Learn about breast cysts, their symptoms, types, causes, and the differences between nipple and sebaceous cysts. Stay informed and stay healthy.

Breast Cyst

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ZAKA CLINIC GULBERG LAHORE

Saad Ullah Siddiqui

Overview

Breast cysts are fluid-filled sacs within the breast that are mostly benign. 
&nbsp;

Breast cysts are the most common cause of breast symptoms in women. They are part of a benign condition called fibrocystic breast disease. According to research, the lifetime prevalence rate of fibrocystic breast disease varies between 70% and 90%<a href="http://#accordion">[2]</a>.

A palpable breast cyst is estimated to affect 7% of all women in the United States<a href="http://#accordion">[2]</a>. It is most prevalent in females aged 30 to 50. The occurrence of cyst development rises during these years and then falls significantly afterward.

These cysts can be symptom-free and only revealed by chance, or they can be symptomatic and manifest as lumps, physical discomfort, or nipple discharge. Most breast cysts are benign and do not increase one&rsquo;s risk of <a href="https://merisehat.pk/disease/breast-cancer">breast cancer</a>. 
&nbsp;

Breast cysts are typically divided into simple, complex, or complicated. 
&nbsp;

<ul>
	<li>Simple Cysts </li>
</ul>

Simple cysts are those that form as a result of fibrocystic modifications. These cysts are completely filled with fluid and have sleek boundaries and thin walls. They are always benign and not concerning.

<ul>
	<li>Complex Cysts</li>
</ul>

Complex cysts, as opposed to simple cysts, have irregular boundaries, thick walls, and some solid matter within the fluid. The presence of solid tissue is worrisome. Therefore, doctors may perform a needle biopsy to aspirate the fluid and test it for cancerous changes. 

<ul>
	<li>Complicated Cysts</li>
</ul>

These cysts fall somewhere in the middle of simple and complex. They do not have thick walls, but the fluid may contain some solid matter. The vast majority are harmless. The doctor may recommend a needle biopsy.

Depending on Berg et al. criteria, these cysts can be further divided into four different categories<a href="#accordion">[2]</a>:

<ul>
	<li>Type 1</li>
</ul>

They possess either a thick exterior wall, thick internal septa, or both.

<ul>
	<li>Type 2</li>
</ul>

These cysts have one or more internal masses

<ul>
	<li>Type 3</li>
</ul>

It contains a mixture of cystic and solid components, with the former predominating.

<ul>
	<li>Type 4</li>
</ul>

It is primarily solid (at least 50%), with some eccentric cystic foci. 
&nbsp;

Breast cysts can also be classified based on their size. 

<ul>
	<li>Microcyst</li>
</ul>

These are too small to be felt and are usually seen during imaging tests, such as ultrasound or mammography.

<ul>
	<li>Macrocyst</li>
</ul>

These cysts are big enough to be felt and can be as big as 1 to or 2 inches in diameter. 
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Signs And Symptoms

Breast cysts can occur in either one or both breasts. They may feel like a soft or hard lump that is: 

<ul>
	<li>Smooth and round</li>
	<li>Palpable</li>
	<li>Tender or painful, especially during the menstrual cycle</li>
	<li>Easily movable under the skin 
	&nbsp;</li>
</ul>

Other signs and symptoms of a breast cyst are:

<ul>
	<li>Nipple discharge, which can be clear, yellow, straw-colored, or dark brown.</li>
	<li>An increase in the size of the breast cyst prior to the beginning of the period. A decrease in size and tenderness may occur after the period. </li>
	<li>Breast pain or tenderness</li>
</ul>

Note: Normal breast tissue is frequently lumpy or nodular in appearance. However, if you notice a new breast lump that doesn&#39;t fade away, grows in size, or remains in place after one or two monthly cycles, consult your medical professional immediately. 
&nbsp;

Causes

precise cause of breast cysts is uncertain. Scientists believe they are brought on by hormonal fluctuations caused by monthly menstruation. Breast cysts are uncommon in women after menopause when estrogen levels decline. The majority of benign cysts go away and new cyst development stops a year after menopause because cyst development is correlated with hormone levels in the body<a href="#accordion">[2]</a>. 
&nbsp;

While there are no specific screening tests for a breast cyst, a breast self-exam can prove quite beneficial in detecting any abnormal changes in the breast. It is best done a week after the period ends as hormonal fluctuations during the menstrual cycle can cause changes in breast tissue. 
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Diagnosis

Breast cysts are widespread, particularly among women in their reproductive years. It&#39;s easily possible to misdiagnose them as a cancerous lump. Since cyst development is linked to hormone levels within the body, most benign cysts vanish within one year of menopause, and new cysts cease to develop. 

