
Breast Cysts
Breast cysts are fluid-filled, usually noncancerous sacs inside the breast. There may be one or multiple breast cysts in one or both breasts. Breast cysts usually generate from milk glands, and are most common in women between the ages of 35-50. Cysts are felt as fluid-filled tiny sacs during monthly breast examination. Most breast cysts do not require treatment unless a cyst causes discomfort. Cysts should be periodically checked.
Symptoms of breast cyst
A well marginated, mobile, round or oval shaped mass that is easily felt with hand, colorless, yellow, green or dark brown nipple discharge, pain or tenderness in cystic area which is more prominent immediately prior to menstrual period, shrinkage in size of cysts and relief of tenderness in breast after the period ends.
Breast cysts are classified in two groups by their size as micro cysts (less than 2,5 cm) and macro cysts (2,5-5 cm).
Diagnosis and treatment of breast cysts
Ultrasound scan provides guidance in diagnosis after breast examination. As for the macro cysts, fine needle aspiration under ultrasound is performed for pathological analysis of cystic content. Fine needle aspiration also allows drainage of cyst, therefore it is curative and a sufficient treatment method for most breast cysts. The patient is then followed on periodical basis against new cyst formations. Other treatment courses are used rarely. Those are namely hormonal treatment and surgical approach in rare cases.
Fibrocystic Breast Disease
Fibrocystic breast disease is the most common benign breast disease. They are found in nearly 70% of the women. Although it may develop at any age, it is more common in women aged between 30-50. Fibrocystic breast disease is less among women taking oral contraceptives and in post-menopause course.
Swelling, pain, tenderness and a lump identifiable by hand are the most common signs. Periodic breast pain occurs due to monthly changes in estrogen and progesterone hormone levels during menstruation period. Major factors for fibrocystic breast changes are genetic susceptibility and dietary habits such as fat-rich food and excessive coffee consumption. Physical exam is performed on fibrocystic breasts, and analyzed using imaging methods such as mammography, ultrasonography and magnetic resonance imaging (MRI). Mammography often reveal blurry images of fibrocystic breast changes. Thus, ultrasound scan must be always added for sharper view and diagnosis of a possible cancer. Biopsy may be performed in risky cases.
Is there a link between fibrocystic breast and cancer?
Fibrocystic breast is the most common benign breast lesion among women. There is no direct link between fibrocystic breast and cancer; however, cancer risk is higher for breasts with dense structure than those having normal structure. Women having fibrocystic breast structure should go through periodic examination for timely diagnosis and treatment of breast cancer.
Risks
Cysts are fluid-filled, round thin sacs. They might be simple, complicated and complex cysts. Common simple cysts may conceal presence of underlying lesions. Therefore, they should be examined periodically using radiological imaging methods.
Cancer development risk for complicated cysts is found to be 2% whereas it is found to be as high as 25% for complex cysts. Hence, complex cysts require biopsy.
When to aspirate a cyst
Most of the time, simple cysts do not require a surgical procedure. If the cysts cause pain and undesired aesthetic appearance, they can be drained using a syringe. Repeated cysts can be removed surgically.
Lesions Developing in Fibrocystic Breast
Lesions in typical fibrocystic breasts are not dangerous in common. However, presence of certain changes and cellular proliferation may indicate breast cancer risk. Early diagnosis of such suspicious lesions via radiological methods and surgical removal save lives.
Pain in Fibrocystic Breast
Breast pain is a common complaint particularly among women with fibrocystic breast. Only less than 10% of the women experiencing breast pain are diagnosed with cancer.
Breast pain may appear in one or both breasts, in wide or limited area, and as pre-menstrual or irregular character. If that is the case, a physical examination is performed by a surgeon, followed by suitable imaging methods to identify any cancerous formation.
Surgery for Fibrocystic Breast
There is no surgical intervention which has been defined for complete removal of all cysts from the breast. Patients are monitored using suitable imaging methods and breast examination on certain intervals. Surgical intervention may be required in following cases: Severe discomfort such as pain, tenderness, aesthetic flaws; suspicious lesions inside the cyst or on cyst walls; discharge from nipple linked to milk gland pathology; identification of suspicious lesions during monitoring.
