Breast Cysts: Symptoms, Causes, and Treatment

The breast tissues have a complex structure, primarily composed of milk glands and milk ducts. In the center, there is adipose tissue and connective tissue that support the breast structure. Breast cysts can develop, most of which arise from the dilation of the milk glands. These cysts are surrounded by a thicker epithelium, which appears in a tubular form. Their formation may be linked to an imbalance between milk production and absorption, leading to the obstruction of the milk ducts.

These cysts most commonly occur among middle-aged women, but they can appear at any age. They are most frequently discovered in women during the perimenopausal period, which is the final stage of the menstrual cycle. Breast cysts can pose not only aesthetic problems but may also cause physical symptoms in certain cases, which is important to consider during diagnosis and treatment.

Types and Structure of Breast Cysts

Breast cysts exist in various shapes and sizes. They are typically oval or round, with diameters ranging from a few millimeters to several centimeters. These cysts can appear anywhere in the breast and are often present in both breasts. During examinations, multiple cysts may be detected within one breast. Based on their size, cysts are classified into microcysts (smaller than 2 cm) and macrocysts (larger than 2 cm). Statistics indicate that 23% of benign breast lesions are macrocystic formations.

Three basic types are distinguished based on the internal content of the cysts: simple cysts have thin and even walls and are completely filled with fluid. Complex cysts have uneven walls and may contain solid formations or turbid fluid inside. Complicated cysts are characterized by uneven ultrasound images, and the wall thickness may vary. Research indicates that approximately 25% of lumps found in the breast are cysts.

Symptoms and Causes

Smaller breast cysts typically do not cause symptoms, while larger ones may lead to noticeable changes, such as asymmetric breast enlargement or shape deviations. These cysts can be movable under the skin, and their shape may change due to the fluid inside them. In some cases, they may cause painful sensations, and increased sensitivity can be observed during the premenstrual period.

The causes of breast cyst formation are not yet fully understood, but the role of sex hormones, particularly estrogen, may be significant. Postmenopausal women undergoing hormone replacement therapy are more prone to the appearance of cysts. Research has not yet precisely identified risk factors, but hormonal imbalance and genetics, among other factors, may contribute to the development of cysts.

The Diagnosis Process

During diagnosis, physical examination and ultrasound play a key role. Ultrasound examination allows for the precise determination of the cyst’s location, wall, and internal content. A denser ultrasound image may indicate a higher cellular content. If the cyst wall is thicker or uneven and contains dense material, it is advisable to aspirate the cyst’s content and conduct cytological examination.

If any formation is found inside the cyst, a cytological or histological examination is warranted. Laboratory analysis of the fluid obtained from the cyst can also be useful, especially if blood elements can be detected. The need for follow-up ultrasound examinations depends on age and clinical symptoms. If the cyst wall has thickened, further examinations such as mammography or MRI may be necessary for an accurate diagnosis.

Treatment Options

In the case of small, asymptomatic breast cysts, treatment is generally not required. However, if the cysts cause symptoms or imaging studies are unclear, aspiration of the cyst is recommended. If the cyst contains dense fluid, placement of a drain may also be considered. Recurrence of cysts is common, and in certain cases, surgical removal may be necessary, especially if the cysts persist for a long time.

Hormonal therapy may also be used to alleviate symptoms, and good results have been reported with hormonal contraceptives, tamoxifen, or androgens. In addition to pain relievers and anti-inflammatory medications, various herbal extracts and vitamins are recommended for symptom management. In some cases, reducing coffee, tea, and chocolate consumption may also help alleviate complaints.

Prognosis and Prevention

Breast cysts tend to recur, making regular follow-up important. Scars may remain after cyst aspiration, and follow-up examinations are essential. Among those with multiple breast cysts, the rate of malignant breast tumors does not increase. Approximately 1-3% of breast tumors arise from cysts, so regular check-ups, including physical and ultrasound examinations, are crucial.

There are no well-established methods for prevention, but considering treatment options can reduce the risk of recurrence.

Special Cysts

Galactocele or lactocele can develop in the breasts of pregnant or breastfeeding mothers when the milk ducts become obstructed. Due to trauma, such as bruising, a hematoma may form, which can mimic the appearance of a cyst. Fat necrosis, which refers to the death of breast adipose tissue, can also be associated with cyst formation, particularly after certain surgeries or radiation treatments.

At the end of the article, it is important to emphasize that any breast changes warrant a medical opinion to ensure appropriate diagnosis and treatment.