Palpable lump with negative imaging

I am 48 years old, medication free with regular periods.

In 1990 (age 34) I had a left mastectomy for extensive, multi-focal DCIS indicated only by bloody nipple discharge.  The mammogram was negative but noted extreme density.  Simple mastectomy margins were not clean, so six weeks of radiation treatments followed.  Subsequent lymph node disection revealed 6 negative nodes.  

In 2000 (age 44) I detected a small lump in my left axilla near the end of the mastectomy scar and within the irradiated area.  It turned out to be a 4mm growth of papillary DCIS most likely arising in ectopic breast tissue.  Margins were clean so no followup treatment was planned.

I have had three biopsies on my right breast - in 2000 at the same time as the mastectomy and in 1992 and 1994 for small palpable lumps that ended up being fibrocystic.

In January 2004 I went for my annual mammogram on my right breast.  It showed an area of vague density that ultrasound confirmed was a cyst.  The density disappeared following aspiration.  The mammogram also reported a general increase in density from the previous mammogram.

About four weeks ago I detected a palpable lump in the same general location as the aspirated cyst.  It does not feel as firm and discrete as the DCIS lump I had in 2000.  I have seen my GP and surgeon and had an ultrasound that was negative.  Both doctors think it's OK to watch it for another month or two.  I'm not so sure.  What are your thoughts?

Thank you very much,
JP

[CCF-RN,MSN-rf]

Dear JP:  Given that both doctors have been through all of this with you, it may be that they feel comfortable that this is ok to follow.  However, you are the one with the lump.  If you are worried, you should ask to have it needle biopsied.  If it is a cyst, it will go away.  If not, the cells will be examined and give clarity as to how to proceed.

[jp527]

Sorry, the first biopsy on my right breast was 1990 (not 2000)

[surgeon]

It's pretty easy to poke a needle into a lump, as you've had done in the past. If the lump is a cyst, fluid is drained and the lump goes away. If it's not a cyst, the lump is sampled by the needle, and checked under the microscope. That's my approach to any lump that persists for a period or a month. It quick, simple, cheap, and very useful. On the other hand, evaluation of lumps requires experienced physical exam as well; so if your surgeon is comfortable, it's likely ok. However, it takes two to tango: when I think a lump is ok but the owner needs more info, that trumps my opinion....

[butlerfam]

A related discussion, palpable lump was started.