Whenever I give out a diagnosis of “FIBROCYSTIC BREASTS” or “FIBROCYSTIC CHANGES” to a patient, it automatically means there is no breast problem; it is usual; and most important of all, it is NORMAL.
Fibrocystic breast changes lead to the development of fluid-filled round or oval sacs (cysts) and more prominent scar-like (fibrous) tissue, which can make breasts feel tender, lumpy or ropy. Thus, there may be on and off breast pain or discomfort.
Medical professionals have stopped using the term “fibrocystic breast disease” and now simply refer to “fibrocystic breasts” or “fibrocystic breast changes” because having fibrocystic breasts isn’t really a disease. Breast changes categorized as fibrocystic are considered normal.
My flow of examination and evaluation consists of the following:
- I look for any visible abnormality in the two breasts.
- I then palpate the breasts to look for a dominant mass illustrated below. A dominant breast mass is a three-dimensional distinct mass that is different from the surrounding breast tissue.
If there is no visible abnormality in the two breasts and there is no dominant breast mass, my conclusion / diagnosis is FIBROCYSTIC BREASTS or FIBROCYSTIC CHANGES. When I say FIBROCYSTIC BREASTS or FIBROCYSTIC CHANGES, I mean it be NORMAL breast finding.
Before the advent of the rampant use of ultrasound of the breasts, I usually give out an outright diagnosis of NORMAL BREASTS or NORMAL FINDINGS. Nowadays, with the rampant use of ultrasound of the breasts, I am forced to give out a diagnosis of FIBROCYSTIC BREASTS or FIBROCYSTIC CHANGES but still emphasizing to the patient, it is equivalent to NORMAL BREASTS or NORMAL FINDINGS.
With the rampant performance of ultrasound of the breasts, with the common inclusion of “cystic nodules” and “solid nodules” and usage of “nodules” in the reports, I have to explain to the patients what these “nodules” are in the light of my findings of no dominant breast mass, ergo, FIBROCYSTIC BREASTS or FIBROCYSTIC CHANGES. I would explain it this way – the “cystic nodules” correspond to the “cystic” component of FIBROCYSTIC and the “solid nodules” in the absence of a palpable dominant breast mass, corresponds to the “fibro” component of FIBROCYSTIC. The scar-like (fibrous) tissue of FIBROCYSTIC will appear solid on ultrasound. The solid and cystic nodules on ultrasound in the absence of a palpable dominant breast mass are consistent with a diagnosis of FIBROCYSTIC BREASTS or FIBROCYSTIC CHANGES. I use these terms, FIBROCYSTIC BREASTS or FIBROCYSTIC CHANGES, to facilitate my explanation of my clinical diagnosis, interpretation of the ultrasound results, and most important of all, to allay the fear of the patients, when they see the word “nodules” on ultrasound. At the end of my explanation, I still emphasize that FIBROCYSTIC BREASTS or FIBROCYSTIC CHANGES is equivalent to NORMAL BREASTS or NORMAL BREAST FINDINGS. If I don’t emphasize this, the patient will keep on thinking, therefore, still keep on worrying, that she has a breast condition, though benign.
Please read this link to better understand what I am explaining on the ultrasound of the breasts.
Ultrasound Q. 2002 Mar;18(1):35-40.
Sonographic findings in focal fibrocystic changes of the breast.
From Baylor College of Medicine and Woman’s Hospital of Texas
In 58 patients, there were 60 lesions with a pathologic diagnosis of focal fibrocystic changes (FC). Sonographically, focal FC appeared as solid mass in 28 cases (46.6%) and as cysts in eight (13.3%). In nine cases (15%), heterogeneously echogenic tissue was seen, and in the remaining 15 (25%) cases, there was no sonographically visible focal change.