General Surgery – Breast Lump: By Ralph George M.D.

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General Surgery – Breast Lump
Whiteboard Animation Transcript
with Ralph George, MD
https://medskl.com/Course/Detail/gene...

When considering a patient presenting with a new breast lump, there are a few symptoms and signs that you cannot afford to miss which point to a much higher risk of malignancy. These include a positive family history, the presence of a hard immobile mass, and the presence of new discharge from that breast - especially if bloody.

When I take a history in a woman with a breast lump, here are some important questions that I ask:

Has the new lump suddenly appeared? Does it fluctuate with menses? Is it quite tender? If the answer to these questions is positive in a pre or perimenopausal woman this is a good sign as the probability that the lesion is a benign cyst increases.
How old is the patient? A new mass in a woman over the age of 55 years is more likely to be malignant.
Has the patient noticed new discharge coming from the nipple from the breast with the lump? This is worrisome, especially if the discharge is bloody as it increases the risk of the lesion being malignant.
Is there a positive family history? A family history of breast cancer in a first degree relative or several second-degree relatives is worrisome as it increases the probability of a malignant diagnosis.

When examining the patient it is important to inspect the skin and breast and qualitatively assess the lesion. Here are some important things to remember on examination:

A smooth, mobile, painless mass in a woman under 35 is likely a benign fibroadenoma; whereas a hard immobile mass is more worrisome, especially in an elderly woman.
Always document size changes; benign lesions may fluctuate between visits depending on the patient’s menstrual cycle.
Don’t forget to check the other breast and the regional node basins (axillary, supra and infra clavicular).

All women with a breast lump need to have additional testing. In those under 35 years ultrasound is warranted, but in those over 35 bilateral mammogram plus ultrasound should be ordered. An image-guided biopsy may be necessary to investigate a solid mass noted on ultrasound.

A “triple negative” confirms benign disease without excision of the mass. It is defined as a normal exam and history, normal imaging and a normal biopsy. If all three suggest benign disease (concordance) the patient can be safely followed.