Dedicated to the care of breast cancer and all breast conditions
Dr Sarah Rayne is no longer practising in
Johannesburg and this practice is closed.

These pages are for information only,
and current only until 2018
I’ve just been diagnosed with breast cancer- help!
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I’ve noticed a lump in my breast
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I have breast pain               
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I need advice about breastfeeding
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Lumps in the breast- what could it be?  
The most important thing to know when you feel a lump in your breast is that most breast lumps are not breast cancer and will never develop into breast cancer.

Because it is sometimes hard to tell the difference though, the safest approach to all breast lumps is to always get a lump examined. In addition, no matter how skilled you are as a doctor examining breasts, it can almost never be assumed that a new lump in the breast is of no concern. The best way to check out every new problem is by a physical examination together with a simple non-threatening non painful investigation called an ultrasound or breast sonar.

It’s the easiest way to tell what the breast lump could be.

But what can it be? Ultrasound can see whether it is solid or contains fluid, and what the most likely cause is. This can be paired with a mammogram as you get older (usually over 35 years). If there is any doubt about what it could be a biopy will be suggested. Remember you always have time to think about extra tests- you don’t need to have them the same day. There is more about ultrasound and mammogram and biopsies
Lumps that look solid
Lumps that look filled with fluid (cysts)
Lumps that look solid
These are the most common lumps found in the breast and are present in 25% of all women, most commonly from 15-35 years. They can be in none breast or both, and single or multiple. They are made of normal breast tissue that has become enlarged by hormones. That means they can change during the course of the month in size and tenderness, and can grow in pregnancy. They often get smaller after the menopause.

Fibroadenomas are firm and highly mobile masses. While most fibroadenomas stop growing at 1-2cm some can keep on growing bigger and bigger. Once they get to 3-5cm or if they are painful or growing rapidly removing them with a small operation can be considered. As long as they are proven fibroadenomas, and not causing problems, in most circumstances they can be left alone in the breast with routine follow-up.
Phyllodes tumour (Cystosarcoma Phyllodes)
Phyllodes tumours can often look like fibroadenomas, but they grow quickly and need to be removed. They are not common and can occur at any age. When Phyllodes tumours are taken out, it need to be with a good margin of normal breast because they do have a risk of returning, and in some cases, can be cancerous.
Other solid lumps
Other lesions that can develop within the breast are lipomas (fatty lumps); hamartomas (lumps of mixed cells that can be taken out if problematic); and adenomas. Adenomas can behave like fibroadenomas but most often occur in pregnancy as a rapidly growing mass. They resolve after breastfeeding and can be removed if they don’t. None of these lumps increase your risk of cancer, but it is really important that cancer is ruled out before no further action is taken. If a lump is ever problematic, get it checked out again.
Fat necrosis
After a knock or injury to the breast, there can be hard scarring of the fatty breast tissue, leading to a lump called fat necrosis. It can look and feel like cancer so only a biopsy and close follow-up is appropriate to rule cancer out.
Fibrocystic change
Fibrocystic change is the most common problem of the breast. It is completely natural and a part of aging but can cause lots of problems. Fibrocystic change is characterised by pain in the breast, lumps and bumps, hard and soft parts, and cysts. It is not related to cancer and does not increase your risk of cancer, but it can cause lots of discomfort. There are many strategies to manage fibrocystic change, but only after cancer has been ruled out.
Proliferative breast disease
Areas of the breast involved in fibrocystic change may increase their cell turnover rate abnormally (proliferation). This is often seen as the start of the route than can precipitate breast cancer development, and proliferative breast lesions carry a small increased risk of breast cancer. These risk areas include Atypical ductal hyperplasia (ADH), atypical lobular hyperplasia, lobular carcinoma in situ (often grouped together as lobular neoplasia), papillomatosis and sclerosing adenosis (the latter two being of lower risk than lobular neoplasia). Finding any of these areas in the breast does not mean you will get cancer, but it can increase your risk. Your individual risk should take into account many factors, not just your breast tissue, so careful discussion and risk assessment is essential before any medication or surgery to reduce your risk is necessary.
Lumps that look filled with fluid (cysts)
Cysts are round fluid-filled lumps that can be found in up to one third of women, particularly with fibrocystic change. Many of these will be tiny clumps of microcysts but some will be larger in size and feel like a lump. Ultrasound can identify cysts and unless they are causing a problem or look different or complex, they do not need to be drained or to undergo pneumocystograms (blowing air into the drained cyst). If the cyst becomes suddenly tender or red, aspiration maybe performed and antibiotics started. Complex cysts or those with lumps in them can be associated with cancer so these should be carefully investigated.