Breast lumps surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Surgery

Recommendations

• Women < age 35

  • If no distinct lump found or primary care physician (PCP) unsure: refer to breast specialist for 2nd opinion
  • If non-suspicious lump on exam

    • Reassess 3-10 days after onset of next menses
    • If lump regresses, no further evaluation needed

  • If lump remains palpable and feels cystic

    • Fine needle aspiration (FNA)
    • Management of bloody vs. non-bloody fluid as above

  • If lump does not feel cystic

    • Ultrasound
    • If solid mass: FNAB, core biopsy or excisional biopsy
    • If cyst, FNA as above
    • If non-suspicious solid mass < 1 cm: likely fibroadenoma
    • Can follow by physical examination every 3-6 months

  • Mammography generally not helpful in this age group

• Women age 35 and over

  • Mammography and ultrasonography (note: mammography has 10-20% false-negative rate)
  • Cystic mass

    • FNA with mgmt of bloody vs. non-bloody fluid as above

  • Solid mass

    • Core biopsy, FNAB or excisional biopsy if no suspicious features
    • Excisional biopsy recommended if mass is suspicious by exam or mammogram

  • No specific findings on mammogram and ultrasound: refer to surgeon for likely excision

References

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