Fibrocystic Changes and Fibroadenomas in Breast Health

Regarding breast fibrocystic changes and fibroadenomas?

Hello Dr.
Yuan: Two years ago, during a company health check, I underwent a breast ultrasound examination.
The results indicated a suspicious mass, approximately 0.7 cm in size, located at the five o'clock position on the left side, which was suspected to be a fibrocystic lesion.
The right side showed no abnormalities.
This year, during a follow-up examination, I informed the doctor about the previous findings.
Upon examining the left side at the five o'clock position, the doctor confirmed the presence of the mass, which had decreased in size to 0.54 cm.
However, two additional masses were found: one at the two o'clock position measuring 0.45 cm and another at the eight o'clock position measuring 0.41 cm.
Initially, I thought there were no abnormalities on the right side, but an ultrasound revealed a mass at the eleven o'clock position measuring approximately 0.81 cm.
The doctor indicated that this mass required further investigation because its location in the outer upper quadrant is considered a higher-risk area, and its size is also significant.
Therefore, I was advised to see a breast surgeon.

Two days later, I had the examination scheduled.
The doctor first performed a physical examination, followed by an ultrasound.
The results regarding the number and size of the masses on both sides were consistent with the company health check, with no significant discrepancies.
However, the doctor pointed out the differences in the images: the three masses on the left side appeared as clear black circular or oval shapes, while the mass on the right side was indistinct (with white images within the black circular shape).
The doctor advised that this required monitoring and recommended a follow-up ultrasound in three months.
Due to my anxiety, the doctor performed a core needle biopsy, and I was informed that the report would take a week.
After several days of waiting, I would like to ask Dr.
Yuan if my case indicates a tendency to develop fibrocystic lesions.
Regarding the indistinct mass in my right breast, could it be a fibroadenoma? I have read that the difference between a cyst and an adenoma is that adenomas are solid.
How can the two be distinguished on imaging? Is there a high likelihood of malignancy? Generally, at what size do cysts require surgical intervention? Thank you for your response, Dr.
Yuan.

kira, 20~29 year old female. Ask Date: 2019/03/22

Dr. Yuan Tianmin reply Breast and Thyroid

Some women often find that there are growths in their breasts during examinations.
Initially, if these growths appear to be benign tumors, it is generally recommended to monitor them.
However, if there are differences in imaging results, short-term follow-up may be advised, or a core needle biopsy may be performed to confirm the tissue characteristics.
Of course, the presence of these growths can be attributed to individual body constitution.
Fibrocystic changes and fibroadenomas are differences in tissue composition, and they are both considered benign.
Whether or not to remove them depends on the specific circumstances of each case.

Reply Date: 2019/03/22

More Info

Understanding fibrocystic changes and fibroadenomas is crucial for breast health, especially for individuals who have experienced changes in breast tissue over time, as you have described.
Fibrocystic changes refer to a common condition in which the breast tissue becomes lumpy or rope-like, often accompanied by pain or tenderness, particularly in relation to the menstrual cycle. These changes are benign and are thought to be influenced by hormonal fluctuations. They can manifest as cysts (fluid-filled sacs) or fibrous tissue, and while they can cause discomfort, they are not associated with an increased risk of breast cancer.

On the other hand, fibroadenomas are solid, benign tumors made up of both glandular and fibrous breast tissue. They are typically well-defined, movable lumps that can vary in size. Fibroadenomas are most common in younger women and can sometimes be mistaken for cysts on imaging studies. The distinction between a cyst and a fibroadenoma can often be made through ultrasound imaging. Cysts usually appear as dark (anechoic) areas on ultrasound, while fibroadenomas may appear as solid masses with a more complex structure.

In your case, the presence of multiple cysts and the new lump in your right breast raises important questions. The fact that the left breast cyst has decreased in size while new cysts have appeared is not uncommon and may reflect the dynamic nature of fibrocystic changes. The right breast lump, being larger and described as "fuzzy" on imaging, warrants further investigation. The indistinct margins can sometimes indicate that it is not a simple cyst, which is why your physician recommended a follow-up ultrasound and a core needle biopsy.

Regarding your concerns about the potential malignancy of the right breast lump, it is important to remember that most breast lumps, especially in younger women, are benign. However, the characteristics of the lump, including its size, shape, and the clarity of its borders, can provide clues. Generally, a lump that is larger than 1 cm, has irregular borders, or shows significant changes over time may require closer monitoring or surgical intervention.

As for the question of when surgery is necessary, it typically depends on several factors, including the size of the lump, whether it is causing symptoms, and the results of imaging studies and biopsies. If a cyst is large and symptomatic, or if there is uncertainty about its nature, aspiration or excision may be recommended. For fibroadenomas, if they are small and asymptomatic, they may simply be monitored. However, if they grow or cause discomfort, surgical removal may be considered.

In summary, while your situation may indicate a tendency toward fibrocystic changes, it is essential to follow your physician's recommendations for monitoring and further evaluation. The core needle biopsy will provide more definitive information about the nature of the right breast lump, and your healthcare provider will guide you on the best course of action based on the results. Remember that early detection and regular monitoring are key components of maintaining breast health.

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