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 the 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. Flaxseed and chaste berry may provide relief. 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. They often are very small and not palpable (not able to be felt on the exam); they will often fluctuate in size, filling with fluid prior to the menstrual period which then results in some of the swelling and lumpiness commonly felt at this time of the month. Cysts may become quite large, they may occur suddenly and may be quite painful. Small nonpalpable cysts do not require any specific treatment. Larger cysts that 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, to remove 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 recommended 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 painful but some women have no symptoms. 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 follow up examinations 2-3 times per year. If the patient desires treatment, or if the lesion is enlarging, options may include cryoablation (freezing of the lump under local anesthesia in the office) or removal in the operating room with surgery.
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” – 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 breastfeeding, 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 a mammogram or ultrasound, no specific treatment for the discharge is indicated. Occasionally, an infection will be the cause of the discharge. Sometimes, the discharge is clear or even bloody. This is usually due to growth within a milk duct called a papilloma. Most papillomas 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” refers to many different types of benign conditions that can occur in the breast, often related to hormonal fluctuations. Any change or new finding should be evaluated by your physician.
Updated 15 June 2019