Before puberty, there’s nothing there at all. Then – exciting or intimidating as it may be – breasts begin to grow, taking a few years to reach their final shape and in the process becoming an important part of our body image.
In human beings breasts are sexual organs, and it doesn’t take girls (or boys for that matter) long to discover that! Their exquisite sensitivity gives pleasure and their rounded shape helps define our womanly style – small and sporty, large and motherly, firm or soft.
During pregnancy and after birth, breasts have a new lease on life as we discover their miraculous capacity to feed our babies as much and for as long as we need to. Though not all women are able to breastfeed, with the right help and support most can enjoy this simple, natural way to bond with and nurture our young.
As breasts age, other changes take place which are completely normal – or at least common. Some are medically insignificant, such as the gradual change around the time of menopause from firm, dense glandular tissue to softer fatty tissue.
Others tend to draw attention and cause anxiety because until investigated we cannot be sure that they are harmless. These are the benign conditions of the breast or “aberrations of normal development”.
Lumps within breast tissue
Lumps are common, occurring not only in aging breasts but also sometimes in younger breasts. A lump is a small piece of tissue or area under the skin that feels firmer than the surrounding tissue and can be felt from the outside. It doesn’t usually develop overnight and won’t be noticed until it reaches a certain size – at which point finding it can cause alarm and concern.
Lumps that are medically concerning are those which stay there regardless of the menstrual cycle. Some women have naturally lumpy or uneven breasts and when the tissues swell under hormonal influence these “lumps” are more easily felt. For your own peace of mind, don’t hesitate to ask your doctor or nurse to check anything that worries you, but it’s the distinct lump which will require further investigation.
Worrying as they are, many such lumps turn out to be “benign”. This means that although it is not normal breast tissue and may be growing larger, it does not spread or invade other tissues, either locally or by travelling through the lymph system (as cancer cells do).
If you visit your doctor with a breast lump that worries you, he or he will ask you how long it has been there, whether you’ve ever had a lump like this before, and whether it is painful. In fact, nearly every breast lump that has been noticed is experienced as uncomfortable or painful, which is partly because of the worry they cause and perhaps also because it’s hard to resist checking it all the time.
The two main types of benign lump, though not normal, are fibroadenomas and cysts. Fibroadenomas are rounded, rubbery lumps that move under the fingers; they are more common in young women. If a patient younger than 20 finds a lump it is almost certainly a fibroadenoma and unlikely to need treatment unless it is uncomfortable, though it is best to ask a doctor to check it.
Between the ages of 20 and 40, fibroadenoma remains the most common form of breast lump but should always be investigated, as some breast cancers have a similar presentation. The doctor will feel the lump, may request a mammogram or ultrasound, and/or a Fine Needle Biopsy in which a sample of the cells is removed with minimal trauma. These tests allow your doctor to reach a firm diagnosis.
If the doctor is sure that the lump is a fibroadenoma no further treatment is needed, but larger lumps may be removed to relieve discomfort. If a woman wants to fall pregnant it’s also a good idea to remove the benign lump, as it is likely to get bigger during her pregnancy, causing anxiety at a time when there’s more than enough to worry about already.
Over 40, breast cancers are the most common form of breast lump but cysts are also common. These are hollow fluid filled spaces that form as glandular tissue in the breast ages and retract. Often they are small and can only be seen on an ultrasound, but larger cysts can be felt and sometimes they are hard and tender.
Fine needle aspiration of a problematic cyst will show that it is nothing to worry about – the fluid inside doesn’t look very nice being greenish and thick, but as long as there is no blood present there’s no reason to worry about cancer. A large, uncomfortable cyst should be aspirated to remove the fluid, but otherwise cysts can be left alone as they disappear naturally after menopause.
So, especially for younger women, the chances of a breast lump being non-cancerous or benign are good. However, it important to seek medical advice as there’s always that chance of being able to catch an early cancer – whilst some benign lumps become an uncomfortable nuisance that is best removed.
Even if you have previously had a benign breast lump and find another one that feels much the same, get it checked out. A history of fibroadenoma is associated with slightly higher risks of breast cancer, and knowing the previous size and position of benign lumps in the breast is helpful to your doctor when looking at mammograms or ultrasound pictures.