Breast Lipomas: Pain, Imaging, and Follow-Up Care

Breast lipoma

Hello Doctor, I would like to ask: In April, I felt a hard lump that was painful.
The next day, I went for a breast ultrasound, and the doctor said it looked like a lipoma.
However, the ultrasound could not determine if there was any calcification inside, so the doctor suggested that if I was concerned, I could get a mammogram.
It has been a month since the ultrasound, but the area where the lipoma is located still hurts when pressed.
I am wondering if it might be inflamed.
Is this normal? Additionally, do I need to get a mammogram, or can I continue to monitor it with ultrasound? Thank you, Doctor!

Yuan, 30~39 year old female. Ask Date: 2024/05/02

Dr. Yuan Tianmin reply Breast and Thyroid

Mammography does not enhance your ability to detect breast tumors through palpation; however, it is still advisable for you to seek a second opinion at a breast surgery clinic.

Reply Date: 2024/05/02

More Info

Breast lipomas are benign tumors composed of adipose (fat) tissue. They are generally soft, movable, and painless, but in some cases, they can cause discomfort or pain, especially if they are located near sensitive structures or if they become inflamed. Your experience of feeling a hard lump that is painful to the touch raises several important considerations regarding the nature of the lump, potential inflammation, and the appropriate imaging and follow-up care.

Firstly, it is essential to understand that while lipomas are typically benign and do not pose a significant health risk, they can sometimes be mistaken for other types of lumps, including cysts or even malignant tumors. The fact that your ultrasound suggested a lipoma is a positive indication, but the persistent pain you are experiencing warrants further investigation. Pain in the area of a lipoma can occur for several reasons:
1. Inflammation: If the lipoma has become inflamed, it can cause localized pain. Inflammation can occur due to various factors, including trauma or irritation in the area.

2. Pressure on Surrounding Structures: If the lipoma is pressing against nerves or other tissues, it can lead to discomfort or pain.

3. Changes in the Lipoma: Although rare, lipomas can undergo changes that may lead to discomfort. If the lipoma is growing or if there are changes in its composition, this could also explain the pain.

Regarding imaging, your doctor has suggested a mammogram as a follow-up to the ultrasound. While ultrasound is excellent for evaluating soft tissue structures and can often provide a clear picture of a lipoma, a mammogram can offer additional information, particularly regarding the presence of calcifications or other abnormalities that may not be visible on ultrasound. Calcifications can sometimes indicate changes in the breast tissue that require further evaluation.

In your case, since you are still experiencing pain and discomfort, it would be prudent to follow your doctor's advice and consider getting a mammogram. This imaging can help rule out any other potential issues and provide peace of mind. Additionally, if the mammogram does not provide sufficient clarity, your doctor may recommend further imaging studies, such as an MRI, which can offer a more detailed view of the breast tissue.

As for follow-up care, if the mammogram confirms that the lump is indeed a lipoma and there are no concerning features, your doctor may recommend a watchful waiting approach, where the lump is monitored over time. However, if the pain persists or worsens, or if there are any changes in the lump's size or characteristics, surgical removal may be considered, especially if it is causing significant discomfort.

In summary, while breast lipomas are generally benign, your ongoing pain and the characteristics of the lump necessitate further evaluation through imaging. It is essential to maintain open communication with your healthcare provider, follow their recommendations for imaging, and discuss any changes or concerns you may have regarding your breast health. Regular check-ups and being proactive about any changes in your breast tissue are crucial for ensuring your overall health and well-being.

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