- Single or multiple cysts in the breast.

Causes and Incidence The cause is unclear but is thought to be related to a hormonal imbalance, with an excess estrogen production and a progesterone deficiency during the luteal phase of the menstrual cycle. Fibrocystic disease is the most common breast condition, occurs primarily during the childbearing years, and is estimated to be present in at least half of all women. It accounts for half of all breast surgery.

Disease Process The precise process of cyst formation is unknown. However, a wide variety of morphologic changes occur in fibrocystic disease, including fibrosis, cyst formation, sclerosing adenosis, and ductal hyperplasia. The cysts may be nonproliferative, proliferative without atypia, or atypically hyperplastic.

Symptoms Symptoms typically appear about 1 week before the onset of menstruation and subside about a week after menstruation stops. They include lumpy breast tissue; tender, burning, aching, heavy breasts; and nipple discharge.

Potential Complications Women with atypical hyperplasia have a greater risk of cancer. Infection is another possible complication.

Diagnostic Tests Clinical evaluation with mammography or ultrasound. The definitive diagnosis is made by biopsy and histologic examination of tissue.

Treatments

Surgery
Subcutaneous mastectomy for chronic disease.

Drugs
Progestin/estrogen injections in second half of cycle to correct hormonal imbalance.

General
Support bra, heat compresses to reduce breast pain; forgoing foods with methylxanthines (e.g., coffee, tea, chocolate), which increase metabolic breast activity.

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