What is fibrocystic breast condition?
by Dixie Mills, MD, FACS
Fibrocystic breast condition is a benign (not cancerous) but sometimes uncomfortable
or painful condition. It’s been called all sorts of things over the years,
so you may already know a little bit about it under a different name, like mammary
dysplasia, fibrocystic breast changes, diffuse cystic mastopathy, or fibrocystic
breast disease (our least favorite term). It’s also incredibly common.
In general, the term is a bit of a misnomer because if women were to have a biopsy,
and have their breast tissue looked at under the microscope, not even half with
fibrocystic breast condition would have actual breast cysts. As I’ve said
before, it’s unfortunate that in medical school we do not spend much time
on the normal, resting breast or even the typical non-malignant symptoms. When we
better understand what is normal, perhaps everything other than cancer won’t
get lumped (that is an attempt at a pun) into the category of fibrocystic.
In the meantime, the word fibrocystic technically means “increased
fibrosis and cystic spaces especially in the glandular tissue,” and part of
the reason it sounds so serious is that when you hear of “fibro” or
“cystic,” you might think of cystic fibrosis, a very serious,
inherited glandular (mostly lung) disease discovered usually at childbirth. There
is no correlation — only in name. But although the term “fibrocystic”
can sound a little scary or misleading, it’s really just a wastebasket term
for all types of noncancerous breast issues: lumps, swelling, pain,
discharge, and it is not related to anything functionally or anatomically
in the breast. (Doctors usually need such medical terms to mystify the public —
for years, they called fibrocystic breast condition a disease until it was declared
neither a disease, nor a risk factor for breast cancer. Unfortunately it is a label
many women have been given and carry around as a stigma — and, even worse,
some insurance companies code some women as having a “precondition”).
So it’s important to keep the condition of fibrocystic breasts in a healthy
perspective — it’s really no more a disease than hairy chests are in
men. But some women do experience more severe symptoms than others.
Fibrocystic breast condition is known to be genetic: in other words, if your mother’s
breasts or father’s sister’s breasts were lumpy, yours may be too —
but as you now know, breast lumps can be very subjective. If you’re comfortable
with the idea, I’d encourage you to talk about it — we can at least
share information with our teenaged or adult daughters, if not our older female
But I also noted in Africa, where I was working a couple of weeks ago, that most
of the women’s breasts I examined were much less lumpy than the Caucasian
women’s breasts I had seen over the last two decades in practice. Now, some
of this could be genetics, but I also noted that their diets were very different,
with much less red meat and processed foods and very little white sugar.
How do I know if my breasts are fibrocystic? — the symptoms of fibrocystic
It’s been reported that fibrocystic breasts affect over 60% of women, usually
between the ages of 30�50. Because the condition is typically related to the
normal hormonal fluctuations in a woman’s body, with lumps appearing
and disappearing along the normal menstrual cycle — commonly the week before
the period or in perimenopause from ovulation to menses — fibrocystic breast
condition tends to wane after menopause. But symptoms can be managed well through
hormonal balance and some key nutritional changes which I’ll talk about in
a little bit.
I’ve spoken with many women at the clinic with fibrocystic breast condition
who complained that they didn’t feel one specific lump, but that their breasts
just “felt different.” So to be able to identify something “foreign”
in your breasts, you can examine them regularly and be better equipped to know what
to look for. Since each breast is unique, your symptoms of fibrocystic breast condition
might differ from someone else’s, and there is no one hard and fast way to
identify the condition. But what follows is a list of what most women report when
they have fibrocystic breasts:
- Irregular, dense, rubbery, or bumpy “cobblestone” consistency of the
- Usually more noticeable in the outer upper part of the breast(s)
- Generalized lumpiness which comes and goes
- Breast discomfort (usually in both breasts)
may be persistent or it may come and go
- A feeling of fullness in the breast(s)
- Dull, heavy pain and tenderness
- Tenderness and swelling increases premenstrually
- Occasional nipple discharge
I advise women to exercise caution when they find breast lumps, but not to go right
into panic mode. Remember that a lumpy, bumpy breast doesn’t immediately mean
that the lump is malignant, and the best thing to do if you find an unusual breast
lump or texture that’s out of the ordinary is to speak with your healthcare
practitioner. If they themselves cannot distinguish fibrocystic breast condition
from something more serious, they will refer you to someone who can, and there are
many possible ways they can do this.
How your healthcare practitioner may evaluate fibrocystic breast condition
— ruling out other problems
Usually when your healthcare practitioner is setting out to evaluate fibrocystic
breast condition, there will be an initial breast exam, which can lead
to a mammogram, the most frequently used diagnostic tool for breast lumps.
If your provider has examined your breasts before, he or she may be able to tell
by another examination whether there is a change or not. But usually an imaging
test is recommended.
If there are no clear answers when the mammogram is read, you may be referred for
an ultrasound to outline a part of the breast. Ultrasounds are not just
for examining pregnancies; they’re useful to further evaluate possible abnormalities
found during mammograms or physical examinations. They are also recommended for
women too young to have a mammogram — those under 40 years. And different
types of breast tissue, solid areas, and fluid-filled cysts have distinctive appearances
on an ultrasound screen.
What is a fibroadenoma?
Fibroadenomas are among the most common breast lumps, particularly in women
younger than age 40. They are usually detected as benign breast lumps, and felt
as one dominant, freely mobile lump. They can be smooth, rubbery, or hard, and can
be difficult to tell from a cyst, and less often from a cancer.
