Breast Cysts

What are they?
Cysts are fluid filled pockets that form in the tissues of the breast, causing a mass. Mammography or ultrasound can suggest that a breast mass is a cyst.

Diagnosis and Treatment
A cyst is diagnosed definitively when a needle is inserted into it and the doctor is able to draw out fluid. This is ideal for women with cysts, because the procedure both diagnoses and removes the cyst at the same time. A cyst should completely disappear when drained and the tension of it is relieved.

If the fluid removed is not bloody, it does not have to be sent to a lab for analysis, unless the women is post-menopausal and not on hormone replacement. The woman needs to come in for a follow-up in 4-6 weeks. If she is normal at the re-check, then she may resume routine breast screening. If the cyst reforms, then she will be sent to a specialist who will check her out for a type of breast cancer called intracystic carcinoma. A biopsy of the tissue around the cyst will be done.

If the fluid removed is bloody, it will be sent to a lab for analysis and the women will be referred to a specialist immediately. Again, this is to check for the possibility of intracystic carcinoma. A biopsy will be performed to determine what the breast mass is made of.

If there is a still a breast mass after the removal of all the fluid, that remaining solid mass should be evaluated like any other solid breast mass. This means that either the woman will be referred to a specialist for biopsy or she may be followed with a technique called 'triple diagnosis". The goal of triple diagnosis is to decrease the number of unnecessary biopsies. Triple diagnosis is the combination of Clinical Breast Exam, Mammography, and Fine Needle Aspiration Biopsy. These are all done in the clinic or office. If the results of all three tests are negative, then there is about a 99% chance that the mass is harmless. Even so, follow-up at three and nine months is necessary. If there is any indication of growth of the mass at the follow-up or if the woman misses parts of the follow-up of the mass, then a biopsy will be done.

A woman who has had a cyst drained should not have a mammogram as the aspiration can cause false positive results.

The Bottom Line
When a woman is suspected of having a cyst, it will be drained. She will be followed up according to her situation and the character of the fluid. The goal of breast cyst management is to determine if and when a woman needs a biopsy in the hospital to check for cancers. However, the cyst in and of itself should not be the cause of great concern. It is just best to be cautious.

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