Axillary Lumps: When to Seek Further Medical Advice

Axillary lump

Hello doctor, two years ago during a health check-up, I was found to have multiple fibrocystic lesions in both sides of my chest.
Since I was preparing to study abroad, I had one of the larger lesions surgically removed.
About a year and a half ago, I noticed a small hard lump under my right armpit, less than 1 cm in size, which is not painful and does not cause any sensation when pressed.
During my regular follow-up for the fibrocystic lesions, I mentioned this to my doctor, who said that the ultrasound showed nothing significant and that I shouldn't worry about it.
However, recently I have noticed that the lump in my armpit has increased in size and there seems to be more lumps.
When pressed, it feels slightly tender, similar to a bruise.
Last week, I went to a major hospital for a follow-up, and the doctor again said not to worry and just to continue regular monitoring, but did not clarify what it actually is.
I am concerned that it may continue to grow.
Since the doctor was not clear, I feel even more uneasy.
Should I consider switching to another hospital for a second opinion? I am currently seeing a general surgeon; what other specialties should I consult, or do you have any recommendations for specialized hospitals? Thank you.

Jiang Xiaojie, 20~29 year old female. Ask Date: 2017/07/26

Dr. Chen Jiaming reply Surgery

In general, fibrocysts and fibroadenomas are common benign lesions found in young women.
Fibrocysts are often associated with breast tenderness before menstruation and are significantly influenced by hormonal changes, causing fluctuations in size.
Fibroadenomas are solid masses that can be singular or multiple, commonly felt by women in their twenties and thirties, and they may continue to grow.
If there is a trend of rapid growth, early removal is recommended.

In larger hospitals, breast ultrasound examinations are often performed by radiologists or technicians due to high patient volume, rather than by the clinical physician directly examining you.
As a result, the clinical physician may only review the images and state that no abnormalities were found in the axillary lymph nodes.
(A helpful tip: when undergoing the ultrasound, directly inform the technician about any suspicious areas you have palpated, and request a focused scan and imaging capture of that area to assist the clinical physician in making a determination.)
Generally, lumps felt in the axilla can range from superficial sebaceous cysts (similar to non-emerging acne, commonly known as epidermoid cysts) to subcutaneous lipomas (benign) and deeper enlarged lymph nodes.
Enlarged lymph nodes can be classified as benign enlargement, often due to inflammatory responses or infections, many of which may be tender to the touch (ultrasound images typically show normal structure); whereas abnormal lymph nodes, such as those involved in breast cancer metastasis or lymphoma, will exhibit atypical imaging characteristics as cancer cells invade normal structures, usually presenting as painless.
Overall, the diagnosis of axillary lumps falls under the realm of general surgery (such as breast surgery).
If you remain concerned, it is advisable to consult another facility and communicate your worries with a clinical physician.
I hope this information is helpful to you.

Reply Date: 2017/07/26

More Info

When it comes to axillary lumps, especially in the context of a history of fibrocystic changes, it is essential to approach the situation with caution and awareness. Your concern about the changes in the lump's size and the emergence of new lumps is valid, particularly given your previous medical history.
Fibrocystic breast changes are common and often benign, but any new or changing lump warrants thorough evaluation. The fact that you have noticed an increase in size and number of lumps, along with mild tenderness, is a signal that further investigation may be necessary. While your doctor has suggested regular monitoring, it is crucial to ensure that you feel comfortable and confident in the management plan.

Here are some considerations and recommendations regarding your situation:
1. Seek a Second Opinion: If you feel uncertain about the explanations provided by your current healthcare provider, seeking a second opinion is a reasonable step. Different physicians may have varying perspectives on the same clinical findings, and another doctor might offer additional insights or suggest further diagnostic tests.

2. Consider Specialized Care: While you have been seeing a general surgeon, it may be beneficial to consult with a breast specialist or a surgical oncologist. These specialists have extensive training in breast conditions and can provide a more focused evaluation of your axillary lumps. They may recommend imaging studies such as a mammogram or ultrasound, or even a biopsy if deemed necessary.

3. Imaging Studies: If you haven't already had imaging studies like an ultrasound or mammogram since the changes in your lumps, it would be prudent to request these tests. Imaging can help determine the characteristics of the lumps, such as whether they are solid or cystic, and can provide valuable information regarding their nature.

4. Monitoring Symptoms: Keep track of any changes in your symptoms, such as increased pain, changes in the skin over the lumps, or any new systemic symptoms like fever or weight loss. These could be important indicators that warrant immediate attention.

5. Discuss Your Concerns: When you see a new doctor, be sure to express your concerns clearly. Discuss your history of fibrocystic changes, the previous surgeries, and the recent changes in your axillary lumps. This information will help the new physician understand your situation better and guide their evaluation.

6. Follow-Up: If you decide to stay with your current provider, ensure that you have a clear follow-up plan. Regular monitoring is essential, but it should be accompanied by clear communication about what to watch for and when to seek further evaluation.

In summary, your health and peace of mind are paramount. If you feel that your concerns are not being adequately addressed, it is entirely appropriate to seek a second opinion or consult with a specialist. Early detection and intervention are key in managing any potential issues related to breast health, and you deserve to have your concerns taken seriously.

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