In January, I found a grape-sized lump in my left breast. It wasn’t brought to my attention at the gyno’s office, but rather during a mundane and medically irrelevant event: a hug.
As my boyfriend and I stood on the subway platform, he pulled me into a tight squeeze, and in that normal gesture, I felt an abnormal pang of pain on the left side of my chest. I shifted my stance to see if maybe it was a “bad angle” — but nope, that spot was tender no matter what direction the pressure came from.
When I got home, I did a more thorough exam of the area, tracing my breast until I came across a small lump at the tender spot. Then, I did what any modern hypochondriac would do: I burst into tears and hopped online for a diagnosis.
I was pretty sure I had cancer at this point (thanks, Google), so I booked a next-day appointment with my gynaecologist. She didn’t think it was anything serious, but she agreed I needed an ultrasound. The results a few weeks later seemed to confirm my dire prognosis.
“It’s a solid mass,” the radiologist said, adding that it “looked suspicious and had irregular borders.” Within 20 minutes, I was lying topless on an examination table while a very nice doctor jabbed a needle into my left breast, removing a piece of the tumour in the process. Since nothing good ever has irregular borders, I hopelessly accepted Google’s prophecy while awaiting the biopsy to confirm.
After what felt like the two longest days known to man, the lump came back C-word-free. It turned out to be a fibroadenoma, a benign tumour that’s pretty common in young women and something I had never heard of in my life.
Of course, I was relieved by this news. But I wish I’d known beforehand that that there is such a thing as a non-horrible breast lump — I could have saved myself a lot of unnecessary anxiety.
October after October, the world turns pink to remind us that we might get breast cancer and that we need to remain vigilant. No one could say this is a bad thing: It’s good to be aware that breast cancer is increasing in young women. Plus, breast cancer when you’re young tends to be more aggressive, with lower survival rates.
But it’s also true that finding something unusual in your breasts is not uncommon, and it’s often not a sign of something serious. “More than 99% of lumps in women under 30 are benign,” says David Michael Euhus, MD, director of breast surgery at Johns Hopkins. “And for women 30 to 40, it’s about 95%.”
After going through this myself, I learned that even benign masses (yep, there’s more than one kind) are not created equal. Some will get bigger, some might hurt, and some might still need to be removed ASAP. With the help of breast experts, we’ve put together a list of the benign breast lumps every twentysomething should know about.
Fibroadenomas are the most common kind of benign lump found in women in their 20s and 30s; they occur when dividing breast tissue decides to get a little YOLO.
Basically, the breast is made of three types of cells: fat cells, epithelial cells that make the milk glands, and stromal cells that make up the fibrous connective tissue. “Fibroadenomas occur when the epithelial and stromal cells can’t quite get organised, so a few of them develop irregularly to form a solid mass,” says Dr. Euhus.
Fibroadenomas aren’t painful. They will usually feel like a smooth marble under the skin, and they move easily when you press on them. But aside from that, they can be pretty diverse. Some are so tiny, they can only be spotted on an ultrasound, while others can get as big as a golf ball. It’s possible to have one or more in each breast, too.
Your doctor will usually order an ultrasound to make sure the lump is solid (suggesting it’s a fibroadenoma, in most cases) versus a fluid-filled cyst (more on those coming up), which can require a different course of action. If it looks a little off — for example, if your borders are irregular, as mine were — you may also need a core needle biopsy, in which a tiny needle grabs some of the cells to make sure they aren’t cancerous. Though it sounds scary, the biopsy is pretty painless, and you’ll usually be in and out in around 35 minutes, no down time needed. (Though depending on where the lump was, you might be sore afterward. Icing can help.)
If the test reveals your lump is a fibroadenoma, doctors usually let it just hang out. “Most do not completely go away, but many require no intervention,” says Melissa Pilewskie, MD, a surgical breast oncologist at Memorial Sloan Kettering in New York. “We typically follow up every six months to check up on it, and if it’s painful or grows more than three centimetres, we can remove it.”
Illustrated by Aimee Sy.
A cyst is another type of lump that results from some breast cells going ham, while others sit back. “Sometimes the epithelial cells change and begin secreting a watery fluid, while the cells that provide structure to the breast become lax, so a cyst forms,” Dr. Euhus explains.
Hormones such as oestrogen may be to blame for cysts, although experts are not exactly sure why some people get them while others don’t, adds Diane Radford, MD, a breast surgeon at the Cleveland Clinic.
