Fibrocystic breasts: breast pain and benign fibrocystic changes

What are fibrocystic breasts?

Fibrocystic breasts describe a group of benign changes in breast tissue: small fluid-filled cysts, more fibrous areas and sometimes an increase in the number of small glands (adenosis). Doctors now prefer to speak of “fibrocystic changes” rather than a “disease”, because this is usually an exaggerated but normal response of the breast to the hormones of the menstrual cycle.

This topic is covered within the wider field of gynaecological cancer care, because fibrocystic changes are often the first explanation for a worrying lump or pain, and because they must be distinguished from cancer.

Who is affected?

Fibrocystic changes mainly affect women aged 30 to 50, during the years when they have periods. Both breasts are usually affected. The changes usually ease after the menopause, unless you take hormone therapy.

What causes fibrocystic breast changes?

The breast is very sensitive to hormones. In each cycle, oestrogen stimulates the ducts and glandular tissue; after ovulation, progesterone prepares the gland, and everything then settles down with your period. In some women, this process leaves traces: ducts widen and form cysts, and the supporting tissue thickens and becomes fibrous.

A relative imbalance between oestrogen and progesterone is often suggested to explain very painful forms, particularly during the perimenopause, when cycles become irregular. To understand these hormonal changes, see our article on the menstrual cycle.

What are the symptoms of fibrocystic breasts?

• Breast pain or tenderness (mastalgia), often in the days before a period and easing afterwards;
• heavy, swollen breasts that are sensitive to touch;
• lumpy, granular breast tissue on examination, especially in the upper outer part of the breasts;
• one or more mobile, sometimes tender lumps, which may get bigger before a period (cysts);
• less often, a harmless greenish or milky discharge from several openings in both nipples.

Bloody discharge or discharge from a single opening, a hard lump that does not change with your cycle, or a change in the skin are not typical of fibrocystic breasts: you should see a doctor. During pregnancy or breastfeeding, breast pain has other causes, described in our article on breast pain during pregnancy.

Do fibrocystic breasts increase the risk of breast cancer?

This is the question most patients ask. The answer depends on what microscopic analysis shows, when a biopsy has been done. Large follow-up studies classify benign lesions into three groups:

Common fibrocystic changes, made up of cysts and fibrosis, belong to the first group. Breasts that are simply fibrocystic on examination and imaging therefore do not, on their own, need any special monitoring. On the other hand, atypical hyperplasia found on a biopsy usually leads, according to French guidelines, to surgical removal of the area; monitoring instead may be discussed at a multidisciplinary team meeting. Family history remains a factor to consider alongside this.

What tests are needed for fibrocystic breasts?

Diagnosis is based first on your history and a clinical breast examination, ideally in the first half of your cycle, when the breast tissue is less tense. Imaging is requested depending on your age and symptoms:

• Breast ultrasound: the first-line test before 40 and for any lump. It tells a cyst (filled with fluid) from a solid lesion.
• Mammogram: recommended from 40 if you have symptoms, or as part of the French national screening programme between 50 and 74. See our article on mammography.
• Fine-needle aspiration of a cyst, if it is large and painful: it gives immediate relief.
• Core needle biopsy if an image is classed as suspicious or uncertain (ACR 4 or 5).

The radiologist classifies the results using the ACR (BI-RADS) system. The vast majority of fibrocystic breasts are classed ACR 1 or 2, meaning normal or benign. For breast pain with normal imaging, neither MRI nor biopsy is recommended.

Simple cyst or complicated cyst?

On ultrasound, a simple cyst looks completely black, with a thin wall: it is benign and needs no specific follow-up. A so-called “complicated” cyst, containing thicker fluid, is also usually benign; a follow-up ultrasound a few months later is generally offered. A cyst with a solid part inside, however, must be biopsied.

How can I relieve painful fibrocystic breasts?

No treatment makes fibrocystic changes disappear, but the pain can be eased considerably. The first step is often reassurance: knowing that it is not cancer is enough for many women.

Simple measures

• a well-fitting, supportive bra, including at night during painful spells or for sport;
• cold or warmth applied locally, whichever helps;
• a simple painkiller or an anti-inflammatory gel, on medical advice.

Medical treatments

• Reviewing any contraception or hormone treatment that makes the pain worse;
• progesterone gel applied to the breasts, sometimes offered, with unproven benefit;
• in severe forms that do not respond, other medicines exist, but their side effects limit their use: they are discussed case by case.

Evidence for evening primrose oil, vitamin E or cutting down on caffeine is weak. Surgery has no role in simple fibrocystic changes. It is reserved for a suspicious or atypical lesion, or a benign lump that is growing.

When should I see a doctor about breast lumps or pain?

See a doctor promptly, within a few days, if you have:

• a new lump that persists after your period, especially if it is hard and fixed;
• bloody discharge or discharge from a single opening of the nipple;
• puckering of the skin or nipple, redness, or skin that looks like orange peel;
• pain always in the same spot, which does not follow your cycle;
• a hard lymph node in the armpit.

Regular follow-up with your gynaecologist, with a clinical breast examination once a year from age 25, is still recommended. If you find a lump, our article breast lump: what should I do? explains the steps. To book an appointment at the practice: Doctolib or +33 1 43 79 59 79.

Frequently asked questions

General information article: it does not replace a medical consultation. In an emergency, call 15 or 112 in France, or your local emergency number.