Painful Breast Lumps: Causes and When to See a Doctor - Obstetrics and Gynecology

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Breast lumps, especially when accompanied by pain, can be concerning and warrant a thorough evaluation. The presence of a painful lump beneath the nipple, as you described, can arise from various causes, and understanding these can help alleviate anxiety while guiding you on the appropriate steps to take.


Common Causes of Painful Breast Lumps
1. Hormonal Changes: Many women experience breast tenderness and lumpiness due to hormonal fluctuations, particularly related to the menstrual cycle. Conditions such as fibrocystic breast changes can lead to lumpy, painful breasts, especially in the days leading up to menstruation.

2. Infections: Mastitis, an infection of the breast tissue, can cause localized pain, swelling, and sometimes a lump. This is more common in breastfeeding women but can occur in others as well.

3. Cysts: Fluid-filled sacs within the breast can develop and may become painful, especially if they are large or if they rupture.

4. Fibroadenomas: These are benign tumors that can feel like lumps in the breast. They are usually painless, but some women report discomfort, especially if the lump is pressing against surrounding tissue.

5. Breast Cancer: While the presence of a painful lump does not automatically indicate cancer, it is crucial to rule out this possibility, especially if the lump is new, persistent, or accompanied by other symptoms such as changes in the skin, discharge from the nipple, or changes in breast size or shape.


When to See a Doctor
You should seek medical attention if you notice any of the following:
- A new lump that persists beyond your menstrual cycle.

- Changes in the size, shape, or contour of your breast.

- Persistent pain that does not improve or worsens over time.

- Any unusual discharge from the nipple.

- Skin changes such as redness, dimpling, or puckering.


What to Expect During a Medical Evaluation
When you visit a healthcare provider for a breast lump, they will typically perform the following:
1. Clinical Breast Exam: The doctor will physically examine your breasts to assess the lump's characteristics, including its size, shape, and tenderness.

2. Medical History: You will be asked about your medical history, including any previous breast issues, family history of breast cancer, and your menstrual cycle.

3. Imaging Tests: Depending on the findings, the doctor may recommend imaging tests such as:
- Mammogram: An X-ray of the breast that can help identify abnormalities.

- Ultrasound: This can provide a clearer picture of the lump, helping to determine if it is solid or fluid-filled.

4. Biopsy: If there is a concern about the nature of the lump, a biopsy may be performed. This involves taking a small sample of tissue from the lump to be examined under a microscope.


Conclusion
While the presence of a painful lump beneath the nipple can be alarming, many causes are benign and treatable. However, it is essential to consult with a healthcare provider for a proper diagnosis and to rule out any serious conditions, including breast cancer. Early detection and intervention are key to managing breast health effectively. If you have any concerns or if the lump persists, do not hesitate to seek medical advice. Your health and peace of mind are paramount.