Any time one undertakes a discussion of breast abnormalities, breast cancer is the first issue that usually comes to mind, and for good reason. It is a serious and deadly disease. But there are many other changes in the breast that are not dangerous or malignant, but unless they are properly understood, they can cause undue concern. Let’s see if we can sort it all out, and get a good overview of the situation.
What is Fibrocystic Breast Disease?
Fibrocystic Breast Disease is an out of date term that was once used to describe a variety of issues related to the female breast, including lumps, bumps, tenderness, pain, and other changes in breast tissue. Most researchers now agree that this family of disorders should not be labeled a disease. Therefore, the preferred term is now fibrocystic breast changes or fibrocystic condition. Incidentally, lest you be confused, the term “fibrocystic breast disease” is also a technical term still used in some medical literature referring to the appearance of breast tissue in imaging technologies such as ultrasound, x-rays, and under the microscope.
Fibrocystic condition occurs so commonly among over 50% of women (some estimates place it at up to 90%), that it is now thought of as a normal variation in breast tissue that often accompanies hormonal changes relating to menstruation, pregnancy, menopause, and aging. These most common breast changes are called “cyclic,” and the vast majority of them are benign. It can certainly be unnerving to discover a lump or other change in your breast, but because of the complex nature of the female breast, and the multiple types of tissue found there, along with the significant effect of hormonal changes on the breasts, variations are quite normal and typically nothing to be concerned about. However, changes in your breasts should never be taken for granted. That is why self-examinations are so important. You should be familiar with what is normal for you, so that you can personally be aware of any changes in your breast condition. What is “normal” for one woman may not be “normal” for another.
How Is the Female Breast Designed?
Over the years, many terms have been used to describe the changes associated with fibrocystic condition. Some common ones were: Chronic cystic mastitis, mastopathy, mammary displasia, indurative mastopathy, lumpy breasts, or physiologic nodularity. The truth of the matter is that each breast is unique in its own way. There is no such thing as a typical breast. They come in all shapes and sizes, with some having a smooth appearance, while others can be quite lumpy. To further complicate the issue, female breasts are dynamic and consistently changing due to hormonal cycles, age, and body chemistry. They also can experience changes due to pregnancy, lactation, weight gain or loss, and trauma or injury to the breast.
The breast is actually a type of sweat gland, and breast milk, the equivalent of perspiration in a typical sweat gland, appears when hormonal or environmental stimuli bring it out. The breast is not one mass of uniform pulpy tissue, but is formed of several different types of tissues. Among the main components are milk glands along with their accompanying ducts for transporting the milk. In addition, a normal breast includes nerves, blood vessels, lymph nodes, lymph vessels, fatty tissue, and fibrous connective tissues. This conglomeration of different tissue types is always changing, so it is no wonder that the breast does not remain constant in shape or texture.
What Are the Symptoms of Fibrocystic Condition?
There are various types of changes that a woman may notice in her breasts. Most of these phenomenon are considered normal in the sense that most women experience them to some degree, and the vast majority are benign and do not increase your chances of getting breast cancer. Others are caused by infections in the breast, but are generally not dangerous once the infection has run its course. Let’s break them down by common types.
This first category could also be called “cyclic changes,” as this most common form of fibrocystic condition is related to monthly hormonal changes associated with menstruation. They are typically experienced just before the menses. Usual symptoms include:
- Breast pain and tenderness
- Sensation of fullness or hardness in the breast
- Thickened, lumpy areas in the breast
- Benign (noncancerous) cysts
- Non-bloody nipple discharge
Some women will experience similar symptoms in the same part of the breast every month. With others it may change from month to month. That is again why it is so important to be familiar with your own breasts and monthly patterns through regular self-examinations. Make it your business to know your breasts, and the rest of your body, better than anyone.
Fibrocystic changes are associated with growth in the tissues of the glandular tissue of the breast, along with changes in the fibrous connective tissues that intertwine throughout the breast. Overgrowth and changes in these connective tissues is known as fibrosis, and such overgrowth can be responsible for blocking milk ducts and causing cysts to form. Hence the term fibrocystic. This process is driven by monthly hormonal changes, and tends to lessen as women get older and approach menopause when levels of hormones such as estrogen and progesterone naturally decrease.
