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by Polsdorfer R

Fibrocystic Disease

(Benign Breast Masses; Breast Cysts; Cystic Disease; Chronic Cystic Mastitis; Mammary Dysplasia)

Definition

Breasts are composed of ducts, milk glands, and fatty and fibrous tissues. Fibrocystic disease occurs when there are fluid-filled lumps (cysts) of duct tissue. These lumps are surrounded by a scar-like capsule of tissue in the breasts.
Although harmless, these lumps can sometimes be the site of pain (mastalgia) that recurs late in each menstrual cycle. The greatest problem with fibrocystic disease is telling the difference between this condition and breast cancer.
Breast Cysts
Breast cyst2
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Causes

The glandular tissue of the breasts cycles monthly with menstrual periods. It enlarges to prepare for a pregnancy, and then shrinks if one does not occur. This cycling causes cysts and excess fibrous tissue to build up. Virtually all women will have some form of this condition during their reproductive years. However, most women will not seek treatment.

Risk Factors

All women between puberty and menopause are at risk for this condition.

Symptoms

Symptoms may include:
  • Multiple lumps (cysts) in both breasts that cycle with menstrual periods
  • Cysts that may produce no symptoms or cause pain and tenderness
A fibrocystic lump may be difficult to tell apart from a cancerous mass. But, its rapid disappearance with menses and reappearance in the next menstrual cycle help to distinguish this condition from breast cancer.

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done.
Images may be taken of your breasts. This can be done with a mammogram.

Treatment

Once it has been determined that the lump is not a cancer, it can be left alone. If the lump's identity is still in doubt, it should be biopsied.
Treatment may include:
  • Needle aspiration—If the fluid is removed, the cyst usually resolves.
  • Biopsy (removal) of the suspicious area

Aspiration

After numbing the area with a local anesthetic, a small needle is inserted into the lump. This is to draw fluid out. If the lump disappears, cancer is highly unlikely. If the lump remains, or if the fluid withdrawn is bloody, it will need to be examined to see if cancer is present.

Biopsy

There are 2 types of biopsies:
  • A fine needle biopsy is nearly identical to an aspiration. The only difference is that a tiny piece of tissue is also drawn out of the lump.
  • An excisional biopsy removes the entire lump through a surgical incision. This can be done with local anesthesia if the lump is small and superficial.
Once cancer has been ruled out, fibrocystic disease may be safely treated with observation and conservative measures, including:
  • Over-the-counter pain relievers
  • Hormone medications for severe cases
  • Applying a heating pad
  • Wearing a supportive bra
  • Dietary changes, such as caffeine avoidance

Prevention

There are not current guidelines to prevent fibrocystic disease. The most important issue for you and your doctor is being able to distinguish this condition from breast cancer. Follow your doctor's guidelines for regular breast cancer screening.

RESOURCES

American Cancer Society
http://www.cancer.org
Women's Health—US Department of Health and Human Services
http://www.womenshealth.gov

CANADIAN RESOURCES

Canadian Breast Cancer Foundation
http://www.cbcf.org
Canadian Women's Health Network
http://www.cwhn.ca

References

A healthy pregnancy for women with diabetes. American Congress of Obstetricians and Gynecologists website. Available at: http://www.acog.org/~/media/For%20Patients/faq176.pdf?dmc=1&ts=20130726T0945559945. Updated December 2011. Accessed June 7, 2016.
Miltenburg DM, Speights VO Jr. Benign breast disease. Obstet Gynecol Clin North Am. 2008;35(2):285-300.
Phyllodes tumor of breast. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 23, 2014. Accessed June 7, 2016.

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