Fibrocystic breasts

General

Fibrocystic breasts are composed of tissue that feels lumpy or rope-like in texture. Doctors call this nodular or glandular breast tissue.

It’s not at all uncommon to have fibrocystic breasts. More than half of women experience fibrocystic breast changes at some point in their lives. In fact, medical professionals have stopped using the term “fibrocystic breast disease” and now simply refer to “fibrocystic breasts” or “fibrocystic breast changes” because having fibrocystic breasts isn’t really a disease. Breast changes categorized as fibrocystic are considered normal.

Although many women with fibrocystic breasts don’t have symptoms, some women experience breast pain, tenderness and lumpiness — especially in the upper, outer area of the breasts. Breast symptoms tend to be most bothersome just before menstruation. Simple self-care measures can usually relieve discomfort associated with fibrocystic breasts.

Symptoms

Signs and symptoms of fibrocystic breasts may include:

  • Breast lumps or areas of thickening that tend to blend into the surrounding breast tissue
  • Generalized breast pain or tenderness
  • Breast lumps that fluctuate in size with the menstrual cycle
  • Green or dark brown nonbloody nipple discharge that tends to leak without pressure or squeezing
  • Breast changes that are similar in both breasts
  • Monthly increase in breast pain or lumpiness from midcycle (ovulation) to just before your period

Fibrocystic breast changes occur most often in women in their 20s to 50s. Rarely do postmenopausal women experience fibrocystic breast changes, unless they’re on hormone therapy.

When to see a doctor

Most fibrocystic breast changes are normal. However, make an appointment with your doctor if:

  • You find a new breast lump or area of prominent thickening
  • You have specific areas of continuous or worsening breast pain
  • Breast changes persist after your period
  • Your doctor evaluated a breast lump but now it seems to be bigger or otherwise changed

Causes

The exact cause of fibrocystic breast changes isn’t known, but experts suspect that reproductive hormones — especially estrogen — play a role.

Fluctuating hormone levels during your menstrual cycle can cause breast discomfort and areas of lumpy breast tissue that feel tender, sore and swollen. Fibrocystic breast changes tend to be more bothersome before your menstrual period, and the pain and lumpiness tends to clear up or lessen once your menstrual period begins.

When examined under a microscope, fibrocystic breast tissue includes distinct components such as:

  • Fluid-filled round or oval sacs (cysts)
  • A prominence of scar-like fibrous tissue (fibrosis)
  • Overgrowth of cells (hyperplasia) lining the milk ducts or milk-producing tissues (lobules) of the breast
  • Enlarged breast lobules (adenosis)

    Diagnosis

    Tests to evaluate your condition may include:

    • Clinical breast exam. Your doctor checks for unusual areas by visually and manually examining your breasts and the lymph nodes located in your lower neck and underarm area. If your medical history and the clinical breast exam indicate normal breast changes, you may not need additional tests. If your doctor finds a new lump and suspects fibrocystic changes, you may come back a few weeks later, after your menstrual period, to have another breast exam. If the changes persist, you’ll likely need a mammogram or ultrasound.
    • Mammogram. If your doctor detects a breast lump or prominent thickening in your breast tissue, you need a diagnostic mammogram — an X-ray exam that focuses on a specific area of concern in your breast. The radiologist closely examines the area of concern when interpreting the mammogram.
    • Ultrasound. An ultrasound uses sound waves to produce images of your breasts and is often performed along with a mammogram. If you’re younger than age 30, you might have an ultrasound instead of a mammogram. Ultrasound is better for evaluating a younger woman’s dense breast tissue — tissue tightly packed with lobules, ducts and connective tissue (stroma). Ultrasound can also help your doctor distinguish between fluid-filled cysts and solid masses.
    • Fine-needle aspiration. For a breast lump that feels a lot like a cyst, your doctor may try fine-needle aspiration to see if fluid can be withdrawn from the lump. This helpful procedure can be done in the office. A fine-needle aspiration may collapse the cyst and resolve discomfort.
    • Breast biopsy. If a diagnostic mammogram and ultrasound are normal, but your doctor still has concerns about a breast lump, you may be referred to a breast surgeon to determine whether you need a surgical breast biopsy. A breast biopsy is a procedure to remove a small sample of breast tissue for microscopic analysis. If a suspicious area is detected during an imaging exam, your radiologist may recommend an ultrasound-guided breast biopsy or a sterotactic biopsy, which uses mammography to pinpoint the exact location for the biopsy.

    Treatment

    If you don’t experience symptoms, or your symptoms are mild, no treatment is needed for fibrocystic breasts. Severe pain or large, painful cysts associated with fibrocystic breasts may warrant treatment.

    Treatment options for breast cysts include:

    • Fine-needle aspiration. Your doctor uses a hair-thin needle to drain the fluid from the cyst. Removing fluid confirms that the lump is a breast cyst and, in effect, collapses it, relieving associated discomfort.
    • Surgical excision. Rarely, surgery may be needed to remove a persistent cyst-like lump that doesn’t resolve after repeated aspiration and careful monitoring or has features that concern your doctor during a clinical exam.

    Examples of treatment options for breast pain include:

    • Over-the-counter pain relievers, such as acetaminophen (Tylenol, others) or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others) or prescription medication.
    • Oral contraceptives, which lower the levels of cycle-related hormones linked to fibrocystic breast changes.

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