Breast Mass Excision

Breast lumps don’t normally go away on their own and excising them when they are small ensures a smaller incision. Excising, aspirating, or biopsying a breast mass allows your medical team to figure out what kind of mass it is and what treatment, if any, is required.

Sometimes the doctor is sure the lump is fibrocystic changes and if there are many small lumps, the doctor may simply continue to monitor them by making appointments every two to three months to check them. These lumps can disappear on their own but may need to be removed if they change in size. If the lump is a cyst, the doctor may simply drain it.

Breast lumps
A breast lump is a mass that develops in the breast. Breast lumps are commonly found in one breast but can appear in both. Some may be too small or too deep to be felt from the outside and may appear in imaging studies like mammogram and/or ultrasound. Others may be detectable from the outside during a self-examination or a physical examination by a doctor.

Breast lumps can be found at all ages. Girls who are beginning puberty will experience breast changes due to hormonal changes. Breasts will grow as the milk-producing glands and ducts develop. This process can make the breasts feel “lumpier.” These lumps will settle as she enters adulthood. Breast lumps can also be found in boys, especially during the teenage years, also due to hormonal changes. They too tend to disappear on their own.
Types of Lumps
There are many types of breast lumps. The most common include:
  • Fibrocystic changes account for 40% of all breast lumps.
  • Fibroadenoma makes up 7-10% of breast lumps.
  • Other benign lumps (13-20% of breast lumps) include cysts (fluid-filled sacs), lipomas (fat masses), phyllodes, hyperplasia, and adenosis.
  • Malignant growths make up 10% of breast lumps.
Sometimes a patient may think they feel a lump in their breasts that the doctor is not able to find from the physical examination or imaging studies. This occurs in 30% of women who think they feel a lump.
  • Fibrocystic changes occur due to hormonal changes that accompany menstrual cycles. Usually the lumps can be found in both breasts and often do not have well-defined borders. The skin may be dimpled and the lumps are usually soft and moveable. Fibrocystic changes are often accompanied by other symptoms, such as pain or tenderness of the breasts, the lumps, or under the arms. Breasts may look and/or feel swollen. Symptoms worsen close to menstruation, but usually improve once periods start. Birth control pills can alleviate these symptoms, while hormone replacement therapy, usually prescribed after the removal of the ovaries or menopause, can cause more lumps to develop. Fibrocystic changes do not usually become cancer.
  • Fibroadenoma is a non-cancerous tumor that is commonly found in women under the age of 30. The cause for it is unknown, but it is believed to be related to hormones as the incidence is higher in women who take birth control pills before the age of 20. In most women the lump disappears after menopause. The tumor feels round and has a smooth surface. It is movable, slightly hard, and not painful. It can be big or small and there can be one or multiple tumors in one or both breasts. When the cells of the fibroadenoma are normal or have not changed (atypia), it is called simple fibroadenoma and is not at risk of becoming malignant. If the cells begin to change, it is called complex fibroadenoma. This puts the patient at higher risk than a normal woman for developing breast cancer. A biopsy can reveal exactly what kind of cells make up the tumor.
  • Fat necrosis and oil cysts in the breast can be found after impact to the breasts, an accident, surgery, or radiation of the chest, causing death of the fat cells in the breast and leading to adhesions and/or oil cysts, which can feel like lumps in the breast. The lump is usual round, not too hard, and is slightly movable. Some hurts and some do not. There is usually an indication for the development of these lumps and these do not develop into cancer.
  • Fluid-filled cysts do not have definitive causes, but are thought to be related to hormones as they seem to develop with fibrocystic changes. They occur in the reproductive age and disappear with menopause. The cysts may be round or oval, may or may not hurt, are usually movable, feel like water balloons, can be of varying sizes, and do not usually develop into cancer. Rarely the walls of the cysts may develop abnormally and increase a woman’s risk of breast cancer.
  • Phyllodes or phylloids are rare, but when they occur are found in women of all ages, though most common between the ages of 30 and 40. The cause is unknown and the characteristics are like those of the fibroadenoma. Rarely do phyllodes become cancer (5%), but they have a high recurrence rate if removed surgically.
