts?
• Have you ever had a mammogram or breast ultrasound?
• Have you ever been diagnosed with breast cancer?
• Do you have any relatives who have noncancerous (benign) breast lumps or breast cancer?
• Do you have any health risks?

• Animal and Human Bites
• Breast Cancer
• Breast Self-Examination
• Chest Pain
• Cuts
• Fibrocystic Breasts
• Inflammatory Breast Cancer
• Mastitis While Breast-Feeding
• Menopause and Perimenopause
• Puncture Wounds

Citations

1. National Cancer Institute (2006). Probability of breast cancer in American women. National Cancer Institute Fact Sheet. Available online: http://www.cancer.gov/cancertopics/factsheet/Detection/probability-breast-cancer.

Author:	Jan Nissl, RN, BS	Last Updated: November 3, 2007
Medical Review:	Anne C. Poinier, MD - Internal Medicine Deborah A. Penava, BA, MD, FRCSC, MPH - Obstetrics and Gynecology
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