Breast lump

and Sabine Schrör, medical journalist

Ingrid Müller is a chemist and medical journalist. She was editor-in-chief of for twelve years. Since March 2014 she has been working as a freelance journalist and author for, among others, Focus Gesundheit, the health portal ellviva.de, the publishing house living crossmedia and the health channel of rtv.de.

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Sabine Schrör is a freelance writer for the medical team. She studied business administration and public relations in Cologne. As a freelance editor, she has been at home in a wide variety of industries for more than 15 years. Health is one of her favorite subjects.

More about the experts All content is checked by medical journalists.

A lump in the breast does not necessarily indicate breast cancer. Most hardenings and swellings are not malignant tumors, but rather have harmless causes. Nevertheless, you should have a doctor clarify any change in your breast. Read here about the types of breast lumps and how to diagnose and treat them.

Brief overview

Causes and forms: Benign causes and forms of breast lumps: cysts, fibroadenomas, lipomas, mastopathy. Malicious cause of breast lumps: breast cancer.
When to see a doctor: Always as soon as possible if a breast lump is noticed.
Diagnosis: recording of the medical history in conversation, palpation examination, ultrasound, mammography (X-ray examination of the breast), biopsy, puncture.
Treatment: depending on the type of lump (benign or malignant, with or without other complaints), e.g. puncture for cysts, punch biopsy under local anesthesia for fibroadenomas, medication for mastopathy, stage-appropriate therapy for breast cancer (surgery, chemotherapy, radiation therapy, anti-hormone and Antibody therapy).
Early detection: regular palpation of the breasts between the third and seventh day of menstruation.

Breast lumps: causes and forms

The female breast consists of glandular, adipose and connective tissue. All of these types of tissue can change. Doctors estimate that 90 percent of all women will feel a lump in their breast in their lifetime. Most of the time, these nodes are benign. They arise hormonally and disappear by themselves.

The most common causes of benign breast lumps are cysts, fibroadenomas, lipomas, and mastopathy. A malignant lump in the breast is breast cancer.

Benign breast lumps: cysts

These are fluid-filled cavities in the lobules of the gland. They can arise, for example, when the outlet of a glandular lobe closes during pregnancy or while breastfeeding. Then the milk produced in the glandular lobe can no longer flow away and builds up - a cyst develops.

However, cysts can also form regardless of pregnancy or breastfeeding. It usually affects women between the ages of 30 and 50 as well as women going through menopause. However, it is not known why the cysts then form more frequently.

Benign oil cysts contain tissue fluid with a high percentage of fat. They form when adipose tissue is injured, for example after an operation.

From a certain size, cysts press on the surrounding tissue and displace it - this can cause pain. However, the risk of breast cancer is not influenced by cysts.

Benign lumps in the breast: fibroadenomas

These are benign nodes made up of connective tissue and gland cells. Your growth is influenced by the female sex hormones. They feel rough and rubbery, and they are easy to move. It mainly affects young women between the ages of 20 and 40. Like breast cysts, fibroadenomas do not increase the risk of breast cancer.

Benign breast lumps: lipomas

Lipomas are benign, slowly growing new formations made from adipose tissue. They feel rather soft and are easy to move because they are not attached to the skin. They also do not increase the risk of breast cancer.

Benign lumps in the breast: mastopathy

Mastopathy is an umbrella term for various benign changes in the female breast that occur hormone-dependently during the menstrual cycle. Most women between the ages of 30 and 55 are affected, and the changes usually show up in both breasts. It could be a breast lump, cyst, or swelling. Feelings of tension, tenderness to touch, chest pain (mastodynia) and enlarged breasts are typical characteristics. When palpating the breasts, cherry stone-sized, easily delimited, movable nodes can be felt. In addition, the nipple sometimes secretes fluid.

Mastopathy is often accompanied by cysts on the glandular lobules. Doctors then speak of "cystic mastopathy". If connective tissue cells grow, it is a "fibrous mastopathy". The most common is the combination of both forms - the "fibrous-cystic mastopathy".

The symptoms increase and decrease as the cycle progresses. At the latest after the menopause, they disappear completely. Doctors suspect that a hormonal imbalance - too much estrogen, too little progesterone - triggers mastopathy. But it can also be due to a thyroid disease with impaired hormone production. In addition, certain medications such as antidepressants and heart medications with the active ingredient digitalis can influence hormone production.

Graduation of mastopathy

Doctors differentiate between three degrees of mastopathy, which is important for diagnosis and prognosis:

Grade I: increased connective tissue, enlarged milk ducts, sometimes cysts. No tendency towards malicious development. Around 70 percent of all mastopathies belong to this category.
Grade II: benign cell growth in the milk ducts with a little increased risk of breast cancer. Around 20 percent of mastopathies fall under grade II.
Grade III: The proliferating tissue cells differ significantly from normal cells ("atypical proliferating mastopathy"). Multiple foci often form in the chest. Both breasts are affected in a third of women affected. The risk of developing breast cancer is increased. Around 10 percent of all mastopathies belong to grade III.

Malignant lumps in the breast: breast cancer

Most breast lumps are harmless. But sometimes breast cancer (breast cancer) can also be behind it. In Germany, every eighth woman will develop this malignant tumor disease at some point in her life. Every year there are around 70,000 new cases in this country.

The suspicion of breast cancer arises mainly from a palpable and immovable lump in the breast. Other possible breast cancer symptoms are, for example, crystal clear, cloudy or bloody secretions from a nipple and retraction of the breast skin or a nipple.

