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Nickson Jara Breast mass Definition A breast lump is a swelling, protuberance, or lump in the breast.

Considerations Normal breast tissue is present in both males and females of all ages. This tissue responds to hormonal changes and, therefore, certain lumps can come and go. Breast lumps may appear at all ages: •

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Infants may have breast lumps related to estrogen from the mother. The lump generally goes away on its own as the estrogen clears from the baby's body. It can happen to boys and girls. Young girls often develop "breast buds" that appear just before the beginning of puberty. These bumps may be tender. They are common around age 9, but may happen as early as age 6. Teenage boys may develop breast enlargement and lumps because of hormonal changes in mid-puberty. Although this may distress the teen, the lumps or enlargement generally go away on their own over a period of months. Breast lumps in an adult woman raise concern for breast cancer, even though most lumps turn out to be not cancerous.

Causes Lumps in a woman are often caused by fibrocystic changes, fibroadenomas, and cysts. Fibrocystic changes can occur in either or both breasts. These changes are common in women (especially during the reproductive years), and are considered a normal variation of breast tissue. Having fibrocystic breasts does not increase your risk for breast cancer. It does, however, make it more difficult to

interpret lumps that you or your doctor find on exam. Many women feel tenderness in addition to the lumps and bumps associated with fibrocystic breasts. Fibroadenomas are noncancerous lumps that feel rubbery and are easily moveable within the breast tissue. Like fibrocystic changes, they occur most often during the reproductive years. Usually, they are not tender and, except in rare cases, do not become cancerous later. A doctor may feel fairly certain from an exam that a particular lump is a fibroadenoma. The only way to be sure, however, is to remove or biopsy it. Cysts are fluid-filled sacs that often feel like soft grapes. These can sometimes be tender, especially just before your menstrual period. Cysts may be drained in the doctor's office. If the fluid removed is clear or greenish, and the lump disappears completely after it is drained, no further treatment is needed. If the fluid is bloody, it is sent to the lab to look for cancer cells. If the lump doesn't disappear, or recurs, it is usually removed surgically. Other causes of breast lumps include: •

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Milk cysts (sacs filled with milk) and infections (mastitis), which may turn into an abscess. These typically occur if you are breastfeeding or have recently given birth. Breast cancer, found on mammogram or ultrasound, then a biopsy. Men also can get breast cancer. Injury -- sometimes if your breast is badly bruised, there will be a collection of blood that feels like a lump. These lumps tend to get better on their own in a matter of days or weeks. If not, your doctor may have to drain the blood. Lipoma -- a collection of fatty tissue. Intraductal papilloma -- a small growth inside a milk duct of the breast. This often occurs near the areola, the colored part of the breast surrounding the nipple, in women ages 35-55. It is harmless and often cannot be felt. In some cases the only symptom is a watery, pink discharge from the nipple. Since a watery or bloody discharge can also be a sign of breast cancer, your doctor should check this.

Home Care For fibrocystic changes, birth control pills are often helpful. Other women are helped by: • • •

Avoiding caffeine and chocolate Limiting fat and increasing fiber in the diet Taking vitamin E, vitamin B complex, or evening primrose oil supplements

When to Contact a Medical Professional Call your doctor if: • • • • •

The skin on your breast appears dimpled or wrinkled (like the peel of an orange) You find a new breast lump during your monthly self-exam You have bruising on your breast, but did not experience any injury You have nipple discharge, especially if it is bloody or pinkish (bloodtinged) Your nipple is inverted (turned inward) but normally is not inverted

Also call if: • •

You are a woman, age 20 or older, and want guidance on how to perform a breast self-examination You are a woman over age 40 and have not had a mammogram in the past year

What to Expect at Your Office Visit Your doctor will get a complete history from you, with special attention to factors that may increase your risk of breast cancer. The health care provider will perform a thorough breast examination. If you don't know how to perform breast self-examination, ask your health care provider to teach you the proper method. Medical history questions regarding breast lumps include: • •

When and how did you first notice the lump? Do you have other symptoms such as pain, nipple discharge, or fever?

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Where is the lump located? Do you do breast self-exams, and is this lump a recent change? Have you had any type of injury to your breast? Are you taking any hormones, medications, or supplements?