&nbsp;

Doctors use the triple assessment approach to diagnose cystic disease in breast tissue accurately. It includes:

<ol>
	<li>Clinical evaluation</li>
	<li>Imaging</li>
	<li>Histopathology from fine-needle aspiration or core needle biopsy.</li>
</ol>

&nbsp;

A comprehensive overview and history of the clinical condition, a summary of the pain and its relationship to the menstrual period, any recent trauma to the region, nipple and skin variations, and nipple discharge should all be included in an appropriate clinical assessment. It should also involve the following:

<ul>
	<li>A comprehensive history of recent healthcare and surgical issues.</li>
	<li>Family and relevant social history.</li>
	<li>Current medicines.</li>
	<li>Allergies to medications.</li>
	<li>The menarche age.</li>
	<li><a href="https://merisehat.pk/disease/menopause">Menopause</a>.</li>
	<li>Any relatives or personal history of breast cancer.</li>
</ul>

&nbsp;

A detailed physical assessment for palpable lymph nodes accompanies it. It includes the evaluation of the following:

<ul>
	<li>Both breasts </li>
	<li>Axilla</li>
	<li>Neck</li>
	<li>Chest.</li>
</ul>

&nbsp;

Ultrasound or mammography are common types of imaging, as are tissue biopsies and potentially fine-needle aspiration or a breast biopsy. Histopathology by fine-needle aspiration (FNA) or core needle biopsy completes the triple assessment approach (CNB).

The following are the exams that the doctors employ for diagnosing breast cysts: 
&nbsp;

<ul>
	<li>
	<h5>Breast Exam</h5>
	</li>
</ul>

After considering the clinical signs and medical history, the healthcare professional will physically evaluate the breast lump and look for other breast anomalies. Since a clinical breast exam alone cannot determine whether a breast lump is a cyst, individuals will require additional testing. This will generally include an imaging test or a fine-needle aspiration. 
&nbsp;

<ul>
	<li>
	<h5>Ultrasound</h5>
	</li>
</ul>

This test can assist the health professional in determining whether a breast lump is fluid or solid. A fluid-filled region on the breast is generally a sign of a breast cyst. While a solid-appearing mass is most likely a benign lump like a fibroadenoma. However, solid lumps can also be breast cancer. Therefore, further testing may be required. 

A simple cyst appears on ultrasound as a circular, well-circumscribed, anechoic abscess with a barely perceptible wall. Whereas, a complex cyst can be seen as heterogeneous echogenicity, with debris that mobilizes with a modification in position. 
&nbsp;

<ul>
	<li>
	<h5>Mammography</h5>
	</li>
</ul>

Mammography can usually detect large cysts and groupings of tiny cysts. Microcysts, on the other hand, can be hard or impossible to see on a mammogram. Mammography can help classify and identify linked microcalcifications as well as other strange characteristics.

Mammography is less valuable than ultrasound in distinguishing cystic from solid masses like fibroadenomas, but it is more suitable for breast assessment in persons over 35. Patients under 35 have dense breast tissue, which the doctors can better assess with ultrasound. 
&nbsp;

<ul>
	<li>
	<h5>Magnetic Resonance Imaging (MRI)</h5>
	</li>
</ul>

Magnetic resonance imaging (MRI) is another imaging technique. However, it is not as widely used as ultrasound or mammography because of its price and accessibility. 
&nbsp;

<ul>
	<li>
	<h5>Fine-needle Aspiration (FNA)</h5>
	</li>
</ul>

In the existence of a symptomatic cyst or cysts with strange solid material, the FNA is carried out directly or under ultrasound guidance. Fine-needle aspiration is a procedure that entails introducing a fine needle into a breast lump and aspirating fluid. In most cases, the aspirated components are straw-colored, but in the particular instance of a galactocele, they can be opaque, dark green, or even thick and purulent. If the aspirate emerges purulent, it should be sent to be tested for antibiotic sensitivity and microbiology. However, galactoceles are usually sterile. 

