Fibrocystic breasts are breasts with palpable lumps or cysts that fluctuate in size with the menstrual cycle. The condition is seen more frequently in women ages 30 to 55 and rarely after menopause. Fibrocystic breast tissue exhibits fluid-filled round or oval cysts, fibrosis, and hyperplasia of the cells lining the milk ducts or lobules of the breast. Fibrocystic breasts are fairly common; more than half of women experience fibrocystic breast changes at some point in their lives. Medical professionals stopped using the term fibrocystic breast disease because fibrocystic breasts are not considered a disease.
FIGURE. Fibrocystic breast illustrating fibroadenoma.
The causes of fibrocystic breasts are not well understood, but they are linked to the hormonal changes associated with ovarian activity. There is a tendency for fibrocystic breasts to run in families.
Signs and Symptoms
There may be widespread lumpiness or a localized mass, usually in the upper, outer quadrant of the breast. Pain, tenderness, and feeling of fullness are likely before menstruation. There can be fluctuating size of breast lumps, nonbloody nipple discharge (rare), and changes in both breasts.
Monthly breast self-examinations cannot be overemphasized. Palpation is essential. A mammogram is especially useful if there is any suspicious change in the breast. Ultrasound is particularly helpful in distinguishing between fluid-filled breast cysts and any solid masses. When a suspicious area is discovered through these tests, a biopsy is essential to confirm the diagnosis. The clinical picture of pain, fluctuation in size, and lumpiness helps to differentiate fibrocystic breasts from breast cancer.
No treatment is usually warranted; however, severe pain or large cysts may need treatment. Treatment is usually fine-needle aspiration to draw the fluid from the cyst or, on rare occasions, surgical excision. Acetaminophen or ibuprofen can reduce pain; oral contraceptives to lower the hormone levels linked to fibrocystic breasts may be prescribed. Breast pain also may be lessened with a good supportive bra. Caffeine intake may be restricted, salt intake reduced, and a low-fat diet advised because some studies indicate that these steps may reduce symptoms.
Many women take one capsule of evening primrose oil up to three times a day to manage symptoms of fibrocystic breasts. It is believed that evening primrose oil may replace linoleic acid in women who are deficient in this essential fatty acid that can help to make breast tissue less sensitive to hormonal influences. Removing all forms of caffeine from the diet is suggested.
Teach clients how to perform breast self-examinations. Fibrocystic breasts often feel lumpy, and clients can best assess whether the lumps they feel are normal or abnormal.
The prognosis is good, although exacerbations may continue until menopause, after which they subside. Fibrocystic breasts can make breast examination and mammography more difficult to interpret, possibly causing a few early cancerous lesions to be overlooked.
There is no known prevention. Monthly selfexamination of the breasts and regular mammography are advised. Reducing caffeine and fat in the diet are other helpful measures.