Fibrocystic Breast Changes: Lumps That Are Normal

Do your breasts feel lumpy? It may be that you’re experiencing fibrocystic breast changes—a benign condition that occurs in women of childbearing age.

It sounds very unglamorous, but the human breast is no more than a lumpy gland made up of milk glands and ducts and the tissues that separate and support them. Most breasts have at least one or two lumps; however, if your breast feels especially lumpy and uncomfortable, you're probably experiencing fibrocystic breast changes.

"The vast majority of women have [fibrocystic changes]...and are no worse for it," reports Dr. Carolyn Kaelin, a gynecologist and director of the breast clinic at Brigham & Women's Hospital in Boston.

What Are Fibrocystic Changes?

Fibrocystic changes are benign breast changes. The medical literature used to refer to them as fibrocystic disease. That was before fibrocystic changes were found to be no more a disease than menstruation or ]]>menopause]]>. The breast tissue may feel dense with an irregular area of thicker tissue having a lumpy or ridge-like surface. You might also feel tiny bead-like masses scattered throughout the breasts.

Your breasts may feel tender, swollen, and full with a dull, heavy pain. They may be sensitive to touch with a burning sensation. This discomfort is normal and does not indicate the presence of disease. For some women the pain is so severe that they cannot exercise or lie on their stomachs. Fibrocystic changes usually occur in both breasts. Most often in the upper outer quadrant and the underside of the breast where most of the milk-producing glands are located.

Why Does This Happen?

Fibrocystic changes are associated with hormonal shifts in estrogen and progesterone, which affect the breast tissue. During the menstrual cycle, the breasts swell as the milk glands and ducts enlarge and the breasts retain water. After menstruation, the breast swelling goes down and the breasts return to normal.

Fibrocystic changes generally begin when women are in their twenties or thirties and usually last until menopause. For a small number of women, the condition worsens over the years, causing constant pain and lumpiness. In general, some of the lumps become permanent and may or may not shrink after menopause.

Breast Cysts

Some women with fibrocystic changes develop cysts in their breasts. A cyst is a fluid-filled sac that is usually smooth, firm, movable, and sometimes tender—like a water balloon without the water. The cyst will generally enlarge before the menstrual period and shrink afterwards. A large cyst may be round and feel like an eyeball when pressed with the eyelid closed.

If you are concerned about a lump, your healthcare provider can determine whether or not it warrants further attention. Determining whether a lump is a cyst or something more serious can be determined by a simple office procedure known as ]]>fine needle aspiration]]>. A fine-gauge needle is inserted into the lump and fluid is withdrawn.

If the lump is a cyst, it will collapse once the fluid is removed. If it's a complex cyst, the next step is an ultrasound-guided fine needle aspiration that would likely cause the cyst wall to collapse.

"If we were concerned that there was something in the cyst wall, we would proceed with a biopsy," says Kaelin.

Treatment

While there is no definitive, medically proven treatment for breast pain caused by fibrocystic changes, there are various remedies that can be helpful.

Avoiding Coffee and Cigarettes

For some women, avoiding foods and beverages containing ]]>caffeine]]>, such as coffee, tea, chocolate, and soft drinks, may help to alleviate the discomfort. Women who stop smoking may notice that their lumps decrease as well.

Medication

Aspirin and other pain relievers, as well as heat application can relieve uncomfortable symptoms, as does wearing a bra that provides firm support. In worse case scenarios, oral contraceptives—which change the hormonal balance in your body—can lessen fibrocystic changes. For severe cases, Danazol, a synthetic form of the hormone androgen, may be prescribed. However, many women find that the side effects of Danazol, including weight gain, hair growth, and voice changes, are more distressing than the fibrocystic discomfort.

"Finding out what works for individual women is a trial and error process. If there was one good way to treat the discomfort, everyone would be treated that way. Not every remedy works for everyone but hopefully, at least something works for everyone," Kaelin observes.

Fibrocystic Changes and Breast Cancer

There is no correlation between fibrocystic changes and breast cancer. However, fibrocystic changes can make it more difficult to detect breast cancer. Being familiar with your breasts, and the changes throughout the month may be the best way to alleviate concerns about these cyclic changes.

Clinical Breast Exams

Experts have different views about if and when a woman should have a clinical breast exam (breast exam by a health proffesional). The American Congress of Obstetricians and Gynecologists recommends a clinical breast exam every year. The American Cancer Society recommends that women aged 20-39 have an exam every three years, while women aged 40 and older should have it yearly. Talk to your doctor about a schedule that is appropriate for you.

How to Examine Your Breasts

A breast self-exam (BSE) is a step-by-step examination of your breasts that you do yourself. BSE can be done on a regular schedule, occasionally, or not at all. The goal of the exam is to help you notice any changes or concerns in your breast tissue. Talk to your doctor about the risks, limitation, and benefits of BSE. If you choose to do the exam, follow these guidelines from the American Cancer Society:

1. It is best to do your BSE when your breasts are not tender or swollen.
2. Remove your shirt and bra.
3. Lie down on your back, with your left arm behind your head. This position causes the breast to settle on your chest and spread out more evenly than it would if you were standing up.
4. Use the finger pads on your right hand to feel for lumps in your left breast. Move the finger pads in little circles to feel for any lumps.
5. Apply different amounts of pressure:
   • Light pressure can detect lumps just under the skin.
   • Medium pressure can detect lumps in the middle of the breast tissue.
   • Firm pressure can detect lumps down near the ribs.
6. Move around the breast using a vertical-line pattern. Check the whole breast area—from the ribs to the collar bone, as well as from the chest bone to the underarm.
7. Repeat the procedure on the other breast. Place your right arm behind your head and use your left hand to do the exam.
8. While standing in front of a mirror, press down on your hips. Look both in the mirror and down on your breasts. Look for any changes in the size, shape, or contour of the breasts. See if the skin (including the nipple) has any puckering, dimpling, scaliness, or redness.
9. Lastly, check each underarm while you are sitting or standing. Raise your arm a little so that you can feel the underarm area. (Note: If you raise your arm too high, it will be harder to feel this area.)