Breast Cysts/fibrocystic Breasts

Question 1

Definition of breast cysts

Answer 1

Characterised by ‘lumpy’ breasts, associated with pain and tenderness that fluctuates with the menstrual cycle

Question 2

Aetiology of breast cysts

Answer 2

• Common condition
• Usually seen in <35 year olds (PERIMENOPAUSAL)
• Is associated with oestrogen stimulation
◦ Therefore, nulliparity, late menopause and oestrogen replacement therapy may increase the risk of fibrocystic breast disease

Question 3

Pathophysiology of breast cysts

Answer 3

• There would be an increase in fibrous tissue and dilation of ducts

Question 4

History and Examination of breast cysts

Answer 4

• Mastalgia: Dull aching pain that is usually cyclical (often precedes the onset of menses). Generally diffuse and bilateral pain. In some cases, it can throb or burn
• Diffuse symmetrical lumpiness through both breasts
• Age 30-50
• Can have clear/white discharge

Question 5

Investigations for breast cysts

Answer 5

TRIPLE ASSESSMENT:
• Clinical Examination

• Imaging:
‣ Ultrasound: If young (<35). Is able to detect cysts
‣ Mammogram: If older (usually used for 50-70 year old’s breast cancer screening). Has 2 views
‣ Cysts need to be diagnosed using ULTRASOUND. Would be a benign, fluid-filled rounded lump. Smooth and sharp margins

• Biopsy:
‣ Fine needle biopsy: takes small amount of fluid and tissue (good for cystic lesions). Fast and easy way to biopsy
‣ Core needle biopsy: larger sample, good for solid breast cancer

Question 6

Treatment for breast cysts

Answer 6

Mastalgia:
1) Supportive measures: Relieve patient anxiety, good bra may help, consider simple analgesics

Symptomatic breast cyst:
1) Cyst aspiration: performed in most patients with a palpable cyst, especially if painful and bothersome.

Question 7

Complications and prognosis for breast cysts

Answer 7

• Breast cancer: low risk of developing breast cancer with cysts

Mastalgia may be cyclical and chronic
Events such as menopause can stop the pain
Risk of recurrence of cysts

Question 8

Duct ectasia: What is it, what secretion and how to treat?

Answer 8

• Dilation of central ducts with thick ductal secretions (yellow/green secretions)
• Common in smokers
• Hadfield’s procedure to remove all lactiferous ducts under the nipple

Question 9

Intraductal papilloma: what is it, what secretion and how to treat?

Answer 9

• Small benign tumour that forms in a single milk duct
• Spontaneous unilateral white discharge
• Microdochetomy: surgical removal of a lactiferous duct