Cysts can be frustrating; They can disappear completely (after your period or just because) and suddenly come back into your life just when you think they’re gone for good. Like fibroadenomas, they may shrink on their own or get bigger. Cysts feel smooth and are easily movable, but instead of being solid like a fibroadenoma, they’re filled with fluid and are easily identified on an ultrasound. Usually, nothing needs to be done about them. If they’re large and painful, doctors can use a thin needle to withdraw fluid and “deflate” them (this is also known as cyst aspiration). Some women find that ditching caffeine and cutting back on sodium makes cysts less likely to return, Dr. Radford says.
Illustrated by Aimee Sy.
A breast abscess is a painful collection of pus (yes, essentially a large pimple) that forms in the breast. Most of the time, these form right under the skin and are caused by a bacterial infection.
“Some may be caused by an infection of the milk ducts, which is especially common after breastfeeding but can also happen when bacteria creeps into the breast through a cracked nipple or a nipple piercing,” says Dr. Pilewskie.
Abscesses can also feel swollen and be red and hot to the touch. Antibiotics can usually knock out the infection, but the abscess can also be drained with a needle, if necessary.
Dr. Pilewskie adds that the condition can also crop up more frequently in women who are smokers, since smoking "causes small blood vessels everywhere to tighten, making it harder for the body to fight infection.” Just one more great reason to quit.
Illustrated by Aimee Sy.
The menstrual cycle can bring on all sorts of less-than-pleasant side effects, such as cystic acne, mood swings, and bloating. It can also cause some changes in your breasts, and around your cycle you might feel a few lumps, which are really a combination of cysts and swollen areas of breast tissue.
This used to be called “fibrocystic breast disease” but experts stopped calling it that because it’s not really a disease, according to the Mayo Clinic.
“Some women are more sensitive to the yo-yo-ing hormone levels during this time and can experience breast pain and tenderness that’s due to a combination of many small cysts and swollen fibrous tissue,” Dr. Radford says. “You’ll want to get the lumps checked out to be sure, but it’s likely that if they come and go with the tenderness around your period, they’re fibrocystic changes.”
Roughly 80% of women will experience fibrocystic changes at some point in their lives; these happen roughly mid-cycle, when oestrogen and progesterone levels are spiking. Some cysts may require removal if they stick around or hurt. Your breasts might also feel heavy or firm to the touch, but usually both the discomfort and cysts will disappear right after your cycle. Birth control may help, since it evens out those hormonal ups and downs of a natural cycle, Dr. Radford says.
There are also ways to cut down on the pain if it’s bothersome. OTC pain relievers such as ibuprofen or acetaminophen are the obvious choices, but alternative routes could work, too: Some research suggests that evening primrose oil or vitamin E might help breast pain and tenderness, but the studies have been small.
If you’re interested in trying these remedies, you should work with your doctor. It's best to try one at a time, so if she thinks it's a good idea, she can help you decide on a safe dose of vitamin E or evening primrose oil (depending on which one you want to do first) and recommend reputable supplement brands for you.
Illustrated by Aimee Sy.
This condition is pretty rare in young women, but it can happen when fatty tissue in breasts is damaged, typically in a bad accident, fall, breast surgery, biopsy, or a procedure to drain a cyst.
“The fat lobules lose their blood supply, and they respond by calcifying and turning hard, into a lump,” says Dr. Euhus.
The lump itself is firm and round and can sometimes lead to skin redness or dimpling. Unless the lump is painful, though, fat necrosis won’t need to be treated and usually goes away on its own.
Illustrated by Aimee Sy.
Breasts can change as we get older, with each pregnancy, and even with each monthly cycle. Plus, there are so many conditions that can require different plans of attack, so in the off chance that you do feel a lump, your best bet is not to do the guesswork yourself (or leave it up to Google) and instead, hit up your doctor for a diagnosis.
“Breast cancer is extremely rare in young women, but every lump needs to be checked out and followed up with, just so we are sure,” Dr. Pilewskie says.
After you get evaluated, know this: Even if you do come home with a benign breast lump, having one doesn’t increase your risk for breast cancer later on, Dr. Radford says.
The best thing to do is simply get to know your breasts, so you’ll know what’s normal for you and what’s a red flag. No need to do a monthly self-exam or anything (experts no longer recommend them, because they haven't been proven to work) — just keep your doctor posted on any breast changes, whether that's a lump, dimpling of the skin, or pain.
Illustrated by Aimee Sy.Like what you see? How about some more R29 goodness, right here?
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