  • Lipoma are fat lumps that develop without a clear cause, thought it is believed to be related to genetics. They usually have clear edges, are quite round, are soft, and do not often hurt. They are movable, but do not change in shape with menstruation. They do not develop into breast cancer, but rarely can develop into liposarcoma.
  • Intraductal papilloma develops in the milk duct. It usually occurs in one breast, but can sometimes be found in both. The lump is not usually palpable, but if it is quite large, can be felt under the nipple. The patient may notice milk, blood, or other discharge leaking from the nipple. Sometimes this lump can develop into cancer, but it is rare.
  • Duct ectasia develops when the milk duct is large and its walls are thicker than normal, forming a lump that is palpable under the skin. The lump is usually not too hard and is under the nipple. The nipple may become inverted and may leak a green or black discharge. It usually occurs in one breast. This lump does not develop into cancer.
  • Adenosis develops when the milk duct expands and there are more milk ducts than normal. It occurs in one breast, but may be found in both. It may be felt under the skin and is not usually hard. If hard, it is sometimes due to sclerosing adenosis and can cause the breast to become misshapen. This lump does not usually become cancer, but if there are a lot of adhesions, the risk of breast cancer can go up.
  • Mastitis or an abscess usually develops when a woman is breastfeeding and is caused by a bacterial infection. It is accompanied by a fever, swelling, redness, warmth, and pain. An abscess if usually obvious and may leak discharge from the nipple. This can occur in one breast or both. This does not usually develop into cancer, but some breast cancers can cause the same symptoms. The doctor will ask you about your medical history and decide whether a biopsy is needed to diagnose the problem.
  • Hyperplasia is a term for all growths due to abnormal growth of cells. The doctor will be able to diagnose this through a biopsy where the cells are collected and looked at in the laboratory. Too many abnormal cells can be at risk of becoming breast cancer. If there is a mix of abnormal growth and abnormal cells, the risk of cancer is even higher.
  1. Try to maintain good health. If you have any medical conditions, please discuss them with your doctor to assess your risk of complications with surgery.
  2. Eat nutritious food, especially easily digestible protein like fish and soy, and foods high in iron, such as milk, egg yolk, and leafy green vegetables. Eat fruit and vegetables to prevent constipation.
  3. Get enough sleep. Meditation can help if you have difficulty sleeping.
  4. Exercise to strengthen the muscles, lungs, and heart, such as walking 30 to 40 minutes a day.
  5. Maintain a normal body weight. Obesity can put you at risk of complications, such as from the general anesthesia. Being underweight can put you at risk of excessive bleeding.
  6. Stop smoking and drinking alcohol.
  7. Please let your doctor know about all medication that you are taking as some, such as aspirin, will need to be stopped before the procedure.
  8. Think positive to reduce stress and maintain good immune health.
Please discuss the procedure with your doctor as each doctor has their own technique for carrying out the procedure.
Please consult your doctor for post-procedure instructions.
  • Scarring on the chest.
  • Bruising or hematoma, which will disappear on their own.
  • Infection that might require antibiotics.
  • The risk of complications is higher in patients who smoke, are obese, or have diabetes.
  • If you are taking any blood-thinning medication/anticoagulant, please let your doctor know as some may need to be stopped before you travel for the procedure.
  • Travelers to Thailand should plan to stay in the country for at least two weeks or for the entire duration of treatment.
  • If you plan to return home after the procedure, please speak to your doctor before making travel arrangements. There are no restrictions for air travel.
  • During your follow-up appointment your medical team will assess your health and your incision and you will receive documents detailing your medical and treatment history and your "Fit to Fly" certificate (if needed).
Breast mass excision will remove the lump. Recurrence may occur in 5% of patients who have benign growths.
What if the procedure is not performed?
Breast mass excision is done for diagnosis and/or treatment. Please talk to your doctor about other options.
Treatment options depend on the cause and should be discussed with the doctor. For example, cysts can be monitored for changes and may be drained if they cause too much discomfort. Small masses that don’t appear to be malignant and that do not cause any symptoms may simply be monitored with ultrasound.

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