A bloody aspirate ought to be submitted for cytology.&nbsp; If the fluid drains and the breast lump disappears, the healthcare professional can pretty quickly diagnose a breast cyst.

There is no need for additional research, testing, or therapeutic interventions if the fluid is not full of blood, has a straw-colored look, and the breast lump fades away.

In case the fluid emerges bloody or the breast lump does not disappear on its own,&nbsp; then the healthcare professional may submit a fluid specimen to a laboratory for analysis and recommend the individual to a breast surgeon or a radiologist for follow-up.

If no fluid is discharged, the medical professional will suggest an imaging test, like a diagnostic mammogram or ultrasound. A scarcity of fluid or a breast lump that fails to disappear after aspiration implies that the breast lump &mdash; or a significant part &mdash; is solid. A specimen of the tissue may be taken to test for cancer. 
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Treatment

After aspiration, a massive percentage of simple cysts vanish, and the treatment is considered complete. Follow-up examinations and imaging differ depending on the cyst and the results of aspiration or biopsy.

Simple breast cysts that are fluid-filled, do not lead to symptoms. Those that are revealed by ultrasound or fine-needle aspiration do not require medical attention. Most cystic breast lesions are relatively harmless and thus do not necessitate oncological treatment. 
&nbsp;

Note: Consult your health professional if a cyst lingers, feels stiffer, or you observe skin changes on the skin over the cyst. 
&nbsp;

The unique malignant cystic lesions are treated similarly to breast cancer. The treatment consists of surgical removal and adjuvant therapy. Hormonal therapy, chemotherapy, radiotherapy, immunotherapy, and biological agents are all examples of adjuvant therapy.

They are explained further below:

<ul>
	<li>Fine-needle Aspiration</li>
</ul>

Fine-needle aspiration could be employed to identify and treat a breast cyst if all of the fluid from the cyst can be eliminated during the process, after which the breast lump and associated symptoms will fade away.

However, for some breast cysts, doctors must drain fluid multiple times. It is common to have recurring or new cysts. If a breast cyst lingers for two to three menstrual periods and expands in size, medical attention should be sought. 
&nbsp;

<ul>
	<li>Hormone Use</li>
</ul>

Birth control pills (oral contraceptives) may significantly minimize the relapse of breast cysts. However, due to the possibility of severe side effects, birth control pills or other hormone therapy, like tamoxifen, are generally only recommended for women with severe symptoms. Stopping hormone therapy after menopause may also aid in preventing breast cysts. It is important to consult a doctor before starting or stopping any medications. 
&nbsp;

<ul>
	<li>Surgery</li>
</ul>

Surgery to remove a breast cyst is only required in extreme cases. If a bothersome breast cyst reappears month after month, or if a breast cyst possesses blood-tinged fluid or exhibits other concerning symptoms, a doctor may perform a surgical removal. 
&nbsp;

<h5>&nbsp;Lifestyle And Home Remedies</h5>

The following measures can help alleviate the discomfort brought on by breast cysts:

<ul>
	<li>A Supportive Bra 
	Supporting the breasts with a well-fitting bra may aid in reducing some of the discomforts.</li>
	<li>Applying a Compress 
	A warm or cold compress can assist in relieving pain.</li>
	<li>Avoiding Caffeine 
	Caffeine and breast cysts do not typically have a link. However, a few women experience therapeutic benefits after removing caffeine from their diet. </li>
	<li>OTC Pain Relievers 
	A few types of breast discomfort may be relieved by taking acetaminophen (Tylenol, for example) or nonsteroidal anti-inflammatory drugs like ibuprofen (Advil, Motrin IB, for example) or naproxen sodium (Aleve, others). These should only be taken after a doctor&rsquo;s consultation. </li>
</ul>
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Breast cysts do not require medical attention unless they are massive, distressing, or uncomfortable. In that instance, draining the fluid from a breast cyst may help alleviate clinical signs. However, if left untreated, breast cysts can be associated with the following complications: 
&nbsp;

