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Friday, April 18, 2014
My last mammogram detected what was diagnosed as cysts in one breast with one of the cysts being about 3/4 " in diameter. My doctor advised to have an ultrasound and then again the diagnosis was cysts. My doctor then recommended that I see a general surgeon. The surgeon said that removal of the cysts was optional and if I did not want the cysts removed at this time, he would recommend a follow up mammogram in six months and then if there were any changes to remove them at that time. If I did want them removed now, he felt that they should be removed under general anesthesia and not removed under local anesthesia or aspirated. I'm 46 and I have had regular mammograms for the past 10 years. Neither I, nor the two doctors can detect the cysts during a physical exam. My questions are: Are there any other options besides/better than removal of the cysts under general anesthesia and is the size and number of cysts significant?
A large cyst is a sac filled with fluid, like a large blister that is usually in the middle of the breast tissue. Some of the larger cysts can be felt if they are close to the surface of the breast. Some are deep and can only be detected by mammogram. The ultrasound your physician ordered was to see if the lumps were cystic or solid. If they are cystic the sound waves go through them showing no shadows. If the lumps are solid, the waves from the ultrasound would have bounced back showing a shadow behind the lump. Dr. Susan Love states that cysts found through a mammogram and ultrasound don't need to be aspirated or removed because it is known by these tests that they are not cancer. Cysts are rarely cancerous. However, it is important to be reevaluated in 6 months to see if there are any changes in the breast tissue.
Some physicians aspirate cysts with a needle in the office to draw out the fluid. This will help relieve the pain in painful cystic breasts. The cyst collapses like a punctured blister. Some doctors send the fluid to a lab to be analyzed, others do not because false positives are common. Sometimes, the doctor will aspirate a cyst to see if the lump is a cyst(filled with fluid) or not instead of doing an ultrasound. Your doctor did the ultrasound to diagnose that you had cysts. Many women have multiple cysts so the number and size do not negate that they are cysts. What is significant is that you continue to see your doctor every 3 to 6 months as indicated by your physician for ongoing evaluation. I am assuming that you have more than one cyst and that they are deep in the breast tissue since they cannot be palpated. This could be the reason for general anesthesia to remove them but the answer to that must come from the surgeon. I hope you feel better about waiting another 6 months for another mammogram and a second evaluation. If you are still concerned and anxious about your breast with this information, you can consider getting a second opinion from another physician. Thank you for writing.
Janet Trigg, RN, MSN, EdD
College of Nursing
University of Cincinnati