Finding a breast lump: What it means and how to get it checked

Breast lumps are common and can occur for a variety of reasons. However, their discovery can be a worrying experience, and it’s natural to have questions and concerns.

Mr Harun Thomas, renowned consultant oncoplastic breast surgeon, explains what breast lumps are, how they are checked, and the treatment options available, providing clear information to help guide you through the next steps if you discover a lump in your breast.

What is a breast lump?

A breast lump is a growth or mass that forms in the breast tissue. These lumps vary in size, shape, and texture, and can feel different depending on their cause. Some are smooth and easily moveable under the skin, while others may feel hard, irregular, and fixed in place.

Breast lumps are often discovered during self-exams, routine medical exams, or imaging tests like mammograms. Many women find their breasts feel different at various times during their menstrual cycle, and some lumps may become more noticeable or sensitive during these changes.

Are all breast lumps cancerous?

Not all breast lumps are cancerous. The majority are benign and arise from conditions such as fibroadenomas, cysts, and lipomas.

However, some breast lumps are cancerous, and so it’s essential to consult a doctor if you discover a new lump or change in breast tissue. There are several investigations that a doctor can order to determine the exact nature of the lump, including:

• Physical examination: A clinical examination can help assess the characteristics of the lump, such as size, texture, and mobility.
• Imaging tests: A mammogram can help detect abnormalities in dense breast tissue and an ultrasound can help distinguish between solid lumps and fluid-filled cysts.
• Biopsy: If a lump appears suspicious or unclear on imaging, a biopsy may be recommended. This involves removing a small sample of the lump tissue for laboratory analysis. A biopsy provides a definite diagnosis.

What treatment options do I have if my breast lump is cancerous?

If a breast lump is determined to be cancerous, there are several treatment options depending on the type, size, location, and stage of the cancer.

Surgery

• Lumpectomy: A lumpectomy involves removing the cancerous lump along with a small margin of surrounding healthy tissue, preserving most of the breast tissue. This procedure is generally recommended for smaller, localised tumours.
• Mastectomy: In cases where the cancer is more extensive, a mastectomy may be necessary. This procedure involves removing the entire breast. Mastectomy options can vary, including skin-sparing and nipple-sparing options, which can help preserve the natural appearance of the breast for reconstruction.

Radiotherapy

Radiotherapy employs high-energy radiation to target and kill cancer cells. This treatment is often administered after a lumpectomy to reduce the risk of recurrence but it may also be used after a mastectomy.

Chemotherapy

Chemotherapy involves using drugs to destroy cancer cells or inhibit their growth. This treatment is recommended to either reduce the size of larger tumours before surgery or to kill any remaining cancer cells afterward.

Hormone therapy

For breast cancers that are hormone receptor-positive, hormone therapy may be used to block hormones like oestrogen or progesterone that promote cancer growth. Hormone therapy is often recommended for several years following surgery to help reduce the risk of recurrence.

Will I need reconstructive surgery after a lumpectomy or mastectomy?

After a lumpectomy, reconstruction may be minimal. Oncoplastic surgery is a specialised field in breast surgery that can reshape the breast post-surgery, ensuring that the breast maintains a natural appearance after tumour removal. This surgical approach can also help minimise scarring and asymmetry, which may otherwise develop after a lumpectomy.

After a mastectomy, more extensive reconstruction options are available. These are commonly discussed as part of the treatment plan. Options include:

• Implant reconstruction: This option involves the placement of a silicone or saline implant to restore the breast shape. Implant reconstruction can be performed during the same surgery as the mastectomy (called immediate reconstruction) or as a separate procedure month or even years after the mastectomy has healed (called delayed reconstruction).
• Autologous or "flap" reconstruction: For women seeking a more natural look and feel, flap reconstruction uses tissue from other parts of the body, such as the abdomen, thigh, or back, to reconstruct the breast. This option may require a more complex surgery but often results in a softer, more natural breast shape.
• Nipple reconstruction: Nipple-sparing techniques may be available if the nipple area is cancer-free. In cases where nipple-sparing surgery isn’t possible, nipple reconstruction and tattooing can be performed at a later stage to recreate the appearance of the nipple and areola.

The decision to have breast reconstruction is highly personal, available to all women who feel it would support their physical and emotional recovery. If you are considering breast reconstruction, it’s important to discuss all options with your surgical and oncology teams.

If you would like to reach out to Mr Harun Thomas, head on over to his Top Doctors profile today.