Breast Cysts

Breast cysts are fluid-filled sacs that form in the fibrous, glandular, fatty tissues of the breast.

They are benign, non-cancerous cysts, but are one of the most common causes of a breast lump and may occur in one or both the breasts.

You may have more than one breast cyst. These are often described as round or oval lumps with distinct borders.

A breast cyst can feel like a grape or a water-filled balloon, but sometimes it feels like a firm nodule.

Breast cysts do not need any treatment unless it is very large, painful, or causes discomfort.

In such conditions, draining the fluid from the breast cyst can relieve your symptoms.

It is believed that breast cysts are a result of natural aging and changes in the breast due to hormonal alterations.

Breast cysts may develop in women at any age, although they are more common before menopause between the ages 35 and 50.

Postmenopausal women who are on hormone replacement therapy can also develop breast cysts.

The signs and symptoms of a breast cyst include:

• A round or oval shaped, easily movable lump with distinct borders suggests a breast cyst
• A clear, yellow, dark brown or straw colored discharge from the nipple
• Breast pain or tenderness
• Increase in the size of the breast lump that becomes tender to the touch just before your period
• After periods, the size of the breast lump reduces with resolution of other symptoms

The presence of breast cysts may pose a difficulty in determining newer breast lumps that would require evaluation by your doctor.

Normal breast tissue is often nodular or lumpy to feel.

If you think that new breast tissue has developed that persists even after a menstrual period, or if there are changes in an existing breast lump, consult your doctor immediately.

The definite cause of breast cysts is not known.

Your breasts consist of several lobes of glandular tissue. These lobes are further divided into smaller lobules that form milk during pregnancy and breast-feeding.

The supporting tissue that gives shape to the breast is composed of fatty tissue and fibrous connective tissue.

Breast cysts usually develop as a result of fluid collection within the glands in the breasts.

Breast cysts may be classified according to their size:

• Microcysts: These are very small to the touch, but may be viewed during imaging tests such as mammography or ultrasound.
• Macrocysts: These are large enough to be felt, and can measure about 1-2 inches (2.5 to 5 centimeters) in diameter. Large breast cysts may exert pressure on the surrounding breast tissues, causing pain or discomfort.

They may develop as a result of hormonal alterations that occur during menstruation.

The excessive estrogen level in your body can stimulate the breast tissues and contribute to development of breast cysts.

Making a diagnosis of breast cysts is done by several tests.

You can initially consult your primary care provider for evaluation of new breast lumps or any abnormalities in your breasts.

Based on the clinical examination and results of imaging test, you may be referred to a breast-health specialist.

The initial evaluation focuses on the details of your medical history.

You can discuss your symptoms, their relation to your menstrual cycle and any other important information.

In order to be prepared for this discussion, make a list that includes:

• All your symptoms, even if they seem unrelated to the reason of your appointment
• Important personal information such as major stresses or recent life changes
• All regular medications, vitamins, herbal remedies, and supplements that you take
• Questions to ask your doctor, starting from the most important to least important in order to be sure you cover the points you're most concerned about

Basic questions to ask your doctor include:

• What is the cause of my symptoms?
• Does having cysts mean an increased risk of breast cancer?
• What type of tests will I undergo?
• Which treatment is likely to be most effective?
• Are there any alternatives to the primary approach that you have suggested?
• Are there any restrictions that I need to follow?
• Are there any printed brochures or websites that I can go to for more information?

Your doctor may ask certain questions to know more about your condition, such as:

• When did you discover the breast cyst or lump?
• Is there any change in the size of the breast cyst or lump from then?
• What kind of symptoms have you experienced, and for how long do you have them?
• Have the symptoms changed with time?
• Do you have pain in your breasts? If so, is it very severe?
• Is there any discharge from the nipple? If so, is it seen in one or both the breasts?
• Has there been any change in the breast cyst during your menstrual periods?
• When was your last mammogram done?
• Has anybody in your family suffered from breast cysts or lumps?
• Have you ever had a breast cyst or lump, a breast biopsy or breast cancer in the past?