Tests that may be performed include: • • • • •

Biopsy of the lump Mammogram Needle aspiration of a cyst and examination of the fluid under a microscope Study of nipple discharge under a microscope Ultrasound to see if the lump is solid or a cyst

Treatment of a breast lump depends on the cause. Solid breast lumps are often removed surgically. Cysts can be drained. Breast infections require antibiotics. If breast cancer is diagnosed, most women receive surgery, radiation, chemotherapy, or hormonal therapy. Discuss these options carefully and thoroughly with your doctor. If you have a family history of breast cancer, your doctor may also suggest testing for genes that make you more likely to get breast cancer. Prevention Breast cancer screening is an important way to find breast cancer early, when it is most easily treated and cured. • • •

Get regular mammograms. If you are over age 20, consider doing a monthly breast self-exam (See: Breast self exam) If you are over age 20, have a complete breast exam by your provider at least every 3 years -- every year if you are over 40.

Having fibrocystic breast tissue, mastitis, or breast tenderness related to PMS does NOT put you at greater risk for breast cancer. Having fibrocystic breasts does, however, make your self-exam more confusing, because there are many normal lumps and bumps.

To prevent breast cancer: • • • •

Exercise regularly Reduce fat intake Eat lots of fruits, vegetables, and other high fiber foods Do not drink more than 1 or 1 1/2 glasses of alcohol a day

Carbuncle Definition A carbuncle is a skin infection that often involves a group of hair follicles. The infected material forms a lump, called mass, which occurs deep in the skin. When you have more than one carbuncle, the condition is called carbunculosis. See also: Skin lesion

Alternative Names Skin infection - staphylococcal; Infection - skin - staph; Staph skin infection; Carbunculosis

Causes, incidence, and risk factors Most carbuncles are caused by the bacteria staphylococcus aureus. The infection is contagious and may spread to other areas of the body or other people. A carbuncle is made up of several skin boils (furuncles). The infected mass is filled with fluid, pus, and dead tissue. Fluid may drain out of the carbuncle, but sometimes the mass is so deep that it cannot drain on its own.

Carbuncles may develop anywhere, but they are most common on the back and the nape of the neck. Men get carbuncles more often than women. Because the condition is contagious, several family members may develop carbuncles at the same time. Often, the direct cause of a carbuncle cannot be determined. Things that make carbuncle infections more likely include: • • •

Friction from clothing or shaving Poor hygiene Poor overall health

Persons with diabetes, dermatitis, and weakened immune systems are more likely to develop staph infections.

Symptoms A carbuncle is a swollen lump or mass under the skin. It may be the size of a pea or as large as a golf ball. The carbuncle may be red and irritated and might hurt when you touch it. It may also: • • • •

Grow very fast Have a white or yellow center (pustule) Weep, ooze, or crust Spread to other skin areas

Sometimes, other symptoms may occur. These may include: • • • •

Fatigue Fever General discomfort or sick feeling Skin itching before the carbuncle develops

Signs and tests Your doctor will look at your skin. The diagnosis is primarily based on what the skin looks like. A skin biopsy may be done to help make the diagnosis or determine the exact type of bacteria involved. Treatment Carbuncles usually must drain before they will heal. This most often occurs on its own in less than 2 weeks. Placing a warm moist cloth on the carbuncle helps it to drain, which speeds healing. Gently soak the area with a warm, moist cloth several times each day. Never squeeze a boil or attempt to cut it open at home because this can spread the infection and make it worse. You need treatment if the carbuncle lasts longer than 2 weeks, returns frequently, is located on the spine or the middle of the face, or occurs along with a fever or other symptoms. Treatment helps reduce complications related to an infection. Your doctor may prescribe: • •

Antibacterial soaps Antibiotics applied to the skin or taken by mouth

Deep or large lesions may need to be drained by a health care provider. Proper hygiene is very important to prevent the spread of infection. Always wash your hands very well after touching a carbuncle. Do not re-use or share washcloths or towels -- this can cause the infection to spread. Clothing, washcloths, towels, and sheets or other items that contact infected areas should be washed in very hot (preferably boiling) water. Bandages should be changed frequently and thrown away in a bag that can be tightly closed.

Expectations (prognosis)

Carbunculus may heal on their own. Others usually respond well to treatment. However, a carbuncle can return again and again for months or years following the first infection. Complications • • • • • •

Abscess of the brain, skin, spinal cord, or organs such as the kidneys Endocarditis Osteomyelitis Permanent scarring of the skin Sepsis Spread of infection to other areas

Calling your health care provider Call your health care provider if: • • • •

A carbuncles does not heal with home treatment within 2 weeks Carbuncles come back often A carbuncle is located on the face or spine You have a fever, red streaks running from the sore, a lot of swelling around the carbuncle, or pain that gets worse

Prevention Good general health and hygiene may help prevent some staph skin infections. Such infections are contagious, so care must be taken to avoid spreading the bacteria to other people. If you get carbuncles often, your doctor may give you antibiotics to prevent them.