The cysts in the breast are usually not related to cysts elsewhere in the body (such as on the ovary or in the skin).  If a breast cyst is close to the skin and large enough, or hard, it can be felt with your fingers.  Often with the ultrasound, many more cysts are detected than you are able to feel during a self-examination.  Not all lumps felt in the breast will be cysts.  Breast tissue is normally lumpy, so often you encounter a "pebbly" texture.  The ultrasound is invaluable in telling you what you are feeling during a self-examination.

Breast cysts can appear at any age --  in teenagers to 90-year-olds.  Most cysts are found in 40-year-olds.  This implies that cysts are related to the increasing hormone irregularity at this age, but this is not the whole story, as they are still seen in women with no hormonal stimulation.  More cysts are seen in post-menopausal women on hormone replacement (estrogen) therapy than in those women who are not taking hormones after menopause.  Health care professionals are not aware of anything in the diet that affects cyst formation or growth.  There is a common misconception that caffeine causes cysts.  This is not true.  Caffeine may cause breast discomfort, but will not cause cysts.

Often, a woman will notice a sore spot in her breast and start touching that area more carefully.  Because breast tissue is normally lumpy, sometimes it will feel like there is a lump in that sore spot.  Patients (and sometimes their physicians) often assume that the pain is caused by a cyst in that area.  While pain and cysts are often indirectly connected (both can be caused by hormones), the vast majority of cysts do not cause pain, and the vast majority of breast pain is not related to cysts.

An ultrasound is the best way to evaluate breast cysts because it is so very sensitive to fluid in the tissues.  It tells if the lumps felt are cysts or solid, or just normal breast tissue.  It detects cysts that are even smaller than 1/8 inch.  Only an ultrasound can tell if a lump felt during a physical exam is a cyst, or if a nodule seen on the mammogram is a cyst.  Ultrasound also has the detail to show the lining of the cyst and its contents.  If these meet requirements for a simple cyst, it is almost certain to be unrelated to cancer.  If the lining is irregular, or there is debris in the cyst, the ultrasound is not sufficient to evaluate the cyst, and the fluid needs to be aspirated (drawn out with a needle) and examined under a microscope.  Even in this situation, the vast majority of complex cysts will be unrelated to cancer.  The debris is usually caused by the lining cells falling off into the fluid and releasing particles and protein contents.

Cyst aspiration is a quick and simple procedure when done with ultrasound guidance.  The skin is frequently numbed, and a needle is quickly inserted.  Suction is applied, and the fluid is drawn into a syringe.  Most cysts will disappear and never return.  While some cysts (less than 25 percent) will come back, there may be nothing wrong with the cyst.  Cyst aspiration is done for diagnostic purposes, as described above, and also to relieve discomfort and/or anxiety from cysts that can be felt.

Having cysts does not mean that you have "fibrocystic disease."  Cysts are so common that almost every woman will have some during her life.  It does not mean that she is at higher risk for developing cancer.  Many patients need multiple cyst aspirations every year, but after a few years the number of cyst aspirations decreases.
  

The NMMC Breast Care Center would like to provide you with more information
about breast health issues.  If you have additional questions after 
reading this information, please ask a breast health specialist,
mammography technologist or radiologist.