Breast Cysts

Question 1

What are breast cysts?

Answer 1

Epithelial lined fluid-filled cavities, which form when lobules become distended due to blockage, usually in the perimenopausal age group

Question 2

How do breast cysts typically present?

Answer 2

Singular or multiple lump(s) & can affect one or both breasts.

On palpation, cysts are distinct smooth masses that may be tender

Question 3

What investigations can be used to identify breast cysts?

Answer 3

1. USS (Definitive investigation)
2. Mammography
   * Typical halo shape seen of breast cyst
3. Aspiration (either freehand or USS) +/- Cytology

• For persisting, symptomatic, or undeterminable cystic masses
• If fluid is free from blood or lump disappears, cancer may be excluded. If not, send cystic fluid for cytology.

Question 4

How are breast cysts managed?

Answer 4

1. No further management
   * Self-resolving, but warn of high risk of recurrance.
2. Aspiration
   * For larger cysts due to aesthetic reasons or patient reassurance.

Question 5

What are some complications of breast cysts?

Answer 5

• Carcinoma
  
  • 2% of patients with cysts have carcinoma at presentation
  • 2-3x greater tisk of developing breast cancer in future
• Fibroadenosis (fibrocystic change)

Question 6

What are the causes, features & management of fibroadenosis (fibrocystic changes)?

Answer 6

Caused by multiple small cysts and fibrotic areas.

Features often include tenderness & asymmetry, hence this fibrosis can often mask malignancy.

Usually managed with appropriate analgesia. Any cyclical pain may be treated with high dose gamolenic acid (GLA) or danazol.