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Fibrocystic breastsBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/fibrocystic-breasts/DS01070
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|Fibrocystic breast changes|
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.
Although breast changes categorized as fibrocystic breasts are normal, they can cause breast pain, tenderness and lumpiness — especially in the upper, outer area of your breasts. Breast symptoms tend to be most bothersome just before menstruation. Simple self-care measures can usually relieve discomfort associated with fibrocystic breasts.
It's important to have your breasts evaluated if you have specific areas where pain continues to occur or worsens, or if you have new areas of lumps or thickening that persist after your period. Your doctor will examine you to see if the new changes are concerning and to eliminate other causes.
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
- Fluctuating size of breast lumps
- Green or dark brown nonbloody nipple discharge that tends to leak without pressure or squeezing
- Changes that occur in both breasts, rather than just one
- 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, if you find a new breast lump or area of thickening that persists after your period, or if a previously evaluated breast lump seems to have grown or otherwise changed, make an appointment with your doctor to get it checked out.
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The exact cause of fibrocystic breast changes isn't known, but experts suspect that reproductive hormones — especially estrogen — play a role.
If you aren't yet menopausal, your discomfort may result from the way your hormone levels fluctuate during your menstrual cycle. The fluctuations can make your breasts have areas of lumpy thickening that feel tender, sore and swollen. Those fibrocystic breast changes often feel the worst before your menstrual period, and the pain and lumpiness tends to clear up 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)
Having fibrocystic breasts doesn't increase your risk of breast cancer, unless the breast changes are associated with atypical hyperplasia (atypia) — the abnormal appearance and overgrowth of cells lining breast lobules and ducts.
Preparing for your appointment
You're likely to start by seeing your family doctor, nurse practitioner or physician assistant. In some cases, based on a clinical breast exam or findings on an imaging test, you may be referred to a breast-health specialist.
The initial evaluation focuses on your medical history. Your health care provider will want to discuss your symptoms, their relation to your menstrual cycle and any other relevant information.
What you can do
To prepare for your appointment, make a list of:
- All your symptoms, even if they seem unrelated to the reason for your appointment
- Key personal information, including the dates and results of any prior mammograms
- All medications, vitamins, herbs and supplements that you take
- Questions to ask your doctor, listing them from most important to least important in case time runs out
Basic questions to ask your doctor include:
- What is causing my symptoms?
- Do these symptoms increase my risk of breast cancer?
- What kinds of tests will I need?
- What treatment is likely to work best?
- What are the alternatives to the primary approach that you're suggesting?
- Are there any restrictions I'll need to follow?
- Are there any printed materials that I can have? What websites do you recommend?
Don't hesitate to ask questions anytime you don't understand something.
What to expect from your doctor
Your doctor may ask you questions, such as:
- What are your symptoms and how long have you had them?
- Do you experience any breast pain? If so, what is the severity of your pain?
- Do your symptoms occur in one or both breasts?
- When did you have your last mammogram?
- Have you ever had breast cancer or precancerous breast lesions?
- Do you have a family history of cancer?
Tests and 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 an unusual lump and suspects fibrocystic changes, he or she may ask you to return a few weeks later, after your menstrual period — then you'll have another breast exam to see if the changes were associated with your menstrual cycle. If the changes persist, you'll likely need a mammogram or ultrasound.
- Mammogram. If your doctor detects a breast lump or unusual thickening in your breast tissue, you need to have a mammogram — an X-ray exam to evaluate a specific area of concern in your breast. Even if your breast exam is normal, your doctor may recommend a mammogram if you're age 30 or older to double-check for suspicious areas in your breast that may be too small to feel.
- Ultrasound. An ultrasound uses sound waves to produce images of your breasts and is often performed along with a mammogram. Women younger than age 30 might have an ultrasound instead of a mammogram because ultrasound can better evaluate dense breast tissue — that is, tissue tightly packed with lobules, ducts and connective tissue (stroma) and less fat than older women have. Ultrasound is also helpful in distinguishing between fluid-filled breast cysts and solid masses.
- Fine-needle aspiration. If your doctor thinks the lump detected on the clinical exam has the consistency of a cyst, he or she will order an ultrasound to confirm the presence of a cyst or use fine-needle aspiration to see if fluid can be withdrawn from the lump. This helpful procedure can be done in the office.
- Breast biopsy. A breast biopsy is a procedure to remove a small sample of breast tissue for microscopic analysis. If your doctor finds a suspicious breast lump, an area of thickening or other unusual change during the clinical breast exam, you'll have an additional imaging test, such as a mammogram or ultrasound. You also may be referred to a breast surgeon to discuss whether you need a breast biopsy. If a suspicious area is seen during an imaging exam, the radiologist may recommend a breast biopsy.
Treatments and drugs
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, removes 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.
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.
Lifestyle and home remedies
You might find relief from symptoms of fibrocystic breasts through one of these home remedies:
- Wear a firm support bra, fitted by a professional, if possible.
- Wear a sports bra during exercise and while sleeping, especially when your breasts are extra sensitive.
- Limit or avoid caffeine, a dietary change many women report as helpful, although medical studies of caffeine's effect on breast pain and other premenstrual symptoms have been inconclusive.
- Decrease the fat in your diet, which may decrease breast pain or discomfort associated with fibrocystic breasts.
- Reduce or stop taking hormone therapy if you're postmenopausal — but be sure to talk to your doctor before making any change in your prescription medications.
- Use a heating pad or warm water bottle to relieve your discomfort.
Evening primrose oil is a form of linoleic acid that's available as an over-the-counter supplement. Many women use evening primrose oil to try to manage breast pain and other symptoms of fibrocystic breast changes. If there is no improvement after two to three months, discontinue using it.
Although the exact mechanism is unknown, some experts speculate that evening primrose oil may replace linoleic acid in women who are deficient in this essential fatty acid. Restoring linoleic acid levels may make their breast tissues less sensitive to hormonal influences.
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