From the Guidelines
Breast tissue that feels like masses but is actually fat does not necessarily require an ultrasound (US) examination if mammography shows a definite benign mass or fatty tissue alone in the palpable region of concern. According to the American College of Radiology Appropriateness Criteria 1, if the mammographic finding correlates with the clinical finding, and fatty tissue alone is identified in the palpable region, US may not be necessary. Breast tissue is composed of glandular tissue, fibrous connective tissue, and fat (adipose tissue), and the fat in breasts can sometimes feel lumpy or nodular, especially in certain areas or during different phases of the menstrual cycle. Some key characteristics to distinguish between normal breast tissue and concerning lumps include:
- Normal breast tissue, including fat, typically feels symmetrical (similar on both sides)
- May change with the menstrual cycle
- Often has a soft, mobile quality
- Concerning lumps tend to be harder, fixed in place, asymmetrical, and don't change with the cycle. If correlation between the mammographic finding and the palpable lesion is uncertain, US is indicated, and it is preferably targeted specifically to the palpable finding 1. If you're concerned about any breast changes or lumps, it's always best to have them evaluated by a healthcare provider, as they can help determine the best course of action and provide guidance on distinguishing between normal breast tissue and potentially concerning lumps.
From the Research
Breast Tissue and Fat
- Breast tissue can sometimes feel like masses, but it is actually fat, as seen in cases of fat necrosis or lipomas 2, 3.
- The presence of fat in breast masses can be detected using digital breast tomosynthesis (DBT), which can help differentiate between benign and malignant masses 3.
- However, the presence of fat in a breast mass does not always indicate benignity, and radiologists must be careful not to misinterpret this finding 3.
Evaluation of Palpable Breast Masses
- Palpable breast masses are common and usually benign, but efficient evaluation and prompt diagnosis are necessary to rule out malignancy 4.
- A thorough clinical breast examination, imaging, and tissue sampling are needed for a definitive diagnosis of breast masses 4.
- Fine-needle aspiration and core-needle biopsy are useful tools in the evaluation of breast masses, but require adequate training and experience to perform accurately 4.
Breast Cancer Risk Reduction
- Raloxifene and tamoxifen are FDA-approved for breast cancer risk reduction, and their use has been studied in various populations 5, 6.
- The use of these medications for breast cancer risk reduction is generally low, but increases with breast cancer risk level 6.
- However, the use of these medications has been decreasing over time, and more research is needed to understand their effectiveness and optimal use 6.