Cysts can form when ducts in the breast become blocked and back up. They are actually fluid filled sacs, and they can be small or large. Cysts are usually smooth and firm, with a round or oval shape. One way to help identify the breast lumps caused by cysts is that they typically feel hard and are painful or tender when touched. They also tend to move a bit when you press on them. They come and go as the tissues of the breast evolve. In the majority of women they will appear about two weeks before your period, and usually disappear on their own after menstruation is over.
Sometimes a large, persistent or painful cyst can be drained by a procedure called fine-needle aspiration (FNA), whereby a needle is inserted into the cyst and fluid is drawn off. If the fluid has any blood in it, it should tested for the presence of any cancerous cells. However, the majority of lumps caused by cysts are not malignant, and will usually resolve themselves without intervention.
These benign masses are also the result of overgrowth of glandular and connective tissues within the breast. They can grow quite large, up to about the size of a golf ball. They are firm and have a rubbery texture that may move or “bounce” when pressed on. They are generally painless, and appear most often in younger women in their twenties and thirties. They usually appear or get larger during times of hormonal fluctuation, including pregnancy. They are not usually a problem for postmenopausal women. Sometimes they will wax and wane with changes in hormone levels, but often they will disappear spontaneously and not return.
These fast growing tumors appear as painless lumps in the breast that can grow quite large. Most of them are benign, but can rarely be malignant. They are very similar in appearance and texture to fibroadenomas, but typically grow larger and much faster than fibroadenomas. Sometimes surgery is suggested, especially if malignancy is at all suspected, as a biopsy can be done at the same time. But keep in mind that even with surgical removal there is a good chance that phyllodes tumors will recur.
These benign growths occur in a milk duct, and can cause small lumps in the breast that are felt near the nipple, and just behind the areola. There is often a discharge, sometimes bloody, from the nipple when an intraductal papilloma is present. The discharge may occur on its own, or when the area is pressed on. If the growth doesn’t clear up on its own, the offending milk duct can be surgically removed.
This is a condition that is the result of trauma to the breast. It is usually the result of an accident or surgery (another reason to carefully consider all your options before undergoing any surgical procedure). Fat necrosis is caused by scar tissue that formed in response to the trauma. They are usually firm, round, and will move a bit when pushed on. There may be some pain or bruising associated with these growths, especially if the trauma was fairly recent. They are benign, and will often disappear spontaneously.
Fat necrosis growths can appear very similar to malignant lumps that are indicative of breast cancer. Therefore, if the growth does not recede on its own, it is recommended that you make sure it is not cancerous. Often a mammogram is suggested, but I would suggest an alternative such as ultrasound to get a better view inside the breast. Mammograms can be quite traumatic to the breast, and may even spread cancerous cells if they are present.
Mastitis is a bacterial infection of the breast typically found in mothers who are breast feeding their babies. Breast tenderness, warmth, and redness typically accompany a mastitis infection, and a lump may form if the infection worsens into an abscess.
A more uncommon form of mastitis is sometimes found in postmenopausal women. This form of mastitis, known as periductal mastitis, involves the inflammation of milk ducts near the areola. It is not known for sure what causes periductal mastitis, but common symptoms include a painful breast lump, nipple discharge, and sometimes nipple retraction. It also can cause scarring in the affected milk ducts.
What Can Help Prevent Fibrocystic Condition?
Certain lifestyle adjustments, as with most wellness issues, can help to avoid or lessen the effects of fibrocystic condition. These include:
- Avoiding caffeinated beverages such as coffee or colas. They only help to retain fluid and increase swelling and discomfort.
- Wearing a supportive bra has helped some women. This can both prevent symptoms, and relieve the discomfort of existing ones.
One final note: If your health care provider ever suggests a medication called danazol, stay away from it. The side effects are very significant, including facial hair, menstrual irregularities, weight gain, acne, and hot flashes. This sounds to me like your system telling you that this drug does not belong in a woman’s body.