Breast Cyst

Cystic masses are characterized by hidden symptoms. They are often detected during preventive screening in women aged 30-50. If a breast cyst has been detected, the issue of specific treatment planning arises. In most cases, only monitoring is needed, but the condition should not be ignored completely, as there is always a risk that it may turn into cancer.

Definition of the disorder and mechanisms of its development

A breast cyst is a benign mass presenting a cavity filled with fluid. It is elastic and has even edges. Often it is a form of mastopathy.

The possible reasons to visit a breast care specialist are such complaints as breast swelling, nipple discharge, irregular cycle. But, according to statistics, in most cases, the disease proceeds without any symptoms.

The causes of the neoplasm development are different. Most often they occur together with mastopathy, presenting one of its manifestations. In this case, multiple fluid-filled sacs form in the breast tissue. As a rule, they are small in size, but their volume can vary depending on the menstrual cycle.

Other causes are also possible, including:

• plugged milk ducts, when the milk does not flow properly and accumulates in the ducts;
• breast trauma, chronic inflammation of the glandular tissue;
• fatty tissue damage, for example, during surgery;
• genetic predisposition.

Breast cyst signs

In most cases, the disease does not show any signs. A small-sized cyst is not palpable and does not cause complaints.

Sometimes one can feel it when palpating the breast. As a rule, it is a painless oval lump, not adhering to the surrounding tissues.

If the size of the mass continues to increase, it begins to squeeze the surrounding tissues. This is accompanied by constant dull pains. It is noteworthy that the clinical symptoms of the disease can increase with hormone imbalance. In this case, the complaints are especially severe in the middle of the menstrual cycle and decrease with the beginning of menstruation. At the same time, the premenstrual syndrome may intensify. Women become weepy, touchy or irritable. There are headaches and weakness. Swelling and palpitations can also occur.

Nipple discharge is observed only in every twentieth case. As a rule, it is small in amount, containing colostrum, serum or blood. This symptom may be an indication that the patient has a papillary mass. It has a high risk of becoming malignant.

Classification and stages of development

Depending on the size, there are the following cyst types:

• Microcysts are small size lumps not distinguished at palpation, causing no pain. They are detected by imaging tests.
• Macrocysts are large masses 2.5-5 cm in diameter, easily felt at palpation. They can compress soft tissues, nerves and vessels, leading to specific symptoms.

If a cyst is detected in the right breast, it is not for sure that the left one is also affected. More often, the lumps are asymmetrical and there are 1-2 of them. Microcysts often occur bilaterally.

Breast cysts can be:

• Simple – with smooth walls, mobile, showing no signs of inflammation.
• Complex – with septa, outgrowths and other changes.

What complications can a breast cyst can lead to?

The appearance of a lump can cause anxiety in a woman. Often patients complain of phobias, panic attacks, depressive disorders.

If there are large cysts, the breasts may look asymmetrical. This causes patients to develop complexes.

Especially dangerous is the fact that fluid accumulion in the cyst can be a favorable environment for bacteria growth. This results in an inflammatory process and even in suppuration. The condition requires surgical intervention and removal of the mass.

Diagnosis

If you suspect a cyst, you should see a breast care provider. After examining and assessing the tissue condition, the doctor will recommend further examination.

Ultrasound examination

It is the most common, informative and safe method of examination. It allows to detect both normal and abnormal changes. With the help of high-frequency sound waves, an image of the breast is created, making it possible for the doctor to detect various phenomena, including tumors and cysts. Since the latter are filled with fluid, they appear dark on an ultrasound scan, and therefore are seen very clearly. Doctors can determine their location and measure the size.

Mammography

X-rays of the breast (mammography) can provide additional information. It can detect other changes in the breast, such as calcifications, signs of malignancy or its precursors. Mammography is not routine, but is including in screening programs starting at a certain age, or when cancer risk factors are present.

Fine-needle aspiration

If primary diagnosis detect cysts, a biopsy may be done to examine their contents. For this purpose, an ultrasound-guided puncture of the lump is performed and the samples are taken for analysis. The procedure allows to distinguish a simple cyst from carcinoma (malignant tumor) in time.

What you should tell during your appointment with a breast care/cancer specialist?

When you see your doctor, it is particularly important to give as much detail as possible about the disease and the possible causes of the cyst. The following information is of major importance:

• When the lump appeared.
• Whether the symptoms vary with the menstrual cycle.
• Whether there has been any trauma preceding the appearance of the mass.
• Whether there are any breast diseases in close relatives.
• Whether there are any hormonal disorders.
• Which medicines you are taking currently.

To make a diagnosis, the doctor evaluates the information obtained. Only after that, treatment of breast cysts can be planned.

Breast cyst therapy

In most cases breast cysts do not need treatment. It is sufficient to see visit your doctor regularly to monitor the dynamics.

If a large mass is detected, its size can be reduced by needle aspiration. In this case, an ultrasound-guided puncture is performed and the contents of the cyst are removed. This will relieve the pressure on the surrounding tissues. The fluid is subsequently sent for histological examination.

It is important to have a follow-up examination 6-8 weeks after the procedure. If there is no further growth, it is considered benign.

Prognosis and prevention

There is no effective prevention of cyst formation. The only preventive measure is self-monitoring of the breast. Inspections should be carried out monthly on the same day of the cycle. In case of suspicious findings, you should immediately contact a breast care specialist.

The prognosis is favorable. On the whole, the presence of these benign formations does not pose a threat to health and does not bring much trouble, so when they are detected, a wait-and-watch approach is usually chosen. The most important thing is to be sure that the nature of the formation is determined correctly, that is, it is really a generally harmless fluid-filled cavity and not a tumor.

Second opinion

The frequency and relative safety of cystic breast masses do not mean that, having learned about this diagnosis, you can relax. First, it is worth while making sure that it is true. If the node is very small, distinguishing a fluid-containing formation from a solid one is not always easy, whereas the difference is fundamental. Therefore, it is quite a reasonable practice to get a review of your imaging data.

Second, a proper disease monitoring plan is very important in this condition. Which tests are more informative in each specific case, and when they should be performed, depends on individual parameters - age, gland tissue density, hormone levels. The goal is not to overlook changes in the cyst itself or nearby tissues, which can lead to a more serious disorder. Therefore, if your doctor does not provide a detailed plan for some reason, or does not explain the essence and purpose of diagnostic procedures, you can seek a second opinion from another specialist.

When it comes to surgical treatment of a cyst, an independent evaluation by an experienced breast care provider is a way to make certain that this option is indeed unavoidable and the optimal one.

And one more (by no means the least important) argument: it always makes sense to have as much understanding of your disease as possible, including the way it can develop, its treatment options and prognosis. A primary care physician does not always have the time or ability to provide such details. However, you can get them from world-class experts using the breast care second opinion service.

References:

1. Breast Cyst Fluid Analysis Correlations with Speed of Sound Using Transmission Ultrasound
2. Breast cyst aspiration. Can Fam Physician. 2012
3. Breast Cyst. 2021.
4. Human gross cyst breast disease and cystic fluid. 2006.