Breast cysts

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 If fluid is successfully withdrawn and the lump disappears, your doctor can diagnose the condition as a breast cyst right away.
  • If the fluid that is withdrawn from the breast is not bloody and has a straw-colored appearance and the breast lump disappears, then there is no need for any further testing or treatment.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  • If no fluid is withdrawn from the breast, the doctor is likely to recommend an imaging test, such as a diagnostic mammogram or ultrasound.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.