Fibrocystic changes (previously, fibrocystic disease) is a catchall term that refers to mastalgia, breast cysts, and nondescript lumpiness, which may occur in isolation or together; breasts have a nodular and dense texture and are frequently tender when palpated. Fibrocystic changes cause the most commonly reported breast symptoms and have many causes. Most causes are not associated with increased risk of cancer; they include adenosis, ductal ectasia, simple fibroadenoma, fibrosis, mastitis, mild hyperplasia, cysts, and apocrine or squamous metaplasia. Other causes, particularly if fibrocystic changes require biopsy, may slightly increase risk of breast cancer. Fibrocystic changes are more common among women who had early menarche, who had their first live birth at age > 30, or who are nulliparous.
Fibroadenomas are typically painless lumps that feel like small, slippery marbles. They usually develop in young women, often in adolescents, and may be mistaken for cancer, although they are benign and tend to be more circumscribed and mobile. Simple fibroadenoma does not appear to increase risk of breast cancer; complex fibroadenoma may increase risk slightly.
Breast infections (mastitis) causes pain, erythema, and swelling; an abscess can produce adiscrete mass. Infections are extremely rare except during the puerperium (postpartum) or after penetrating trauma. They may occur after breast surgery. Puerperal mastitis, usually caused by Staphylococcus aureus, can cause massive inflammation and severe breast pain, sometimes with an abscess. If infection occurs under other circumstances, an underlying cancer should be sought promptly.
Galactocele is a round, easily movable milk-filled cyst that usually occurs up to 6 to 10 mo after lactation stops. Such cysts rarely become infected.
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