In most cases, breast cancer starts in the milk ducts, and sometimes in the lobes of the glands. There are also some rare forms of breast cancer.

Chest lump in a man

Men also have mammary glands, but they are significantly smaller than those of women. However, breast lumps can form in men as well. As with women, the cause of a lump in the male breast can be benign or malignant. Benign swellings of the mammary glands (gynecomastia), cysts, lipomas, fibroadenomas and mastopathy are possible.

In addition, men can also develop breast cancer. It is estimated that around 750 men in Germany are diagnosed with breast cancer every year. Unfortunately, many men do not seek medical advice until late when they have breast problems. Many of them consider breast cancer to be a disease that only affects women. Often the cancer has progressed so far that a successful treatment is hardly possible.

A lump in the breast is diagnosed and treated in the same way in men as in women.

Breast lumps: when to see a doctor?

Those affected usually recognize a lump in the breast themselves, for example when showering, applying lotion or by regular palpation of the breasts. Then action should be taken quickly - in principle, every lump in the breast should be examined immediately by a doctor.

Usually it turns out that the knot is harmless. But since it can also be a malignant tumor, an early medical examination is very important. Because if breast cancer is discovered before it spreads to other organs and tissue, it is easy to treat and can often even be cured.

Always see a doctor right away if you notice any lumpy changes in your chest. The first point of contact for women is usually the gynecologist and for men the family doctor.

Breast lump: diagnosis

First of all, the doctor will have an initial consultation with you (anamnesis) to collect your medical history. Important questions are, for example:

When did you notice the lump in your breast?
Has the node changed (increased / decreased) since then?
Do you have any other complaints, e.g. chest pain or secretions from a nipple?

The doctor will then examine your breasts to see if the lump is benign or malignant. Important investigation procedures are:

Palpation examination: When palpating both breasts and the lymph nodes in the armpits, the doctor recognizes whether the lump is hard or soft, how big it is and whether it can be moved against the skin of the breast. This information provides initial clues as to the type of lump (cyst, fibroadenoma, etc.).
Ultrasound (sonography): Cysts, lipomas and fibroadenmomas, but also malignant breast tumors, can usually be easily recognized by ultrasound. They all appear dark in the ultrasound image.
Puncture: Larger cysts are punctured to confirm the diagnosis. The doctor sucks fluid out of the cyst with a fine hollow needle. The cells it contains are then analyzed under a microscope.

Mammography: Benign and malignant changes in the breasts can be easily identified and assessed on the basis of this X-ray examination. The images make any existing micro-scale deposits visible. Microcalcifications appear white on mammograms. If it is scattered and does not belong to any structure in the breast, a diagnosis of breast cancer is very likely. The distribution and size of the micro-lime is also instructive.
Biopsy: If the mammography provides evidence of breast cancer, a biopsy usually follows. A tissue sample is taken from the node, which is then examined by a pathologist. The result reliably shows whether the lump in the breast is benign or malignant.

Breast lump: therapy

Whether and how a breast lump is treated depends on a number of factors. For example, it is important: is it a benign or malignant lump? Is the lump causing discomfort? How big is he?

Treatment of cysts

Small cysts (<1 cm) that are normal and cause no discomfort do not necessarily require treatment. However, they should be checked regularly by ultrasound.

Larger, painful cysts are punctured to suck out the fluid, relieving pressure on the surrounding tissue.

Treatment of fibroadenomas

Fibroadenomas should be checked regularly. Because they can continue to grow and damage the surrounding tissue. This often happens to younger women during pregnancy. Because fibroadenomas grow into a lump in the breast under the influence of hormones. Depending on how big the fibroadenoma is, where exactly it is and how fast it is growing, it sometimes has to be removed by a so-called punch biopsy under local anesthesia. However, this can stimulate other, smaller fibroadenomas to continue to grow. That is why the little knots have to be checked regularly.

Treatment of lipomas

If a lump in the breast turns out to be a lipoma, a regular check-up is sufficient for the further procedure.

Treatment of mastopathy

Mastopathy cannot be treated causally, but the symptoms can be alleviated. To do this, the underlying hormonal imbalance (excessively high estrogen levels) is addressed. For example, a progestin gel with which those affected rub their breasts has proven itself. Alternatively, progestogen-containing tablets can also be taken. In addition, herbal remedies can stimulate the organism to produce more getagen itself.

Cysts associated with mastopathy can be treated with a puncture.

Treatment of breast cancer

Breast cancer definitely needs treatment. The form of therapy depends on the size of the malignant lump in the breast, how aggressive the cancer cells are and how far they have already spread in the body - in the lymph nodes or even in other organs.

Important building blocks of breast cancer therapy are:

Surgery: The tumor can usually be removed by breast-conserving surgery (BET). However, sometimes it is inevitable to remove the affected breast (mastectomy, ablatio)
Chemotherapy: The patient is given drugs that slow down rapidly growing cells - such as cancer cells (cytostatics, chemotherapeutics).
Radiation therapy: Here, the cancer cells are fought with high-energy electromagnetic radiation.
Anti-hormone therapy: It can help if the tumor grows under the influence of hormones.
Antibody therapy: It can be used for so-called Her2-positive breast cancer. Her2 is a receptor that lies on the surface of human cells.It conducts growth signals inside the cells and thus also stimulates tumor cells to grow.

Breast lump: you can do it yourself

In order to detect possible tumors as early as possible, you should regularly feel your breasts, including the armpits, yourself. As a woman, it is best to do this between the third and seventh day of your menstruation. Because then the breasts are hormonally soft, so that a lump in the breast can be more easily detected.

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