A 56-year-old female recently came for the annual breast check.
She started seeing me in 2000 when she was 40 years old for breast macrocysts, huge ones, one on each breast. I did needle aspirations and the masses completely disappeared right after the procedure. She was told that the macrocysts are not breast cancers but may recur. There were indeed recurrences every year from 2000 to 2014. I just did repeated needle aspirations for the huge and symptomatic ones. She had menopause in March 2014 and for 2 years now since after her menopause, there had been no recurrences of her macrocysts.
Breast macrocysts are dominant breast masses that represent an exaggerated increase in the size of “cystic” component of a “fibrocystic changes.” The cysts in fibrocystic changes are usually microscopic or less than one cm in size. Fibrocystic changes and macrocysts belong to the same medical condition that is caused by hormonal changes.
The macrocysts contain fluid which can be yellowish, grayish, and brownish. The macrocysts usually completely disappear right after a needle aspiration.
I vividly remember one patient in the past, that was about 20 years ago, who despite my assurance that needle aspirations would do, insisted on her macrocysts operated on. I did not agree to the operation. She went to see another surgeon for the operation.
The above narrated patient (56-year-old female) clearly demonstrated that needle aspiration is the treatment of choice for macrocysts of the breast. The hormonal therapy, usually pills, such as Danazol) has met with unpredictable outcome and the pills are expensive (more than P100 per tab prescribed daily for three to six months). If the macrocyst recurs and is big and symptomatic, repeated aspirations should be done. The macrocysts usually stopped recurring upon the onset of menopause.
The reasons why I don’t recommend excision of the macrocyst (based on my personal experience) are: 1) there is no thick capsule that contains or walls off the cyst in which one can remove the cyst en toto and 2) once one manipulates the cyst and accidentally punctures it, the cyst completely disappears that there is nothing grossly pathologic to remove anymore. A surgeon who shows a patient a piece of breast tissue removed after the breast cyst is accidentally puncture has just removed part of the normal breast tissue surrounding the punctured cyst. The reading by the pathologist on this tissue is usually fibrocystic changes, which constitutes normal breast tissue changes.
After one such experience in 1982 (at the start of my private practice), that is, cyst punctured during an operation and the cyst completely disappears that there is no gross pathologic tissue to remove anymore, I don’t do excision of macrocysts anymore. I just aspirate them. This has been my practice since then.