Ιωαννης Καφεζας

Cysts in the Breast

In Γυναικολογικα,Ιατρικά Θέματα on Απριλίου 22, 2013 at 5:30 πμ

A cyst does not develop into cancer, or raise the risk for cancer.

hb7_breastcyst

A cyst in the breast is a round or oval »bag», filled with liquid. There may be (one or more) in one or both breasts.

When palpated they give the impression of a soft grape or a small balloon filled with water. Another feature is that their limits are well determined and not vague.

In some cases the impression, upon palpation, is not as described earlier – instead, their consistency seems more solid.

When will we find them and how can they be treated?

Cysts occur more often in women between the ages of 30 and 40 years old and tend to disappear after the end of the menstrual cycle (menopause). In cases where women are treated with hormones after menopause, the cysts remain.

Cysts in the female breast require no special treatment, except in cases where they are very large and painful or cause intense discomfort and annoyance.

In these cysts a puncture is necessary to drain the liquid and stop the symptoms.

In general, symptoms and findings of cysts are:

  • Soft , clearly circumscribed and agile oval or round “bags”
  • Pain in the breast or a feeling of tension in the area where the cysts are –with a notable deterioration in the days immediately prior to the woman’s period.
  • An increase in size, on said days, followed by a reduction after the period


Why do women get cysts?

Each breast contains glandular tissue (called mammary gland), which forms 15 to 20 lobes. They, in turn, are divided into smaller ones –which produce the milk needed during the lactation period.

BREAST LOBES

Milk from each lobe exits through an excretory duct and eventually all the ducts coming together lead the milk under the nipple in a kind of reservoir, which makes it easy for the infant to receive via breast feeding.

The lobes, whether smaller or larger, are separated and supported by fibrous connective tissue. If lobes, lobules and their connective tissue are over- proportionately developed, their excretory ducts are likely to be occluded. That leads to the formation of cysts that fill up with liquid.

We can discern:

a) small cysts that cannot be palpated but are characterized by their slightly annoying symptoms and only become evident in imaging tests and

b) large cysts that can grow up to 5 cm in size. Due to the tension they exercise on the surrounding tissue, large cysts cause pain and tenderness.

We do not know exactly what triggers the hyperplasia of lobes and their connective tissue. It may be related to increased estrogen production – although this is not entirely proven.

The road to diagnosis and treatment

The discovery and definite diagnosis of breast cysts begins with either the woman herself or her physician detecting a difference (not observed in the past), during the course of a physical examination of the breasts.

It should be stressed that a clinical examination doesn’t offer grounds for certainty and that the doctor can, at that point, only speculate on the existence of a cyst.

Further testing in the form of either a mammogram (rarer) or a breast ultrasound (more often) will, therefore, probably be deemed necessary.

The cyst might also be punctured using a thin needle to remove some of the fluid within, whereby the diagnosis is safe. If the effluent is clear it’s all over, if it is bloody we need to check the cells it contains and move on to imaging tests for further monitoring.

During testing it is easy to reach a diagnosis when a cyst is filled with liquid but the things can be quite difficult if the finding seems to be of a more solid nature. That may mean that we are dealing with a fibro adenoma, but the possibility of cancer can also not be excluded.

There is no need for treatment in the case of simple breast cysts –which only require monitoring. These are most likely to disappear by themselves. In cases of severe pain or sensitivity, puncture and removal of the fluid relieves suffering.

The puncture may need to be done again in future, either on the same cyst (which filled up with fluid once again), or on other ones which are likely to occur in the woman .

The use of oral contraceptives reduces the potential for recurrence of cysts in women of reproductive age . In post- menopausal women who use hormones for substitution, an interruption decreases the chance of developing cysts.

Can cysts in the breast be operated on?

A cyst in the breast does not need surgery. Surgery will very rarely be needed, either in cases with very frequent recurrences or if after a puncture that drew bloody fluid the physician has reason to be cautious and is unwilling to leave room for risk.

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