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Breast cysts

Breast cysts are fluid filled pockets/sacs that form in the tissues of the breast – these sacs form when normal milk glands in the breast get bigger. Breast cysts grow inside the breasts. You can have one or many breast cysts at a time. They usually feel like a fluid filled balloon with distinct edges. Breast cysts are common in all women, but in particular women from 30 to 40 (most reproductive period). They usually disappear after menopause unless a woman is on hormone replacement.

Actually breast cysts are just a collection of fluid in the breast. Fluid is being produced and reabsorbed constantly in the milk ducts in the breast. When a duct becomes blocked, or the amount of fluid produced is greater than the amount absorbed, fluid accumulates causing breast cysts. In general breast cysts can be single or multiple. They can come and go, and vary during the menstrual cycle. When breast cysts become large, they can cause a lump. Classically the lump is smooth, soft, and moves easily. If the fluid is under tension, it can feel firm when examined. Breast cysts are often tender. Even if there is no distinct lump to feel, the breast tissue containing a cyst or cysts is very tender.

Breast cysts range in size from smaller than a pea to larger than a ping pong ball. Although larger breast cysts can sometimes be felt as “lumps,” many cysts cannot be felt by physical examination. Cysts that cannot be felt could be found during mammography or ultrasound observations.

BREAST CYSTS facts

Breast cysts

Breast cysts

  • Breast cysts move easily to the touch and are hard and round. They are not attached to the breast tissue around them.
  • Most Breast Cysts are benign.
  • Self breast examination is an effective way to discover Breast Cysts.
  • Breast cysts are known to recur in some of the cases. Some women get breast cysts several times during their life, usually between the ages of 25 and 45.
  • Breast Cysts become tender just before a menstrual period.
  • Breast Cysts constitute nearly 15% of all discrete breast masses.
  • Nearly 7% of women develop Breast Cysts.

BREAST CYSTS symptoms

Most common breast cysts’ symptoms include:

  • Smooth, easily movable round or oval breast lump which is well circumscribed.
  • Breast pain or tenderness in the area of the breast lump. This can be acute.
  • Increase in breast tenderness just before the period.
  • Decrease in breast lump size and tenderness after period.

BREAST CYSTS causes

Each of female breasts contains lobes of glandular tissue, arranged like the petals of a daisy. The lobes produce milk during pregnancy and breast-feeding. Small ducts conduct the milk to a reservoir just beneath the nipple. Breast cysts usually develop when an overgrowth of glands and connective tissue block ducts, causing them to dilate and fill with fluid.

Breast cysts are formed when milk-producing glands are enlarged. Breast Cysts usually appear in the upper half of the breast and are noticed in women over the age of 30-35. Presence of cysts is also seen in women who are on hormone replacement therapy (HRT). Most instances of cysts are noticed in pre-menopausal women. Breast Cysts vary in size and can change in size depending on the menstrual cycle.

Imbalance between normal production and absorption of fluid is seen as a cause for cysts. They are seen to increase in size prior to the menstrual period and may feel tender. Breast cysts can appear by themselves or in groups scattered throughout the breast. The glands and ducts of the breast secrete fluid even when not in a lactating phase. It is when the ducts are plugged with skin cells that fluid buildup takes place.

BREAST CYSTS diagnosis

  • Breast Exam
    Breast cysts screening and diagnosis usually begins with breast exam (made by your doctor or by yourself).
  • Mammography
    During mammography breast cysts can sometimes be seen as a smooth, round mass in the breast tissue. When a mammogram shows a possible cyst, a breast ultrasound is usually done.
  • Breast Ultrasound
    Ultrasound analysis can help determine whether a lump is fluid-filled or solid; it also shows whether a cyst is a “simple cyst” or “complex cyst.” A fluid-filled area usually indicates breast cysts. Breast ultrasound is the best way to identify and diagnose breast cysts because it is 95-100% accurate.
    Based on what the doctor can see on the ultrasound, the decision about future biopsy and/or breast cysts aspiration will be made.
  • Aspiration
    Breast cysts are diagnosed definitively when a needle is inserted into it and the doctor is able to draw out the fluid. This is ideal for women with cysts, because the procedure both diagnoses and removes the cyst at the same time. A cyst should completely disappear when drained and the tension of it is relieved.
    If the fluid removed is not bloody, it does not have to be sent to a lab for analysis, unless the woman is post-menopausal and not on hormone replacement. The woman needs to come in for a follow-up in 4-6 weeks. If she is normal at the re-check, then she may resume routine breast screening. If the cyst reforms, then she will be sent to a specialist who will check her out for a type of breast cancer called intra-cystic carcinoma. A biopsy of the tissue around the cyst will be done.
    If the fluid removed is bloody, it will be sent to a lab for analysis and the women will be referred to a specialist immediately. Again, this is to check for the possibility of intra-cystic carcinoma. A biopsy will be performed to determine what the breast mass is made of.
  • Biopsy
    If there is any indication of growth of the breast cysts mass at the follow-up or if the woman misses parts of the follow-up of the mass, then a biopsy will be done.

BREAST CYSTS treatment

Cysts causing no symptoms and showing typical benign (noncancerous) features on imaging require no treatment. Most cysts fit into this category. Sometimes lesions are seen on imaging that may be cysts (fluid) but could also be solid, and these require further testing with drainage of the cyst (aspiration). This involves inserting a needle into the cyst, often under the guidance of ultrasound, to remove fluid from the cyst. If the cyst has watery fluid in it, it may disappear with aspiration. If it has a thick pasty or gel-like fluid in it, the cyst may not drain completely – but this is not a reason for concern. Cysts that are tender are often aspirated to reduce discomfort. Sometimes a sample of the aspirated fluid is sent for testing by a pathologist to confirm that it is a cyst.

Occasionally surgery is recommended to remove a cyst. This is very uncommon, and is usually reserved for cysts that keep coming back after repeated drainage, or cysts that show worrying features on imaging or pathology tests.

The possibility of intra-cystic carcinoma should be checked. The biopsy might also be done on the breast mass. While benign cysts are round or oval, malignant ones are irregularly shaped and display micro-nodular groups of fluid collection.

BREAST CYSTS and cancer

Almost all breast cysts identified as “simple cysts” by ultrasound are benign and never become cancerous. There is a rare condition called ‘intra-cystic cancer’ that can develop inside a cyst, but these cysts usually look unusual on ultrasound and behave differently when aspirated. It is estimated that one in 1,000 cysts contains a tumor (but they are usually benign). These tumors can be identified by ultrasound in most cases. Women with breast cysts are not at greater risk for cancer although this risk may be slightly higher if there is a family history of breast cancer (mother, sister, or daughter).


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