What are fibrocystic changes in the breast?
Women who have fibrocystic breasts often describe themselves as feeling lumpy all over. Sometimes this diffuse lumpiness can be associated with pain and tenderness that increases or decreases at various times of the month. These changes are usually part of the normal hormonal changes that women experience throughout the month as part of their menstrual cycle.

Lumpiness is normal for some women. It is usually helpful for women to learn breast self examination so they can become familiar with their breast tissue. Most fibrocystic lumps are multiple, soft, and mobile and may come and go with the menstrual cycle. Discrete lumps and thickenings that do not change with your cycle, are new, or are a change in what is normal for you should be evaluated. Most breast findings are not breast cancer, but it is important to determine that it is not cancer. Sometimes we may need to do imaging such as mammography or ultrasound or even a biopsy to determine a change
is benign (not cancer).

Does having fibrocystic breasts increase my risk of breast cancer?
Having fibrocystic breasts does not increase a women’s chance of getting breast cancer. In women whose breast tissue changes and requires multiple biopsies, those women may have a higher risk. Occasionally, when a breast biopsy is done and the result is benign (no cancer), we find cells that indicate “atypia” meaning the cells are not cancer but are changing or growing. We consider this to be a higher risk condition, especially when combined with a family history of breast cancer.

Fibrocystic breasts may appear more dense on mammography and make screening for breast cancer more challenging. A clinical breast exam at the same time as the mammogram is important to make sure a thorough examination is done. Sometimes ultrasound or MRI is required for complete evaluation

Breast changes due to your period
Many women have swelling, tenderness, and pain in their breasts for sometimes 1-2 weeks prior to their menstrual cycle. This can be due to hormonal changes or extra fluid in the breasts from fluid retention. Most of the time, the breast changes such as lumps or thickenings found prior to the menstrual cycle resolve after the menstrual cycle.

How can I learn what is normal for me?
One of the ways a woman can learn what her normal breast tissue is like, is by doing monthly breast self examination. A good time to start is after one of your health care providers has examined you, and told you your exam is normal. Have them review breast self examination techniques with you to give you more confidence or schedule a session with the nurse practitioner at 847-797-9000. She can provide you with one-on-one instruction.

For what types of changes in my breasts should I notify my doctor?
Most breast changes are not breast cancer, but any change in what is normal for you should be evaluated.
Common breast changes may include:
• a lump in your breast or under your arm
• thickness or firm tissue in your breast or under your arm
• nipple discharge or tenderness
• swelling or pain in the breast
• itching or other skin changes such as redness, scaling, dimpling or pulling in or puckering of the breast tissue
• a change in the size or shape of the breast

Lumps
Many times, women develop lumps in the breast that do not go away with the menstrual cycle. About 80% of the time these lumps are benign. These lumps should be checked carefully to make sure a lump is not cancer, either by using breast imaging such as ultrasound or a biopsy to make a tissue diagnosis. The most common benign lumps are cysts and fibroadenomas.

• Cyst- A cyst is a lump filled with fluid. Cysts are most always not cancer. Most cysts occur in women ages 35-50, they can be multiple and are often found in both breasts. Your doctor may look at it with ultrasound to confirm the diagnosis, aspirate the cyst to make it go away, or monitor the cyst over time.

• Fibroadenoma - A fibroadenoma is a growth of normal breast tissue that forms a lump. They are common in young women but can be found at any age. On mammography and ultrasound they usually have smooth borders, with clearly defined edges. But because fibroadenomas are solid lumps like cancer, it is important to make a tissue diagnosis (biopsy) to confirm the diagnosis. Once the diagnosis has been established, your doctor may recommend cyroablation (freezing of the lump), excision (removal of the lump), or follow-up.

Nipple discharge
Nipple discharge is a common finding in many women. Most nipple discharge is benign. Nipple discharge can be spontaneous, coming out of the duct on its own, or may come out only when a woman’s nipple is squeezed. Nipple discharge can be a wide variety of colors, or can sometimes be bloody. Nipple discharge can be evaluated in a variety of ways. Nipple discharge can be a result of fibrocystic changes of the breasts, response to certain medications, infection, inflammation of the ducts, growths in the ducts, or a cancer.

Often times, a simple check to determine if there is blood in the discharge is the first step. This can be done in the office or sending the discharge on a slide to the lab for analysis. Another test that can be used is ductoscopy. This is a procedure that can be done in the office by a breast surgeon who is specially trained in this procedure using a ductoscope - a thin catheter that has a tiny camera that can be inserted and see into the nipple ducts. A ductoscopy helps the breast surgeon determine whether there is an abnormal growth in the duct that may be causing the discharge or cells that are abnormal. If infection or inflammation is identified, antibiotic treatment is sometimes indicated.

Breast pain
Many women experience breast pain. This can sometimes be cyclical occurring 1-2 weeks prior to your menstrual cycle and improving after menstruation. Other women find their breasts tender without relation to their cycle. Most often, breast pain does not indicate that you have breast cancer. But with all new changes you note in your breasts, a good clinical breast examination and some imaging studies such as a mammogram or ultrasound might be needed to assure there is no specific findings that need evaluation first. Once the breast pain has been thoroughly evaluated, there are some recommendations you can try to relieve the pain.

For more information or assistance, please call our office at 847-797-9000.