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  • Fibrocystic Breast Changes: Lumps That Are Normal

    IMAGE Do your breasts feel lumpy? It may be that you are experiencing fibrocystic breast changes—a benign condition that occurs in women of childbearing age.
    It sounds very unglamorous, but the human breast is no more than a lumpy gland made up of milk glands, ducts, and the tissues that separate and support them. Most breasts have at least one or two lumps; however, if your breast feels especially lumpy and uncomfortable, you are probably experiencing fibrocystic breast changes.

    What Are Fibrocystic Changes?

    Fibrocystic changes are benign breast changes. The medical literature used to refer to them as fibrocystic disease. That was before fibrocystic changes were found to be no more a disease than menstruation or menopause. The breast tissue may feel dense with an irregular area of thicker tissue having a lumpy or ridge-like surface. You might also feel tiny bead-like masses scattered throughout the breasts.
    Your breasts may feel tender, swollen, and full with a dull, heavy pain. They may be sensitive to touch with a burning sensation. This discomfort is normal and does not indicate the presence of disease. For some women the pain is so severe that they cannot exercise or lie on their stomachs. Fibrocystic changes usually occur in both breasts, most often in the upper outer quadrant and the underside of the breast where most of the milk-producing glands are located.

    Why Does This Happen?

    Fibrocystic changes are associated with hormonal shifts in estrogen and progesterone, which affect the breast tissue. During the menstrual cycle, the breasts swell as the milk glands and ducts enlarge and the breasts retain water. After menstruation, the breast swelling goes down and the breasts return to normal.
    Fibrocystic changes generally begin when women are in their 20s or 30s and usually last until menopause. For a small number of women, the condition worsens over the years, causing constant pain and lumpiness. In general, some of the lumps become permanent and may or may not shrink after menopause.

    Breast Cysts

    Some women with fibrocystic changes develop cysts in their breasts. A cyst is a fluid-filled sac that is usually smooth, firm, movable, and sometimes tender. The cyst will generally enlarge before the menstrual period and shrink afterwards. A large cyst may be round and feel like an eyeball when pressed with the eyelid closed.
    If you are concerned about a lump, your healthcare provider can determine whether or not it warrants further attention. Determining whether a lump is a cyst or something more serious can be determined by a simple office procedure known as fine needle aspiration. A fine-gauge needle is inserted into the lump and fluid is withdrawn.
    If the lump is a cyst, it will collapse once the fluid is removed. If there is concern about the lump, a needle biopsy or a surgical biopsy can be done.

    Treatment

    While there is no definitive, medically proven treatment for breast pain caused by fibrocystic changes, there are various remedies that can be helpful.
    For some women, avoiding foods and beverages containing caffeine, such as coffee, tea, chocolate, and soft drinks, may help to alleviate the discomfort. Women who stop smoking may notice that their lumps decrease as well.
    Aspirin and other over-the-counter pain relievers, as well as heat application can relieve uncomfortable symptoms, as does wearing a bra that provides firm support. In serious cases, oral contraceptives—which change the hormonal balance in your body—can lessen fibrocystic changes. For severe cases a synthetic form of the hormone androgen, may be prescribed. However, many women find that the side effects, including weight gain, hair growth, and voice changes, are more distressing than the fibrocystic discomfort.

    Fibrocystic Changes and Breast Cancer

    There is no correlation between fibrocystic changes and breast cancer. However, fibrocystic changes can make it more difficult to detect breast cancer. Being familiar with your breasts, and the changes throughout the month may be the best way to alleviate concerns about these cyclic changes. If you have any concerns though, it is a good idea to get any breast changes evaluated by your doctor.
    Experts have different views about if and when a woman should have a clinical breast exam (breast exam by a health professional). For women with average risk, The American Congress of Obstetricians and Gynecologists recommends a clinical breast exam every 1-3 years for women ages 20-39 and every year for women over 40. Talk to your doctor about a schedule that is appropriate for you.
    A breast self-exam (BSE) is a step-by-step examination of your breasts that you do yourself. BSE can be done on a regular schedule, occasionally, or not at all. The goal of the exam is to help you notice any changes or concerns in your breast tissue. Talk to your doctor about the risks, limitations, and benefits of BSE. If you choose to do the exam, follow these guidelines from the American Cancer Society:
    1. It is best to do your BSE when your breasts are not tender or swollen.
    2. Remove your shirt and bra.
    3. How to Perform a Breast Exam 4 Lie down on your back, with your left arm behind your head. This position causes the breast to settle on your chest and spread out more evenly than it would if you were standing up.
    4. How to Perform a Breast Exam 6Use the finger pads on your right hand to feel for lumps in your left breast. Move the finger pads in little circles to feel for any lumps.
    5. Apply different amounts of pressure:
      • Light pressure can detect lumps just under the skin.
      • Medium pressure can detect lumps in the middle of the breast tissue.
      • Firm pressure can detect lumps down near the ribs.
      • A firm ridge in the lower curve of each breast is normal.
    6. How to Perform a Breast Exam 5Move around the breast using a vertical-line pattern. Check the whole breast area—from the ribs to the collar bone, as well as from the chest bone to the underarm.
    7. Repeat the procedure on the other breast. Place your right arm behind your head and use your left hand to do the exam.
    8. How to Perform a Breast Exam 2While standing in front of a mirror, press down on your hips. Look both in the mirror and down on your breasts. Look for any changes in the size, shape, or contour of the breasts. See if the skin (including the nipple) has any puckering, dimpling, scaliness, or redness.
    9. Lastly, check each underarm while you are sitting or standing. Raise your arm a little so that you can feel the underarm area. (Note: If you raise your arm too high, it will be harder to feel this area.)

    RESOURCES

    Centers for Disease Control and Prevention http://www.cdc.gov

    Office on Women's Health http://www.womenshealth.gov

    CANADIAN RESOURCES

    The Canadian Women's Health Network http://www.cwhn.ca

    Health Canada http://www.hc-sc.gc.ca

    References

    Benign breast problems and conditions. American Congress of Obstetrics and Gynecologists website. Available at: http://www.acog.org/~/media/For%20Patients/faq026.pdf?dmc=1&ts=20130214T1505295029. Accessed May 8, 2014.

    Breast awareness and self-exam. American Cancer Society website. Available at: http://www.cancer.org/cancer/breastcancer/moreinformation/breastcancerearlydetection/breast-cancer-early-detection-acs-recs-bse. Updated January 28, 2014. Accessed May 8, 2014.

    Breast cancer screening. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 15, 2014. Accessed May 8, 2014.

    Ferrara A. Benign breast disease. Radiol Technol. 2011;82(5):477M-462M.

    Fibrosis and simple cysts. American Cancer Society website. Available at: http://www.cancer.org/Healthy/FindCancerEarly/WomensHealth/Non-CancerousBreastConditions/non-cancerous-breast-conditions-fibrocystic-changes. Updated January 14, 2014. Accessed May 8, 2014.

    Mannello F, Tonti GA. Benign breast diseases: Classification, diagnosis, and management. Oncologist. 2013;11(10):1132-1134.

    Palpable breast mass evaluation. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 30, 2014. Accessed May 8, 2014.

    Smith RL, Pruthi S, Fitzpatrick LA. Evaluation and management of breast pain. Mayo Clin Proc. 2004;79:353.

    Understanding breast changes: A health guide for women. National Cancer Institute website. Available at: http://www.acog.org/~/media/For%20Patients/faq026.pdf?dmc=1&ts=20130214T1505295029. Updated March 25, 2014. Accessed May 8, 2014.

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