<ol>
	<li>Pain Or Discomfort: Breast cysts can cause pain or discomfort, particularly around the time of menstruation. If the pain is severe or persistent, it may require treatment.</li>
	<li>Infection: Although rare, breast cysts can become infected, causing redness, warmth, swelling, and tenderness in the affected area. Antibiotics may be needed to treat the infection.</li>
	<li>Rupture: In some cases, a breast cyst may rupture, causing the fluid to leak into the surrounding breast tissue. This can cause pain, swelling, and inflammation, and may require drainage.</li>
	<li>Malignancy: Although breast cysts are generally benign, there is a small risk that they can be associated with breast cancer. Women with a family history of breast cancer or other risk factors may need additional testing to rule out cancer.</li>
	<li>Psychological Distress: In some cases, the presence of breast cysts can cause anxiety, worry, or psychological distress. Women who are concerned about their breast health or who experience symptoms related to breast cysts should talk to their doctor about their concerns. 
	&nbsp;</li>
</ol>

The following factors can increase the risk of breast cysts in women.

<ol>
	<li>Age: Breast cysts are more common in women who are between the ages of 35 and 50<a href="#accordion">[3]</a>. As women get older, their risk of developing breast cysts increases.</li>
	<li>Hormonal Factors: Changes in hormone levels can affect the risk of developing breast cysts. Women who are going through menopause, using hormone replacement therapy, or taking birth control pills may be more likely to develop breast cysts. Furthermore, hormonal fluctuation during a menstrual cycle can also increase the risk of a breast cyst.</li>
	<li>Family History: Women who have a family history of breast cancer or breast cysts may be at a higher risk of developing breast cysts themselves.</li>
	<li>Breast Trauma: Women who have experienced trauma to the breast, such as a blow or injury, may be more likely to develop breast cysts.</li>
	<li><a href="https://merisehat.pk/disease/obesity">Obesity</a>: Obesity is a risk factor for many health conditions, including breast cysts. Women who are overweight or obese may be more likely to develop breast cysts.</li>
	<li>Alcohol Consumption: Drinking alcohol has been linked to an increased risk of breast cysts. Women who drink alcohol regularly may be at a higher risk of developing breast cysts. 
	&nbsp;</li>
</ol>

There is no known way to prevent breast cysts from developing. However, there are some things that women can do to reduce their risk of developing breast cysts and other breast health issues: 
&nbsp;

<ol>
	<li>Practice Good Breast Health: Regular breast self-exams and breast screenings, such as mammograms or ultrasounds, as recommended by the doctor can help prevent breast cysts.</li>
	<li>Maintain A Healthy Weight: Being overweight or obese can increase the risk of breast cysts, as well as other breast health issues. Maintaining a healthy weight through a balanced diet and regular exercise can help reduce this risk.</li>
	<li>Quitting Alcohol Consumption: Drinking alcohol has been linked to an increased risk of breast cysts, as well as breast cancer. Therefore, quitting alcohol is recommended.</li>
	<li>Manage Hormone Levels: Women who are going through menopause, using hormone replacement therapy, or taking birth control pills may need to manage their hormone levels to reduce this risk.</li>
	<li>Avoid Breast Trauma: Trauma to the breast, such as a blow or injury, can increase the risk of developing breast cysts. Women should take care to avoid any trauma or injury to the breast area. 
	&nbsp;</li>
</ol>
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Key Points

<ul>
	<li>Breast cysts are fluid-filled sacs that can develop in the breast tissue.</li>
	<li>They are most common in women between the ages of 35 and 50, but can occur in women of any age.</li>
	<li>Breast cysts are usually not harmful and don&#39;t increase the risk of breast cancer.</li>
	<li>They can be detected through mammography or ultrasound and may cause symptoms such as breast pain or tenderness.</li>
	<li>If a cyst is causing discomfort or is large, it can be drained with a needle, or surgically removed.</li>
	<li>Women should perform regular breast self-exams and report any new or unusual breast changes to their doctor. 
	&nbsp;</li>
</ul>
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[1] Norwood SL. Fibrocystic breast disease. An update and review. J Obstet Gynecol neonatal Nurs  JOGNN. 1990;19(2):116–21.

[2] Kowalski A, Okoye E. Breast Cyst. 2020;

[3] Celis JE, Gromov P, Moreira JMA, Cabezon T, Friis E, Vejborg IMM, et al. Apocrine cysts of the breast: biomarkers, origin, enlargement, and relation with cancer phenotype. Mol \& Cell Proteomics. 2006;5(3):462–83.