The phrase “fibrocystic breast condition” is commonly used when referring to lumps, cysts, nipple discharge, and pain. Fibrocystic breast condition is a nonspecific phrase which really just refers to various responses of the breast tissue to normal hormonal changes. Previously, women were labeled as having “fibrocystic disease”. The term “disease” is no longer used, as fibrocystic changes are actually part of normal breast anatomy and physiology – everyone has some degree of lumpiness. At times, the changes become more pronounced, resulting in masses, pains, or discharge which are concerning to patients. It used to be thought that simply having “lumpy” breasts was a precursor to cancer – many women were actually advised to have surgery to remove their breasts. We now know that in most cases, fibrocystic breast condition is a completely benign condition.
The most common component of fibrocystic change is breast pain. The medical term for breast pain is mastalgia or mastodynia. The pain is often cyclic, which means that it occurs in relation to (often just before) the menstrual period. The pains are at times severe, and most commonly occur in the upper outer breast and may also extend to the nipple or underarm. Usually the pains resolve after the menstrual period begins. Non-cyclic mastalgia refers to pains which are not related to the menstrual period. Often, only one breast will have pain, and it may be localized to a single pinpoint area. The pains may be fairly constant and “aching” in nature, or may be sharp, burning, or stabbing in character. Evaluation to rule out a specific mass or cyst is indicated, but most times, the pains are not related to any specific lesion (including cancer), and often resolve over time. Pulled chest wall muscles, pinched nerves, or costochrondritis (inflammation of the cartilage of the ribcage) may also cause pain which appears to originate in the breasts.
Careful history and examination can usually rule out a significant cause of the pain. Often, a mammogram or ultrasound will be done to ensure that there is no mass or other specific lesion causing the pain. If no specific abnormality is found, simple maneuvers such as reducing intake of caffeine, salt, and tobacco, wearing a supportive bra, and using over-the-counter medications such as ibuprofen during the premenstrual period will help to control symptoms. Vitamin E, B-complex vitamins, and Evening Primrose Oil have also shown benefit in some patients in treating persistent pain, but none have been proven effective in placebo-controlled clinical trials. Relaxation techniques and acupuncture may be helpful, but studies are limited. For more severe cases, hormonal agents may also be indicated. Persistent pains or pains associated with any mass or lump require evaluation by a physician.
Breast cysts are very commonly seen as a component of fibrocystic change. Cysts are fluid-filled “sacs” in the breast – think of them like small water balloons. They often are very small and not palpable (not able to be felt on exam); they will often fluctuate in size, filling with fluid prior to the menstrual period which then results in the swelling and lumpiness commonly felt at this time of the month. Cysts may become quite large, and they may seem to occur suddenly and can be quite painful. Small nonpalpable cysts do not require any specific treatment. Larger cysts which are painful or palpable usually require aspiration – a procedure performed under local anesthesia in the office. An ultrasound can usually confirm that a palpable lump is indeed a fluid-filled cyst. Aspiration involves placing a small needle into the cyst after the area is numbed, and draining the fluid. The fluid may be clear, yellow, milky, green, brown, or almost black in color – all of these are normal. Surgery is not usually needed except when there is a sold component associated with the cyst, or if the fluid removed contains blood.
Fibroadenomas are also very common lesions. These are solid growths, not fluid-filled like the cysts. Fibroadenomas most often occur in young women, including teenagers. They may be tender to the touch, or not painful at all. They are often described as feeling “rubbery”, and are usually quite movable on examination. Fluid filled cysts and solid tissue appear very different on ultrasound. If a solid mass is seen, a needle biopsy may be recommended to confirm the diagnosis – ultrasound can be suggestive of or consistent with a fibroadenoma, but to confirm the diagnosis, a tissue sample is needed. If the needle biopsy confirms a fibroadenoma, the patient will often have several options for treatment. Small fibroadenomas may often be observed, with with follow up examinations 2-3 times per year. If the patient desires treatment, or if the lesion is enlarging, options include cryoablation (freezing of the lump under local anesthesia in the office) or removal in the operating room with surgery. Cryoablation is not an option for all patients, but it usually results in less scarring than surgical removal.
Nipple discharge is another very common condition. Most women with nipple discharge are very concerned that they have cancer, but in fact, the majority of nipple discharge is what we refer to as “physiologic” – in other words, related to normal hormonal fluctuations. The discharge may be yellow, green, or brown – just like cyst fluid. It may also be milky, especially in women who have had children. Sometimes milky discharge is related to elevations of a hormone called prolactin. Prolactin is normally produced during breast-feeding, but occasionally growths in the pituitary gland (a small gland in the brain that produces many of the body’s hormones) can cause an elevated prolactin level. Usually, in the absence of a specific mass or abnormality on mammogram or ultrasound, no specific treatment for the discharge is indicated. Occasionally, an infection will be the cause of the discharge and will respond to antibiotics. Sometimes the discharge is clear or even bloody. This is usually due to a growth within a milk duct. Often times the growths are benign, but due to the potential for cancer, anyone with bloody nipple discharge will be recommended to have a biopsy to rule out cancer.
In summary, “fibrocystic breast condition” is not really a “condition” or “disease”, but more a description of the many different responses of the breast to changes in hormonal levels. Most of these symptoms are benign and do not require specific treatment. However, any change or new finding should be evaluated by your physician.
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