Fibrocystic Breast: An Overview

You’re taking a shower one day when you realize that one of your breasts feels tender to the touch. You gingerly poke around the area and discover that not only is it tender, but you can feel a lump beneath the skin. What should you do?

First, you shouldn’t panic. About 80% of breast lumps are benign (noncancerous). Second, you should call your doctor. An expert should examine any newly discovered breast lump.

And you should take some comfort in knowing that your situation is not unique, or even unusual. Most women at least occasionally experience breast changes. Fibrocystic breast is a descriptive name for a whole constellation of benign breast conditions whose symptoms can include pain, general lumpiness, individualized lumps, and asymmetry. (There’s much discussion and some disagreement among experts about the terms that should be used to describe this condition. We’ll examine the question of terminology in a future article. For now, let’s use the term fibrocystic breast.)

Estimates for the number of women who experience these changes range anywhere from 50% to 90% of all women, so it seems safe to say that the majority of women will experience breast changes at some time during their lives. Many of these changes are caused by hormones and are related to a woman’s menstrual cycle. Other breast changes occur as we get older.

To understand these changes, let’s first look at the anatomy of a typical breast. Underlying the breast, or behind it when you’re standing, is muscle tissue, the pectoral muscle. On top of the muscle is the breast itself, which consists of a combination of breast tissue, connective tissue, and fat. Breast tissue is rubbery and firm, while fat is less firm. The breast also contains glands that produce milk and ducts that carry the milk to the nipple.

One of the most common symptoms of fibrocystic breast is pain, which may be either cyclical or noncyclical. Cyclical pain is related to the menstrual cycle. Just as the uterus prepares for pregnancy, so the breasts prepare to produce milk. For about a week preceding her period, a woman’s breasts may feel swollen and tender. This discomfort wanes once menstruation begins. Cyclical pain generally affects women in their 20’s, 30’s, 40’s, and 50’s but ceases after menopause except for women taking hormone-replacement therapy.

Noncyclical pain doesn’t vary with the menstrual cycle. It is usually localized to a particular spot. There may or may not be a palpable lump in the tender area. A doctor should check out any noncyclical pain, although most times it’s harmless.

Breast lumps are by far the most frightening aspect of fibrocystic breast, even though most breast lumps are benign. All breasts, because of their combination of fatty tissue and rubbery breast tissue, have a certain amount of lumpiness, and this lumpiness may feel different at different points in the menstrual cycle. For this reason it’s a good idea to get used to examining your breasts regularly and at different points in the menstrual cycle so that you can learn what feels normal for you. General lumpiness may also increase as a woman gets older and her breasts take on more fatty tissue.

Any lump that feels individualized should be checked by your doctor. Cysts, fluid-filled sacs, are common in women in their 30’s, 40’s, and early 50’s; cysts feel soft, smooth, and somewhat squishy and can range in size from very small to about as big as a lemon. Another specific kind of breast lump is a fibroadenoma, a round, solid, rubbery lump that is usually harmless but that your doctor may feel warrants removal.

Another often frightening aspect of fibrocystic breast is nipple discharge. Susan M. Love, M.D., a breast surgeon and author of Dr. Susan Love’s Breast Book, says that a small amount of nipple discharge is not abnormal. Like other breast changes, though, you should contact your doctor about nipple discharge, particularly if you haven’t experienced it before, because it could signal an infection.

Experts now believe that there is no relationship between fibrocystic breast and the development of breast cancer. However, because fibrocystic breasts can feel lumpy and even contain individual lumps, this condition can mask the growth of cancerous tumors. This is why it’s very important for women with fibrocystic breast to perform regular breast self-examination (BSE). Even women with lumpy breasts can learn what feels normal for them. Then, if they should detect something abnormal in their breasts, they’ll be able to tell their doctor about it immediately.

Finally, remember that all of this general information is just that—general information. It should not replace a consultation with your doctor about your personal medical status.

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