Breast Cysts and Fibrocystic Breast Disease

It is estimated that more than 60 percent of all women have benign (noncancerous) lumps in their breasts. This is most common in women between the ages of 30 and 50 and seems to run in families. The use of the term “disease” is a bit misleading, since many physicians believe that it is a common, noncancerous breast condition that affects many women, and it is considered a somewhat normal variant. The condition is hormone related – which is why the symptoms come and go around the menstrual period. After menopause, most women no longer experience the symptoms.

Women may experience dense, irregular and bumpy consistency in the breasts, and it usually is worse in the upper, outer portion of the breasts. Patients complain of discomfort that can be constant or occur off and on. Others say their breasts feel “full” or dull, heavy and tender. Some women experience premenstrual tenderness and swelling that improves after the menstrual period. Others complain of sensation changes or itching in the nipple area. Cysts are fluid-filled sacs that form in the breasts – these are typically the “lumps” felt by women. In some women, fibrosis (scar-like connective tissue) forms, making exams difficult.

Having fibrocystic breasts is not a risk factor for breast cancer, but patients should be examined to rule out the disease. The lumps typically are round with smooth borders and are rubbery or changeable in shape.

To rule out other conditions, a mammogram, breast biopsy or aspiration of the cyst with a small needle is used. Because the condition causes breasts to be more dense, it sometimes is difficult to detect on physical exam, so a mammogram or ultrasound may need to be performed. Mammography can be difficult because of the breast tissue density. Therefore, the physician may want to perform a fine needle aspiration – in which fluid is removed from the cyst and tested – to make sure it’s not cancerous.

Treatment typically includes limiting dietary fat intake to 25 percent or less of the total calorie intake, eliminating caffeine, performing monthly breast self-exams and wearing a well-fitting bra to provide good breast support. Some patients believe that vitamin E, vitamin B-6 and herbal preparations such as evening primrose oil help their symptoms. Doctors prescribe oral contraceptives to some patients because they decrease the symptoms.

Because having fibrocystic breast disease can make breast exams and even mammography difficult, early cancerous lesions sometimes can be missed. It’s important for the patient to tell her doctor if she feels new or unusual lumps during her breast self-exam.

Surgeons who treat breast cysts:

Rebecca L. Aft, MD, PhD
Amy E. Cyr, MD
Timothy J. Eberlein, MD
William E. Gillanders, MD
Julie A. Margenthaler, MD

For an appointment with a Washington University breast surgeon, please call (314) 362-2280.