Many women are anxious about an evaluation of any breast abnormality. The majority of breast evaluations end up being benign, but the process can be worrisome. The following information from The American College of Obstetricians and Gynecologists (ACOG) helps provide a roadmap for the terminology and typical tests performed for the most common benign breast lesions:

What is breast tissue made of?

Your breasts are made up of glands, fat and fibrous tissue. Each breast has 15-20 sections called lobes. Each lobe has many smaller lobules. The lobules end in dozens of tiny glands that can produce milk.

What kinds of changes occur in breast tissue throughout life?

Your breasts respond to changes in levels of the hormones estrogen and progesterone during your menstrual cycle, pregnancy, breastfeeding and menopause. Hormones cause a change in the amount of fluid in the breasts. This may make the breasts feel more sensitive or painful. You may notice changes in your breasts if you use hormonal contraception such as birth control pills or hormone therapy.

What are benign breast problems?

Benign breast problems are not cancerous. There are four common benign breast problems: fibrocystic breast changes, cysts, fibroadenomas, and mastitis.

Fibrocystic breast changes include swollen, lumpy or tender breasts. The condition is more common in the childbearing years but also can happen after menopause in women who are taking hormone therapy and the condition will resolve itself.

Breast cysts are small sacs filled with fluid. They can be almost any size. Some cysts feel like a soft grape or water-filled balloon, but some can feel firm. You may have pain or tenderness in the area of the cyst. The cyst may get bigger just before your menstrual period. Cysts are common in women between the ages of 25 and 50 years and they usually go away after menopause, although women who take hormone therapy may continue to have cysts.

Breast cysts are treated if they are large and painful. If your cysts are causing discomfort, your health care provider may drain the fluid with a procedure called fine-needle aspiration. The cyst also may be surgically removed. Birth control pills may be used to help prevent cysts from coming back.

Fibroadenomas are solid lumps that occur most often in young women. They may appear in both breasts. The lumps have a well-defined smooth shape and usually do not cause any pain. In most cases, treatment is not needed. Some women, however, decide to have surgery to remove the lumps. This is called a lumpectomy.

Mastitis is an infection in the breast tissue. It most commonly happens when a woman is breastfeeding and a duct becomes clogged with milk and does not drain properly. Infection sometimes can occur unrelated to pregnancy and breastfeeding. Mastitis can cause flu-like symptoms such as fever, aches and fatigue. Your breasts may also be swollen, painful, have red streaks and feel hot to the touch. Treatment may include emptying your breast milk, antibiotics or applying a warm, wet cloth.

What should I do if I find a lump in my breast?

If you find a lump, you should contact your health care provider for a physical exam. Based on the results, more tests may be recommended.

What is a mammography?

A mammography can be used as a screening test for breast cancer or to help diagnose a suspicious area or problem. An annual screening mammography is recommended for women aged 40-75.

What happens if a suspicious lump or area is found during a routine screening mammogram?

If a suspicious lump is found, you will be called back for a follow-up test to find the exact cause of the problem which may include a diagnostic mammogram, an ultrasound exam or an MRI.

If the results of the follow-up tests are abnormal you may have a biopsy. There are several types of biopsies which depend on several factors including the size and location of the lump or area:

• Fine-needle aspiration is the removal of a small sample of tissue from the lump through a thin, hollow needle into a syringe.
•  Core biopsy is the removal of a sample of tissue with the use of a need with a special tip
• Surgical biopsy or lumpectomy is a procedure which a surgeon removes part or all of the lump.

If you have any specific concerns or questions about breast conditions, please make an appointment with one of our physicians.