Fibrocystic breasts

Definition

Fibrocystic breasts are composed of tissue that feels ropy, lumpy or bumpy 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 at all.

Although the 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 alleviate discomfort associated with fibrocystic breasts.

Fibrocystic breast changes

Fibrocystic breast changes

Fibrocystic breast changes lead to the development of fluid-filled round or oval sacs (cysts) and more prominent scar-like (fibrous) tissue, which can make breasts feel tender, lumpy or "ropy.&...

Symptoms

Symptoms of fibrocystic breasts may include:

• Breast lumps or areas of thickening
• Breast pain or tenderness
• Fluctuating size of breast lumps
• Green or dark brown nonbloody nipple discharge
• Changes 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 perfectly 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.

Causes

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

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)

Breast anatomy

Breast anatomy

Each of your breasts contains 15 to 20 lobes of glandular tissue, arranged like the petals of a daisy. The lobes are further divided into smaller lobules that produce milk during pregnancy and breast-...

Complications

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. Women with atypia do have an increased risk of breast cancer compared with the general population. A diagnosis of atypical hyperplasia often is made following a breast biopsy to evaluate a mammogram or an abnormality found during a clinical breast exam.

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 examination or findings on an imaging test, you may be referred to a breast health specialist.

What you can do
The initial evaluation focuses on your medical history. You'll discuss with your doctor the symptoms you're experiencing, their relation to your menstrual cycle and any other relevant information. To facilitate this discussion:

• Take note of all your symptoms, even if they seem unrelated to the reason for which you scheduled the appointment.
• Review key personal information, including the dates and results of any prior mammograms.
• Make a list of all medications, vitamins and supplements that you regularly take.
• Write down questions to ask your doctor. List your questions from most important to least important in case time runs out.

What to expect from your doctor
Your doctor may ask you questions about:

• How long you've experienced symptoms
• Whether you experience any breast pain and the severity of your pain
• Whether symptoms occur in one or both breasts
• When you had your last mammogram
• Your family history
• Your personal history of precancerous breast lesions

Tests and diagnosis

Tests to evaluate your condition may include:

• Clinical breast exam and physical exam. During this exam, your doctor checks for unusual areas in your breasts, visually and manually examining your breasts and the lymph nodes located in your lower neck and underarm area. If your medical history and the physical exam findings are consistent with normal breast changes, you may not need additional tests. If your doctor finds something unusual during your breast exam, he or she may ask you to return a few weeks later for reassessment.
• Mammography. If your doctor detects a breast lump or unusual thickening in your breast tissue, you need to undergo diagnostic mammography — an X-ray exam to evaluate a specific area of concern in your breast. Even if your physical exam is normal, your doctor may recommend mammography 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 exam uses sound waves to produce images of your breasts and is often performed in conjunction with mammography. Women under age 30 might undergo ultrasound instead of mammography because ultrasound can better evaluate dense breast tissue — that is, tissue tightly packed with lobules, ducts and connective tissue (stroma) and less fat. Ultrasound is also particularly helpful in distinguishing between fluid-filled breast cysts and solid masses.
• Breast biopsy. A breast biopsy is a test during which a small sample of breast tissue is collected for microscopic analysis. If your doctor finds a suspicious breast lump, area of thickening or other unusual change during the clinical breast exam, you may be referred to a breast surgeon to discuss whether you should have a breast biopsy. If a suspicious area is seen during an imaging exam, the radiologist performing that exam may also 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.

Treatment options for breast pain include:

• Over-the-counter pain relievers, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others).
• Oral contraceptives, which lower the levels of cycle-related hormones linked to fibrocystic breast changes.
• Danazol, a prescription medication that mimics a male sex hormone, relieves severe breast pain. But significant side effects — which include excess body hair and acne — limit its use.

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 eliminate caffeine, a dietary change many women swear by, although medical studies of caffeine's effect on breast pain and other premenstrual symptoms have been inconclusive.
• Decrease the fat in your diet to less than 20 percent of total calories, which may decrease breast pain or discomfort associated with fibrocystic breasts.

Alternative medicine

Evening primrose oil is a form of linoleic acid that's available as an over-the-counter supplement. Many women use evening primrose oil — taking one capsule up to three times a day — to manage breast pain and other symptoms of fibrocystic breast changes. Although the exact mechanism is unknown, 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.