An Overview of Fibrocystic Breast Changes

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About half of women develop them fibrocystic breast changes at some point in their lives. While fibrocystic breast tissue can be painful and feature lumpy or rope-like textures, which may cause concern, these changes are completely healthy. The benign condition is neither a symptom of nor a risk factor for breast cancer.

This used to be referred to as "fibrocystic breast disease," but doctors are now more likely to call it simply "fibrocystic breasts" or "fibrocystic breast changes," as the condition is not something that is harmful.

Symptoms

The primary symptom of fibrocystic breast tissue is its lumpy, rope-like texture. If you were to look at fibrocystic tissue under a microscope, you would likely see several components that contribute to this, including:

  • Round or oval-shape cysts filled with fluid
  • Fibrous tissue that resembles scar tissue (fibrosis)
  • Hyperplasia (overgrowth) of cells lining the milk ducts and milk-producing lobules of the breast
  • Enlarged breast lobules (adenosis) 

Typically, lumps aren't attached to surrounding tissue but will move slightly when manipulated. 

Many women with fibrocystic breasts have no symptoms beyond that. However, those who experience some often find them unpleasant. The most common symptoms of fibrocystic breasts are:

  • Swelling
  • Tenderness
  • Generalized pain

Some women with fibrocystic breasts also experience a greenish or dark brown nipple discharge that's free of blood and may leak without pressure or squeezing. There also can be pain in the armpit.

Frequently, fibrocystic breast symptoms worsen just before a woman's menstrual period and lessen near the end of her cycle. The actual size of individual lumps may fluctuate with the menstrual cycle as well.

While it should be reassuring to know that not all changes to your breast are worrisome, if you notice thickened areas or changes in texture, it's still a good idea to see your doctor to make sure that they are indeed due to fibrocystic breast changes, as you suspect.

Bloody nipple discharge can be a sign of breast cancer; see a doctor immediately if you encounter this symptom.

Causes

What spurs breast tissue to develop the lumpy, tender, swollen areas that are characteristic of fibrocystic changes isn't fully understood. Experts agree, though, that reproductive hormones are closely involved. Estrogen is particularly likely to play a part. 

Note that fibrocystic breasts are most common in women between ages 20 and 50 or so—in other words, those who are still getting their periods. However, postmenopausal women who are on hormone therapy may experience fibrocystic breast changes due to estrogen replacement.

Diagnosis

According to the American Cancer Society (ACS), most women notice changes in their breasts (including symptoms that could indicate cancer) during activities such as bathing or dressing. For this reason, the ACS says, "Women should be familiar with how their breasts normally look and feel and report any changes to a healthcare provider right away."

This type of vigilance is called breast self-awareness and is preferred over breast self-exams (BSEs) by the ACS, the American College of Obstetricians and Gynecologists, and the U.S. Preventive Services Task Force, among other bodies, based on lack of evidence that regular BSEs are beneficial.

Whether you choose to practice breast self-awareness or do BSEs (or both), you may find it difficult to distinguish lumps or bumps due to fibrocystic changes from potential tumors. It's important to remember that the majority of breast lumps aren't cancerous. Still, your doctor will need to confirm this.

All breasts lumps must be investigated to rule out breast cancer and/or to begin immediate treatment if breast cancer is diagnosed.

This typically is done with a mammogram or ultrasound. It's sometimes difficult to tell the difference between a fibrocystic breast symptom and a potentially cancerous lump or growth on a regular mammogram, so an ultrasound may be the preferred method for diagnosing changes that are felt or that show up on a routine mammogram.

Women with dense breasts often are urged to have both tests regularly. (Dense breasts are common in younger women, as breasts tend to become fattier with age.) Density can only be determined by mammography, not by the look and feel of breasts.

When screening and/or testing reveal that a lump may be a fluid-filled cyst, sometimes a doctor will choose to do a fine-needle aspiration, in which a thin, hollow needle is used to extract the fluid.

If any of these tests are inconclusive—that is, if a doctor still isn't certain that cancer can't be ruled out as the cause of lumps or other changes in breast texture—then a biopsy may be necessary. Most women with fibrocystic breasts will not have abnormal breast cells when a biopsy is performed.

Fibroadenomas

Fibroadenomas are another possible cause behind a breast lump. These benign lumps are made of fibrous and glandular tissue, and they can cause pain.

