Symptoms accompanying breast cysts may include a feeling of tension and pain in the breast, typically accentuated in the premenstrual period.
Usually, the cystic formations of the breast are benign in nature and do not evolve towards malignancy; however, the presence of one or more lesions makes clinical monitoring advisable.
Breast cysts generally do not require any treatment, except in cases where the symptoms and size of the lesions cause discomfort to the patient. In these cases, it is useful to drain the fluid contained inside the sack-like formations by means of needle aspiration (a procedure that is both diagnostic and therapeutic); alternatively, although rarely, surgical removal may be indicated.
Alterations in normal hormone levels (such as an excess of estrogen) and changes in breast tissue (glandular, fibrous and adipose) with age may play a role in the development of cysts. The likelihood of their formation decreases, however, abruptly after birth. menopause.
The cysts tend to form in correspondence with the terminal unit of the lobular duct, ie at the point where the lobules join the milk ducts (tubes that carry the milk produced by the mammary glands to the nipple). In particular, cystic cavities can arise by an abnormal development of the mammary glandular component and the stroma that surrounds it; these situations, if they lead to the obstruction of a segment of the ducts by the hyperplastic epithelium, can cause dilation and accumulation of fluid.
Breast cysts can occur in the context of fibrocystic mastopathy. In this case, symptoms such as pain (mastodynia) and a sense of breast tension are more intense in the second half of the menstrual cycle or during pregnancy.
Although they are predominantly a female disorder, cysts can also develop in the breasts of men.
discreetly mobile.
In the breast, one or more cystic formations may develop. Generally, these lesions form in only one breast, but it is not excluded that they can affect both breasts at the same time. The size of breast cysts can vary from a few millimeters (microcysts) to a few centimeters (macrocysts).
Generally, microcysts cause no symptoms, but they can be found by imaging tests, such as ultrasound or mammography.
Breast macrocysts can, on the other hand, be perceived upon self-examination of the breast, as a rather soft grain of grapes or a small balloon full of water. rounded and smooth and well defined margins.
Large breast cysts can cause pain (mastodynia), a sense of tension and deformity of the normal breast profile, so they can be a cause for concern for the patient. In some cases, moreover, transparent or straw-colored nipple discharge may appear. The discomfort and pressure exerted on the breast tissue can be alleviated by draining the contents of the cyst with a needle (fine needle aspiration).
Simple and complex breast cysts
- "Simple" breast cysts are fluid-containing lesions that have a very regular shape and smooth, thin walls; these represent the most common cystic formations and are generally benign.
- There are, however, cysts that have thicker wall sections or appear as clusters of small nodules, separated by septa. Another picture occurs when the formation is not uniformly filled with liquid, but has some solid elements suspended inside it. Usually, these "complex" cysts are biopsied to discriminate their nature, and the interval between one follow-up and the other will be shorter than that established for monitoring simple cysts (for example, every 6 months rather than once. once a year).
Therefore, when a breast cyst is found during self-examination, it is advisable to undergo a medical examination.
The direct examination with the observation and palpation of the breast (breast examination) allows you to feel a lump in the breast, while the breast ultrasound allows you to evaluate the presence of fluid and exclude solid parts or septa.
In order to further discriminate the nature of this lesion, the breast specialist can proceed by taking the contents of the formation (fine needle aspiration or agocentesis of the cysts). This procedure is performed under ultrasound guidance, inserting a fine needle into the suspected lesion and aspirating the material contained in it, which will be examined.
The presence of clear, yellow or greenish liquid usually indicates a breast cyst. When the collected material appears streaked with blood, has solid impurities or neoplastic cells and remains unchanged after the agocentesis, instead, it is sent to the laboratory for cytological investigation.
In the event that no fluid is aspirated, it will probably be necessary to resort to mammography or histological examination (taking a sample of cells through breast needle biopsy).
When the cysts begin to increase in volume and cause discomfort in the patient, however, an outpatient procedure (fine needle aspiration) may be indicated to drain the fluid from the formations, reducing the volume so as to make the mammary gland less tense and painful. The disappearance of the palpable mass or the ultrasound findings indicate complete aspiration.
Often, however, breast cysts can form again, as the outer capsule remains and can collect more fluid. Therefore, if the lesion persists for two or three menstrual cycles, has a certain tendency to relapse after needle aspiration or progressively increases in volume, it is advisable to consult your doctor to evaluate whether to resort to the drainage procedure again or to consider treatment. pharmacological (eg oral contraceptives, danazol or tamoxifen) to reduce the recurrence of breast cysts. Stopping hormone therapy after menopause can also help limit the disturbance.
Only in exceptional cases, ie when the symptoms are particularly accentuated and the lesion evolves abnormally or contains blood material, can surgical removal of the breast cyst be indicated.