Once your doctor identifies a breast lump, further screening and diagnosis will be required.

Your doctor may order a diagnostic mammogram and/or a breast ultrasound.

Depending on the results of these imaging tests and the physical examination by your doctor, a fine-needle aspiration or breast biopsy may be ordered.

• Breast ultrasound: A breast ultrasound determines whether a breast lump is fluid-filled or a solid mass. A fluid-filled area indicates a breast cyst, whereas a solid-appearing mass is most likely to be a noncancerous lesion such as a fibroadenoma, but solid lumps can also be breast cancer. Your doctor may advise a biopsy for further evaluation of a mass that appears solid.
• Fine-needle aspiration: During a fine-needle aspiration, your doctor will insert a fine needle directly into the breast lump and withdraw fluid from it. Usually, fine-needle aspiration is done under an ultrasound guidance for precise placement of the needle. If the breast lump disappears as the fluid is withdrawn, it is most likely a breast cyst. If the aspirate is not bloody, then further evaluation will not be needed. In conditions where there is a bloody aspirate and the breast lump remains after fine-needle aspiration, your doctor will send the fluid sample for laboratory testing and refer you to a breast surgeon for further treatment. In some cases, there may be no aspirate withdrawn from the lump. Your doctor will advise an imaging test such as a diagnostic mammogram or ultrasound. The absence of fluid or a breast lump that does not disappear following aspiration may indicate a cancerous mass.

Simple breast cysts that are fluid-filled and not symptomatic do not require any medical treatment.

But if the lump is persistent or undergoes changes over time, please consult your doctor.

• Fine-needle aspiration: A Fine-needle aspiration can both diagnose and treat a breast cyst. If your doctor aspirates all the fluid from the cyst at the time of diagnosis, your breast lump disappears completely and your symptoms get resolved. Sometimes, you may need to have the fluid aspirated more than once. Recurrent formation of new cysts is a common concern.
• Hormonal therapy: Use of birth control pills (oral contraceptives) to regulate your menstrual cycles may control the recurrence of breast cysts. It is usually indicated in women with severe symptoms only, taking into account the possible significant side effects.
• Surgery: Surgery for the removal of a breast cyst is suggested only in circumstances such as an uncomfortable breast cyst that recurs every month or if a breast cyst is filled with blood-tinged fluid.

Consult with your physician before starting any alternative and homeopathic remedies for breast cysts.

Evening primrose oil is a fatty acid (linoleic acid) supplement that is available over-the-counter.

A few studies have suggested that evening primrose oil is helpful in relieving breast tenderness during menstrual periods, which may sometimes be associated with breast cysts.

Further research is necessary as these studies have been uncontrolled and the evidence is inconclusive.

Some experts believe that women with a linoleic acid deficiency are more susceptible to fluctuations in hormonal levels during their menstrual cycle, resulting in breast pain.

Lifestyle modifications are necessary in order to cope with breast cysts.

To manage the discomfort associated with breast cysts, you may follow certain self-care measures such as:

• Wear a well-fitting, supportive bra: Well supported breasts may help relieve some discomfort.
• Apply a warm/cool compress: If the cysts are painful, application of either a warm or cool compress can provide some relief. Application of an ice pack may also reduce your pain.
• Avoid caffeine: Consider avoiding caffeinated beverages if you feel your symptoms improve as some women find it beneficial. However, there is no evidence that proves the link between caffeine and breast cysts.
• Reduce your dietary salt intake: Some experts suggest that the restriction of salt in your diet may help, although studies on reduced salt intake and cyst formation have been inconclusive. Less sodium decreases the fluid retention in your body and that helps in relieving the symptoms of a fluid-filled breast cyst.
• Take over-the-counter pain medications if your doctor recommends them: Some types of breast pain may be relieved by the use of acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin IB) or naproxen (Aleve, Naprosyn).