The presence of a single fibroadenoma doesn't increase your risk of breast cancer, but having a complex one or more than one does indicate a higher risk.

Treatment

If your breasts aren't bothering you, there is no need to treat fibrocystic breasts. If you do experience pain, you have several treatment and management options to consider.

Try a Different Bra

You may get relief from extremely painful breasts by wearing a bra that provides more support. Being fitted for a bra by a specialist is an ideal way to find one that's the right size and shape for you. If the band is too tight or the cup is too small, the fabric, underwire, or other structural elements of the bra may be putting unnecessary pressure on your breasts.

If you play a sport or spend a lot of time working out, you may want to invest in a good sports bra as well. Consider wearing one to bed during periods, when your breasts are likely to be extra sensitive.

Apply Heat

Heat may help alleviate pain from pressure and swelling. Use a regular heating pad or make your own using a tube sock and rice.

Progesterone Cream

Applying 15 to 20 milligrams of progesterone cream per day, starting with ovulation and going until a day or two before your period, sometimes helps breast tissue return to in three to four months. 

Once you have achieved relief of symptoms, you can gradually taper your dose until you find the lowest amount that's effective. Ask your doctor about a prescription if you don't already have one.

Decrease Estrogen Intake

If you're postmenopausal and taking estrogen, talk to your doctor about reducing your dose or stopping hormone therapy altogether.

It also may help to decrease sources of estrogen from your diet, such as commercially-raised meats, which sometimes contain excessive amounts of hormones.

Medications

Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDS) such as Advil or Motrin (ibuprofen) or other pain relievers such as Tylenol (acetaminophen) may help ease soreness caused by fibrocystic breast changes. Ask your doctor what type and dose might work best for you. Your doctor may prescribe prescription versions of these or related medications, as well. 

Birth control pills are sometimes prescribed for pain related to fibrocystic breast changes, as they may help regulate levels of hormones linked to them.

A drug called tamoxifen and androgens (male hormones) also may be used, but because these drugs can have severe side effects, they are typically only recommended if symptoms are severe and not relieved by other treatments.

Supplements

Preliminary research suggests that vitamin E might help relieve breast pain that comes and goes with menstruation. One study found that 200 international units (IU) of vitamin E taken twice daily for two months improved cyclic breast pain.

Evening primrose oil contains an omega-6 fatty acid called gamma-linolenic acid that may make breast tissues less sensitive to hormonal changes. You can find it in drugstores and health food stores, usually in capsule form.

Research also suggests fish oil, another source of essential fatty acids, may also help reduce pain associated with fibrocystic breasts changes. Other vitamin suggestions include vitamin B6 or a B-complex, and magnesium.

Change Your Diet

Although there's little-to-no research to support a link between diet and fibrocystic breasts, anecdotal reports hint that the following changes may help relieve symptoms in some people. Together, they represent an overall nutritionally smart approach to eating. At the very least, trying any or all of them may improve your general health.

  • Cut out (or cut down on) caffeine from coffee, tea, soda, energy drinks, and chocolate.
  • Lower your intake of added sugar.
  • Lessen your sodium intake.
  • Limit the amount of fat in your diet.
  • Increase fiber intake to 30 grams a day.
  • Eat more fruits, vegetables, and whole grains.

Surgery

In extreme cases, cysts or lumps that cause pain can be removed. Options include:

  • Fine-needle aspiration: A hair-thin needle is inserted through the breast and into the cyst in order to drain the fluid from it. This will cause the cyst to collapse, which should relieve pain; it can also confirm that the lump is a cyst and not a tumor.
  • Surgical excision: A cyst that's persistent (won't collapse even after being aspirated several times) may need to be surgically removed.

Coping

Not all doctors take pain seriously, which can feel defeating and frustrating. If your doctor appears to be dismissing your complaints, see someone else if at all possible. With all the options available to you, you shouldn't have to endure chronic pain without treatment.

If you're having trouble dealing with it, and especially if you could be depressed, talk to your doctor. You may benefit from therapy and/or antidepressant medications.

Lastly, dedicating time to some of the self-care measures above can go a long way in making you feel that you're doing all you can to ease your discomfort.

A Word From Verywell

Finding any kind of lump or abnormality in your breast can be scary and make you worry about breast cancer. Try not to let your mind race. Get checked out for peace of mind, but do your best to focus on the fact that cancer is far less likely than something like fibrocystic changes.

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