Breast Lump
Approach
- Expose patient to waist
- Adequately expose breasts and chest wall
- Inspect
- Lump may be tethered to skin / underlying muscle
- May be associated nipple changes, or changes to skin of the breast
- There may be scars from previous surgery
- Palpate
- Begin with the normal breast - examine with patient's hand behind the head
- Site - name quadrant lump lies within
- Size - measure lump approximately
- Surface - smooth / irregular / nodular
- Edge - well / poorly defined
- Consistency - soft / firm /hard
- Tenderness
- Fluctuation
- Fixation
- Palpate axilla, supraclavicular fossa
- Percuss
- Ausculate
Investigations
- History
- Imaging - USS / mammography (if young)
- Cytology - FNAC / trucut
Differential diagnosis of breast lump
- Single lump
- Fibroadenoma
- Breast cyst
- Breast cancer
- Multiple lump
Features suspicious of breast cancer
- Surface - irregular / nodular
- Edge - poorly defined
- Consistency - firm rather than hard
- Tenderenss - usually non-tender
- Fluctuation - usually not fluctuant
- Fixation - to skin or underlying chest wall
- Any involvement of the nipple in the lump or concurrent nipple charnges
Fibroadenomas
- Benign tumours developing from a single breast lobule
- Hormonally dependent - involute after the menopause and increase in size with menstruation
- Commonly present in women 15-25 years
- Well defined, regular, smooth, firm mass
- Freely mobile "breast mouse"
Breast cysts
- Distended, involuted lobules
- Most common in women between 40-55 years old
- Usually fluctuant
- Can be painful
- Well defined and smooth
- Can be multiple
