Fibrocystic breast changes are very common benign changes in breast tissue, with fibrosis and fluid-filled cysts that respond to monthly hormone shifts. They mostly affect women aged 20 to 50 and are not a disease, but they must be told apart from cancer.
Key symptoms
- Breast pain or tenderness before periods
- Lumpy, rope-like tissue in both breasts
- Lumps that change size during the cycle
- Sometimes clear or greenish nipple discharge
What you find on exam
- Diffuse nodularity, often in the upper outer quadrants
- Tender, mobile, smooth cysts
- Exam best done just after the period
- No skin changes or fixed mass
Tests
- Ultrasound for a distinct lump: simple cyst or solid mass
- Mammogram at age 30 or older
- Fine-needle aspiration of a painful cyst; bloody fluid goes to cytology
- Biopsy of any solid or suspicious mass
Treatment basics
- Reassurance and a well-fitted supportive bra
- Acetaminophen or NSAIDs such as ibuprofen, or topical diclofenac
- Aspiration of large painful cysts
- Recheck after the next period if a lump persists
Red flags
- Lump that stays after the period or keeps growing
- Bloody nipple discharge from a single duct
- Skin dimpling, nipple retraction or hard, fixed lymph nodes
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.