By Marshalee George, Kimlin Tam Ashing

Sometimes you have to be like Sherlock Holmes when it comes to investigating changes in your breast beneath the skin. Lumps, bumps, and mass-like structures can develop in the breasts. Breast cysts and dense breasts are frequent findings on mammograms and breast ultrasounds.

Breast masses and fibroadenomas

Often when a woman feels a lump or a mass in the breast, the instinct is to panic. However, 70 percent of masses or lumps found in the breast are benign — noncancerous. These benign masses are often harmless and may not require any treatment if they don’t cause pain.

A fibroadenoma is a common benign mass found in the breast. It may cause the following:

  • Increase in breast size
  • Breast pain (mastalgia)
  • Lumpiness or hardness in the breast, especially before menstrual period

Fibroadenomas are well-rounded, smooth, and movable solid lumps that often develop outside the milk ducts and are most common in young women. They can develop in both breasts, and each breast can have multiple fibroadenomas. Fibroadenomas can get larger or disappear on their own. Fibroadenomas often grow larger during pregnancy.

No one knows what causes fibroadenomas. Because fibroadenomas increase in size and become painful especially during menstrual cycles, researchers have linked them to an abnormal hormonal response (specifically estrogen) in the breast tissue.

Breast cysts

Your breasts may feel lumpy all the time or only throughout your menstrual cycle. Lumpy breasts may be caused from dense breast, hormonal changes, or PMS that increases the formation of benign (non-cancerous) cysts — fluid-filled sacs in the breast. Breast cysts inside the breast may feel like round balls with smooth edges. Some have described breasts cyst as feeling like grapes or small water balloons.

You can have cysts in one or both breasts, and there may be uneven numbers of cysts in each breast. Breast cysts may become tender or more painful just before and throughout your menstrual period or they may be painful all the time.

Treatment for a painful breast cyst may include aspiration — removal of fluid with a fine needle — or non-steroidal anti-inflammatory therapy (for example, ibuprofen, Aleve, and similar medicines).

Talk to your doctor if you have a breast lump, so you can receive the best treatment. Tell your doctor when you first felt the lump, whether it has increased in size, whether it is painful, and what increases the pain. This information will help your doctor determine the next steps or testing that is right for you.

Dense breasts

Many women think that a dense breast is when their breast feels firm and compacted, but that’s not the case. Dense breast is not determined by how your breast feels or the breast size; it’s only determined from the results of a mammogram.

On a mammogram, dense breasts are seen to have more fibrous and glandular tissue. Both cancer and dense breast tissue produce a white appearance on an X-ray.

Women with dense breasts should ask their doctor whether they need a 3D digital tomosynthesis (called a 3D tomo, for short) for additional screening or for their next annual breast cancer screening, instead of a regular 2D mammogram. It is currently recommended that women with extremely dense breasts have a breast MRI and/or breast ultrasound for further evaluation during breast cancer screening.