But imaging radiologists, the people who read mammograms, and sometimes ultrasounds
and MRI�s, are well-trained in identifying a variety of benign breast conditions,
But if there is still uncertainty whether a breast lump or unusual texture is a
cyst or something else, your practitioner may recommend a biopsy. The good news
is that many more procedures are available to women today, so the word “biopsy”
doesn’t immediately mean surgery. Here are four types of preliminary biopsy
- Fine-needle aspiration (FNA) biopsy extracts fluid from the cyst for further
analysis, and can essentially “drain the lump.” This can be a fairly
unsettling experience for some women since a very thin needle has to be inserted
into the breast tissue. But thankfully the procedure is essentially painless because
nerves are located primarily in the skin, not in the breast tissue itself (a topical
anesthetic can be applied to diminish sensation). Even if no fluid is obtained,
some small cells can be sent to a cytopathologist, who can look at them and say
if they look benign or not. In the field of breast
health there is a term called the triple test: a doctor’s
exam, a mammogram, and a fine needle aspiration. If all three are negative there
is a nearly 99% chance that the lump is also benign.
- Another type of biopsy is called a core-needle biopsy, which uses a larger
needle than the type employed with FNAB to examine not just fluid and cells but
also a bit of breast tissue — for this, again, your practitioner will most
likely be using a local anesthetic for the breast area to be biopsied.
- Ultrasound�guided biopsy and stereotactic biopsy are two newer
approaches in which images (either ultrasound or x-rays) of the breast from different
angles are used to better guide a large core needle directly to the site of the
mass, or something questionable seen on mammography. Both of these types of biopsies
are usually done by radiologists in an imaging center.
- Finally, a conventional surgical biopsy is an option, but having surgery
carries its own complications, and the recommendation today is that for diagnosis,
the majority (if not all lumps or questionable areas in the breast) should be biopsied
noninvasively, or with a needle in an outpatient setting, before resorting to the
operating room. While surgery has its place, knowing your full range of options
is a good way to protect yourself from undergoing an unnecessary procedure and longer
What is proliferative fibrocystic breast disease?
The breast condition we address in this article, “fibrocystic breast condition”
is a non-scientific term used by some medical clinicians. It is different from the
condition that some doctors/medical providers refer to as “proliferative fibrocystic
Here are some distinguishing features of proliferative fibrocystic breast disease:
- Can only be diagnosed after a biopsy.
- Characterized by an abnormal increase in the number of cells.
- Cells can appear abnormal under the microscope.
- Not cancerous, but is associated with an increased risk of cancer.
- Often used as a synonym for atypical hyperplasia; however, they are not
exactly the same: increased risk associated with proliferative is 2X, risk from
atypical proliferative or atypical hyperplasia is 4X higher than normal.
If you are told you have fibrocystic breasts, don’t worry about your risk
unless you have had a biopsy which showed some atypia. If you are unsure whether
you may have proliferative fibrocystic breast disease or simply fibrocystic breast
condition, be sure to ask your healthcare provider to clarify the pathology � ask
if you have hyperplasia and/or atypia. You should be seen by a breast specialist
to assess your risk factors.
The important thing is that it’s vital not to “dismiss” a breast
lump as fibrocystic breast condition — especially if you’ve been living
with the condition for a long time. Having regular breast exams by a clinician you
trust is just as important for a woman with fibrocystic breast condition as for
women without, and I recommend regular mammograms if you’re over 40.
So if you find a one particular lump: breathe. Wait until after a period if you
are having them, and if you can, see your healthcare provider then. But even if
the mammogram is normal and you are still worried, follow up on it — see a
breast specialist for their opinion and/or ask about getting a needle biopsy.
But always bear in mind that you are your own best breast health advocate!
So here are a few pieces of advice I like to first share with women who come to
me concerned about a lump in their breast:
- There is no reason to worry or be anxious — find out what it is — worry
and stress aren’t good for anyone.
- High-risk women — those with a family history of breast cancer or a history
of a biopsy with atypical cells — should be followed at a high-risk clinic
with regular exams and ultrasounds and perhaps even MRI’s (magnetic resonance
- There is no way to tell proliferative breast disease or atypia except on a biopsy.
Keep in mind that there is some concern that having biopsies increases a woman’s
risk, so it is best to try to determine the nature of a lump noninvasively if possible
— ultrasound, MRI, needle, or waiting through a cycle.
- Have a lump removed if your intuition is telling you to.
Just spending time to learn about breast health can teach us so much, and each woman
should know her breasts better than anyone. So in that light, I think it’s
time we all looked at the self breast exam a little differently. Getting to know
your breasts can really mean just that — spend a bit more time than your healthcare
practitioner or gynecologist would when giving yourself an exam, and don’t
worry about being clinical about it! Women can examine their own breasts in whatever
way they want, and it does not have to be done just once a month. While there are
certain methods we can all use to examine our breasts, there is no one “correct”
way — self-exam is something each woman does at her own pace, and it shouldn’t
Our Personal Program is a great place to start
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phone consultations with our Nurse–Educators. It is a convenient, at-home
version of what we recommend to all our patients at the clinic.
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Related to this article:
References & further reading
on fibrocystic breast condition
Principal Author: Dixie Mills, MD