Breasts are dynamic organs that change considerably over a lifetime in response to aging and variations in the body’s hormone production. Understanding these changes can help you to distinguish between normal variations and something that may require medical attention. Most conditions causing change, lumps or pain are benign.
The breasts respond to estrogen and progesterone during each menstrual cycle, with growth and fluid retention that can range from barely noticeable to somewhat painful.
During perimenopause, hormone levels begin to fluctuate, and menstrual cycles may become irregular. Effects of hormone changes on the breasts may include increased pain and lumpiness, which understandably can be worrisome if you’re looking for signs of breast cancer. A lump that gets smaller over time is unlikely to be cancer. A lump that remains the same size or gets bigger should be evaluated. (See What if I Have a Lump?)
Some women’s breasts remain lumpy after menopause. Most benign lumps are caused by hormone stimulation, so if you are taking hormones after menopause, the breasts will continue to feel as they used to. Cysts rarely form after menopause, so if a new lump does form, it’s a good idea to have your health care provider examine it.
Breast pain in the postmenopausal years may be coming from the chest wall, arthritis of the spine, or, only rarely, from cancer.
There are several kinds of breast lumps. Cysts are fluid-filled sacs that develop from dilated lobules or ducts, most commonly during your 40s or 50s. They are usually smaller than a pea. Cysts can be identified by ultrasound or by removing the fluid and making sure no lump remains.
As you age, small cysts may fill up further with fluid, sometimes causing tenderness and growing to sizes that can be felt with the fingers. By your 50s, dense glandular tissue and stroma begin to decrease (a process called involution), and fatty tissue increases.
Simple cysts — those that are just fluid, for example — don’t have to be removed unless they are causing pain or are so big that you can’t feel the surrounding breast tissue. A breast ultrasound is the best way to be sure a cyst is simple.
Treatment involves numbing the skin with a local anesthetic, inserting a thin needle into the cyst, and drawing the fluid into a syringe, a process called aspiration. The fluid may look gray and cloudy, dark and oily, or clear yellow or green. If a lump remains after aspiration, or if the fluid looks dark and bloody, you’ll need to have the area biopsied, meaning tissue will be removed and examined under a microscope for further diagnosis.
Cysts may refill with fluid after aspiration. If the same cyst continues to refill, removal may be recommended.
Fibroadenomas are benign growths that form mostly during the teens and 20s; some that form early may last throughout life. They may develop in one or both breasts and feel like smooth, rubbery marbles that can be moved back and forth in place. These growths sometimes shrink at menopause, as hormone levels decrease. A fibroadenoma that continues to grow larger is usually removed surgically.
Fibroadenomas are rarely associated with cancer, although some breast cancers can feel like fibroadenomas. The younger you are, the more likely it is that you have a fibroadenoma and not a cancer. Often a mammogram can confirm that the lump is a fibroadenoma, but the only way to be certain is by doing a biopsy and looking at the tissue under a microscope.
Pseudolumps are areas of dense normal breast tissue. They develop in many women during perimenopause. To make sure there is no cancer, these areas should be evaluated with good breast imaging and follow-up breast exams.
Itching on the areola, breast pain, and a breast infection are some of the other benign conditions of the breast that women experience.
Nipple discharge, especially if it is bloody or coming from just one breast, should always be evaluated because it can be associated with cancer. Other conditions that cause nipple discharge include infection and noncancerous growths in the duct of the breast that become inflamed. Consult your health care provider for any persistent and troubling symptoms.