Fibrosis and simple cysts

Many breast lumps turn out to be caused by fibrosis and/or cysts, benign changes in breast tissue that happen in many women at some time in their lives. Fibrosis is the formation of scar-like (fibrous) tissue, and cysts are fluid-filled sacs. These changes are sometimes called fibrocystic changes, and used to be called fibrocystic disease. They are most often diagnosed by a doctor based on symptoms, such as breast lumps, swelling, and tenderness or pain. These symptoms tend to be worse just before a woman's menstrual period is about to begin. Her breasts may feel lumpy and, sometimes, she may notice a clear or slightly cloudy nipple discharge..

These changes are most common in women of childbearing age, but they can affect women of any age. They are the most common benign condition of the breast. They may be found in different parts of the breast and in both breasts at the same time.

Many different changes can be found when fibrocystic breast tissue is looked at under the microscope. Most of these changes reflect the way the woman's breast tissue has responded to monthly hormone changes and have little other importance.

Fibrosis

Fibrosis refers to a large amount of fibrous tissue, the same material that ligaments and scar tissues are made of. Areas of fibrosis feel rubbery, firm, or hard to the touch. Fibrosis does not increase your breast cancer risk and does not need any special treatment.

Cysts

A round, movable lump, especially one that is tender to the touch, suggests a cyst. Cysts are fluid-filled, round or oval shaped sacs within the breasts. They are most often found in women in their 40s, but they can be seen in women of any age. Monthly hormone changes often cause cysts to get bigger and become painful and more noticeable just before the menstrual period.

Cysts start out with a build-up of fluid inside breast glands. Microcysts (microscopic cysts) are too small to feel and are found only when tissue is looked at under the microscope. If fluid continues to build up, macrocysts (large cysts) are formed. These can be easily felt and can reach 1 or 2 inches across. As they grow, the breast tissue around the cyst may stretch and be painful.

A clinical breast exam often cannot tell the difference between a cyst and a solid mass, so an ultrasound or fine needle aspiration (FNA) biopsy is needed to be sure. FNA biopsy can confirm the diagnosis of a cyst and, at the same time, drain the cyst fluid. Removing the fluid may reduce pressure and pain for some time, but it is not necessary to remove the fluid unless it is causing discomfort. If removed, the fluid may come back later. Having cysts does not increase your risk of later developing breast cancer.

Diagnosis

In most cases, symptoms of fibrocystic changes include breast pain and tender lumps or thickened areas in the breasts. These symptoms may change as the woman moves through different stages of the menstrual cycle. Sometimes, one of the lumps may feel firmer or have other features that lead to a concern about cancer. When this happens, a needle biopsy or a surgical biopsy may be needed to make sure that cancer is not present.

Treating symptoms

Most women with fibrocystic changes and no bothersome symptoms do not need treatment, but closer follow-up may be advised. Women with mild discomfort may get relief from supportive bras or over-the-counter pain relievers.

For a very small number of women with painful cysts, draining the fluid with a needle can help relieve symptoms.

Some women report that their breast symptoms improve if they avoid caffeine and other stimulants (called methylxanthines) found in coffee, tea, chocolate, and many soft drinks. Studies have not found those stimulants to have a significant impact on symptoms, but many women feel that avoiding these foods and drinks for a couple of months is worth trying.

Because breast swelling toward the end of the menstrual cycle is painful for some women, some doctors recommend that women reduce salt in their diets or take diuretics (drugs to remove salt and fluid from the body). But studies have not found diuretics to be better than pills that do not have any medicine in them (placebos).

Many vitamin supplements have been suggested to relieve symptoms, but so far none are proven to be of any use, and some may have dangerous side effects if taken in large doses.

Some doctors recommend hormones, such as oral contraceptives (birth control pills), tamoxifen, or androgens. But these are usually used only in women with severe symptoms because they can have serious side effects.