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A cyst is a fluid-filled sac

A cyst in the breast, which feels and looks like a lump, is actually a sac filled with fluid. Cysts occur most often in women in their 30s and 40s and usually go away after menopause. However, the exact cause of cysts is not yet known. Cysts rarely turn into breast cancer, and having cysts does not necessarily increase your risk of getting breast cancer.

Often, you can easily feel cysts. They feel like round lumps that move easily under your fingers and can change during the menstrual cycle. They are smooth on the outside and "squishy" when pressed. However, if the cyst is very full of fluid, it may be firm. Also, cysts deep in the breast may feel more like a firm lump, and may cause the overlying breast tissue to bulge out.

Cysts vary in size, and can change rapidly in size during the menstrual cycle. They often get larger and feel tender just before the menstrual period. Some can also appear suddenly, even overnight. Cysts are often found in both breasts, producing a feeling of "lumpiness."

Typical appearance of a cyst as seen on an ultrasound image

Figure 1

Typical appearance of a cyst as seen on an ultrasound image
The cyst appears completely black and has a smooth, sharp, rounded border.

Cysts may appear by themselves, or tiny cysts may appear in groups like a bunch of grapes or be scattered throughout the breast. Cysts can also occur within the milk ducts and glands within the breast, covered by some fibrous tissue. This is called a fibrocystic condition.

Cysts are diagnosed by physical exam, medical history, mammography, and ultrasound

Ultrasound is frequently used to tell whether a lump is solid or filled with fluid (a cyst). It is a painless procedure that involves holding a hand-held device against the skin while sound waves are transmitted through the breast (see Figure 1).

Cysts are benign (not cancerous) but can be treated if painful

Since cysts are benign (not cancerous), it is safe to leave them in the breast. If a cyst is large or painful, it can be easily drained using a technique called fine needle aspiration.

Fine needle aspiration takes only a few seconds and causes no more pain than having a blood test. The procedure involves inserting a very thin needle attached to a syringe into the cyst. The doctor then draws out the fluid, collapsing the cyst like a small, punctured balloon (see Figure 2).

Fine needle aspirations

Figure 2

Fine needle aspirations
A doctor inserts a needle attached to a syringe into the fluid-filled sac of the cyst and draws out the fluid, collapsing the cyst.

Lifestyle changes will help to reduce or eliminate symptoms of soreness or tenderness. Such changes include reducing the amount of fat in the diet, exercising regularly, and reducing stress.

Regular examinations are important

Regular examinations by you and your physician are important, since cysts can happen anytime until menopause. All new lumps should be assessed to check whether they are fluid-filled cysts or solid lumps. Cysts sometimes refill and, if painful, can be drained.

Urve Kuusk, MD 
in association with the MediResource Clinical Team 
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