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Breast cysts are cavities filled with fluid. Typically, they do not indicate that you have cancer (benign). Cysts occur when a liquid accumulates within a previously empty milk gland. Although some cysts may be too small to detect, others can grow to several inches in diameter, causing significant discomfort. It’s possible that you may have one or multiple cysts in your breast. These cysts can have varying textures – sometimes feeling hard, and other times feeling more like a grape or a water-filled balloon. Unless a breast cyst is huge, painful, or uncomfortable, treatment is not necessary. In that situation, a breast cyst’s fluid can be drained to reduce symptoms.
Breast cysts can occur in women of any age, but they are more prevalent in women under the age of 50, typically before menopause. However, they can still be found in women of any age. Women who have undergone menopause and are receiving hormone therapy are also prone to developing breast cysts.
Symptoms
One or both breasts may have breast cysts. Signs and symptoms of breast cysts that require attention include:
- A clear, golden, straw-colored, or dark brown nipple discharge
- An easy-to-move, round or oval lump that is smooth and may have smooth edges; this often, but not always, implies that the lump is benign.
- After your period, a smaller breast lump and a remission of other symptoms
- Tenderness or soreness in the breast near the lump there
- Breast discomfort and lump size increasing right before your period
Breast cysts do not increase the risk of developing breast cancer, but they can hinder the detection of new breast lumps or changes that may require medical attention. It’s crucial to be aware of how your breasts feel throughout your menstrual cycle so that you can notice any changes. When you’re menstruating, your breasts may feel lumpy and uncomfortable.
Lumpy or nodular sensations are common in normal breast tissue. However, if you notice a new lump in your breast that does not disappear, grows in size, or persists for more than one or two menstrual cycles, it is crucial to seek medical attention promptly. Similarly, if you observe any new alterations in the skin texture of one or both breasts, you should consult your doctor as soon as possible.
Causes
The human breasts contain lobes of glandular tissue that are arranged like the petals of a daisy. These lobes are further divided into smaller lobules that are responsible for producing milk during pregnancy and breast-feeding. The shape of the breast is maintained by fatty tissue and fibrous connective tissue. Cysts can develop due to the accumulation of fluid inside the breast glands.
The size of breast cysts can be determined:
- Microcysts are too small to feel, but may be noticed during imaging tests like mammography or ultrasound.
- Macrocysts can reach a diameter of 1 to 2 inches (2.5 to 5 centimeters), which is large enough to be felt.
The exact cause of breast cysts is uncertain, but hormonal changes related to monthly menstruation may be a contributing factor.
Diagnosis
When diagnosing a breast cyst, the typical process involves a thorough breast examination, along with the use of imaging tests such as a mammogram or breast ultrasound. Additional procedures that may be recommended include fine-needle aspiration or a breast biopsy.
- Breast exam: Your doctor will conduct a physical examination of the breast lump and examine for any other breast abnormalities after discussing your symptoms and medical history. However, clinical breast exams alone are not sufficient to determine if a breast lump is a cyst, so additional testing will be necessary. Typically, this involves an imaging test or fine-needle aspiration.
- Imaging tests: These tests may be performed:
- Mammography. A mammogram is a medical test that uses X-rays to produce images of the breasts. During the procedure, the breasts are gently pressed between two flat surfaces in order to spread out the breast tissue. The X-ray machine then takes pictures of the breasts, which are displayed on a computer screen for doctors to examine. This helps them to identify any abnormal masses or growths in the breast tissue. While larger cysts and groups of small cysts can often be seen on a mammogram, very small cysts may be more difficult to detect using this method.
- Breast ultrasound. Your doctor may use a test to differentiate between a fluid-filled or solid breast lump. A fluid-filled lump could indicate a breast cyst, while a solid mass may be a noncancerous lump like a fibroadenoma, or it could be breast cancer.
- Fine-needle aspiration: Your doctor may perform a procedure called fine-needle aspiration to diagnose a breast lump. This involves inserting a thin needle into the lump and attempting to remove any fluid present. To ensure accurate placement of the needle, the procedure may be guided by ultrasound. If fluid is successfully withdrawn and the lump disappears, your doctor can diagnose the condition as a breast cyst right away.
- If the fluid that is withdrawn from the breast is not bloody and has a straw-colored appearance and the breast lump disappears, then there is no need for any further testing or treatment.
- If the fluid appears bloody or the breast lump does not disappear, then the doctor may send a sample of the fluid for laboratory testing and refer the patient to a breast surgeon or a radiologist for follow-up.
- If no fluid is withdrawn from the breast, the doctor is likely to recommend an imaging test, such as a diagnostic mammogram or ultrasound. This is because the absence of fluid or the persistence of the breast lump after aspiration suggests that the lump is solid, or at least partially solid. In this case, a sample of the tissue may be collected to determine if there is cancer present.
Treatment
If a breast cyst is confirmed on ultrasound or fine-needle aspiration and is fluid-filled without causing any symptoms, then no treatment is required. In such cases, many cysts tend to resolve on their own. However, if the cyst persists and becomes firmer or if there are any changes observed in the skin overlying the cyst, it is recommended to seek medical attention and follow up with a doctor.
- Fine-needle aspiration: Fine-needle aspiration can be utilized for both diagnostic and therapeutic purposes for breast cysts, provided that the cyst is completely drained during the procedure, leading to the disappearance of the lump and resolution of symptoms.
Nevertheless, some breast cysts may require multiple aspirations to drain the fluid. It is not uncommon for cysts to recur or for new ones to form. If a breast cyst persists and increases in size after two to three menstrual cycles, it is advisable to seek further medical evaluation from your doctor.
- Hormone use: Taking oral contraceptives, also known as birth control pills, can be beneficial for women who suffer from recurring breast cysts by regulating their menstrual cycles. However, it is important to note that birth control pills and other hormone therapies like tamoxifen can cause significant side effects. As a result, medical professionals typically recommend hormone therapy for women who have severe symptoms. Post-menopausal women who stop hormone therapy may also be able to prevent breast cysts from developing.
- Surgery: Typically, a breast cyst can be managed without the need for surgery. However, in exceptional cases where the cyst repeatedly reappears every month causing discomfort or if there are concerning signs such as blood in the cyst fluid, surgery may be indicated.