Monitoring of Fibrocystic Breast
Ultrasound scan is recommended on 6-month intervals for patients with fibrocystic breasts for early diagnosis and treatment of breast cancer. Annual mammography is also performed for patients over the age of 40. Monitoring intervals may vary if there is already a suspicious lesion in the breast or history of breast cancer in the family. Magnetic resonance imaging can additionally be recommended.
Fibroadenoma
It is the most common benign breast tumor. Often found in women between 15 and 35 years of age but it may also develop in elders. They are round, well-shaped, mobile, painless and firm lumps. Pain may be present in rare cases. It may develop in both breasts.
Fibroadenomas develop under the influence of reproduction hormones. It is common in women who consume fat-rich diets and excessive amount of coffee.
Fibroadenomas rarely develop into cancer. They can be clearly diagnosed by ultrasound scan, and a histopathological analysis is performed using core needle biopsy if any enlargement is observed during routine monitoring. When fibroadenomas grow as large as 2,5-3 cm in size, surgical removal is recommended.
Ductal Ectasia
Ductal ectasia is the case where one or more milk ducts under nipple is widened and clogged with fluid. It is generally found in women between 45 to 55 years of age. Although the underlying reasons are unknown, it is believed to occur due to changes in breast tissue, caused by ageing and smoking.
Ductal ectasia may show no symptom at all or a hard lump can be felt under nipple, a light-colored discharge, tenderness or infection can be observed. It may disappear without any treatment. In some cases, antibiotic prescription or warm towel compressions can be required. In case of continued discomfort, diseased milk ducts can be surgically removed through circum-areolar incision.
Fat Necrosis
Fat necrosis is a benign breast tumor with symptoms and findings frequently similar to those of breast cancer. Bruise around the mass, tenderness and retractions may occur on breast skin or nipple. They are formed due to traumas (physical impact) on breast tissue or infections. Biopsy is performed to rule out breast cancer.
Hamartoma
Hamartoma is a benign breast tumor occurring due to excessive growth of adult breast tissue. Average age of occurrence is 45. Rarely found in younger women.
Symptoms are round, well-defined hard or soft lumps that can be felt by hand. They are surgically removed if they cause severe discomfort.
Intraductal Papilloma (IDP)
They are the small and benign tumors developing in milk ducts which are formed of glandular fibrous tissue and blood vessels. Mostly found in middle-aged women. Often occurs between the ages of 35-55.
Light colored or bloody discharge from the nipple and small lumps may indicate intraductal papilloma. They are diagnosed by performing physical examination, mammography and ultrasound scan. Papilloma and the affected section of the milk duct is removed surgically for treatment. Cancer risks are identified via biopsy, and if there are findings of cancer, appropriate treatment procedures are performed.
Wen (Lipoma)
These are benign, slow-growing fatty tumors under the skin. These lumps may develop in any body region containing fat. Lipomas generally occur between the ages of 40-60.
Genetic factors play role in the etiology. Only treatment is surgical intervention. They rarely develop into cancerous tumors.
Breast Infections
Infections such as mastitis, cellulite or abscess are often found in breast. Sometimes they may be confused with skin diseases and cancers. They are usually found in women between 18-50 years of age. They mostly occur after delivery, during or after breastfeeding.
These infections are classified in two groups, namely; lactational and non-lactational. Clogged milk ducts, cracked nipples, smoking, stress, wrong breastfeeding techniques, malnutrition, tight clothes compressing on breasts, etc. are main causes of breast infections.
Symptoms are pain, rash, tenderness, firmness, discharge from nipple, high fever, tremor and fatigue. There are painful, tender lumps than can be felt my physical exam. Untreated breast infections may form abscess. While antibiotic treatment solves mastitis, abscess requires immediate surgical drainage.
Nipple Discharge
If the nipple discharge occurs naturally without squeezing nipples, underlying reasons must be checked. Appearance, color of discharge as well as presence of blood is evaluated. Nipple discharge mostly results from widening of milk ducts or infections, hormones, various medication, cancerous and non-cancerous lesions of breast.
Discharge from single breast, single duct discharge, clear or bloody discharge indicates presence of a lesion in the duct. Nipple discharges must be evaluated by a breast surgeon, and must be examined using appropriate imaging techniques.