Fibrocystic breast changes

Last updated: November 25, 2022

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Fibrocystic breast changes is a nonspecific term that includes a heterogeneous spectrum of breast conditions. Women between 20 and 50 years of age are most commonly affected. Histologically, fibrocystic changes are divided into nonproliferative breast lesions (e.g., simple breast cysts, apocrine metaplasia) and proliferative breast lesions (e.g., ductal epithelial hyperplasia, sclerosing adenosis). Patients typically present with premenstrual bilateral multifocal breast pain with or without palpable nodules, which may be tender. The diagnosis is made during the workup of symptoms (e.g., mastalgia, palpable breast mass, nipple discharge) or incidentally on clinical breast examination and/or imaging. Tissue biopsy, usually a core-needle biopsy, is indicated if there is a clinical suspicion of malignancy. Management of breast lesions without cellular atypia is primarily symptomatic. Proliferative breast lesions with cellular atypia require surgical excision as they are associated with an increased risk of breast cancer.

  • Most common benign lesion of the breast
  • Peak age: 20–50 years
  • Up to 50% of women are affected during their lifetime.

Epidemiological data refers to the US, unless otherwise specified.

Nonproliferative breast lesions [1][2][3]

Proliferative breast lesions (with or without cellular atypia) [1][3]

General principles [1][5]

All patients with a palpable breast mass should be evaluated appropriately, even those with suspected fibrocystic breast changes. [1]


Follow age-appropriate diagnostic workup for a palpable breast mass. The imaging findings in fibrocystic breast changes are heterogeneous and include the following.

Breast ultrasound

  • Scattered calcifications
  • Clustered microcysts [6][7]
  • Simple or complicated cysts (see “Breast cysts” for details). [8][9]
  • Distorted breast parenchyma [9][10]

Mammography [10][11]

  • Focal asymmetry
  • Architectural distortion
  • Round or oval masses with circumscribed borders
  • Calcifications

MRI breast with and without contrast (not routinely obtained) [3]


In patients with suspicious clinical and/or imaging findings, a tissue biopsy is indicated to rule out malignancy.” See “Histologic subtypes” for findings [3][12]

Nonproliferative breast lesions or proliferative breast lesions without atypia

Proliferative breast lesions with atypia (specifically atypical ductal hyperplasia) [1]

Atypical ductal hyperplasia is associated with an increased risk of breast cancer in both the affected and contralateral breast. [1]

  1. ACOG. Practice Bulletin No. 164 Diagnosis and management of benign breast disorders. Obstetrics & Gynecology. 2016; 127 (6): p.e141-e156. doi: 10.1097/aog.0000000000001482 . | Open in Read by QxMD
  2. Zendehdel M, Niakan B, Keshtkar A, Rafiei E, Salamat F. Subtypes of Benign Breast Disease as a Risk Factor for Breast Cancer: A Systematic Review and Meta-Analysis Protocol.. Iranian journal of medical sciences. 2018; 43 (1): p.1-8.
  3. Choe AI, Kasales C, Mack J, Al-Nuaimi M, Karamchandani DM. Fibrocystic Changes of the Breast: Radiologic–Pathologic Correlation of MRI. J of Breast Imaging. 2021; 4 (1): p.48-55. doi: 10.1093/jbi/wbab071 . | Open in Read by QxMD
  4. Visscher DW, Nassar A, Degnim AC, et al. Sclerosing adenosis and risk of breast cancer.. Breast Cancer Res Treat. 2014; 144 (1): p.205-12. doi: 10.1007/s10549-014-2862-5 . | Open in Read by QxMD
  5. Salzman B, Collins E, Hersh L. Common Breast Problems. Am Fam Physician. 2019; 99 (8): p.505-514.
  6. Goldbach AR, Tuite CM, Ross E. Clustered Microcysts at Breast US: Outcomes and Updates for Appropriate Management Recommendations. Radiology. 2020; 295 (1): p.44-51. doi: 10.1148/radiol.2020191505 . | Open in Read by QxMD
  7. Rinaldi P, Ierardi C, Costantini M, et al. Cystic Breast Lesions. J Ultrasound Med. 2010; 29 (11): p.1617-1626. doi: 10.7863/jum.2010.29.11.1617 . | Open in Read by QxMD
  8. Maimone S, Ocal IT, Robinson KA, Wasserman MC, Maxwell RW. Characteristics and Management of Male Breast Parenchymal Cysts. J Breast Imaging. 2020; 2 (4): p.330-335. doi: 10.1093/jbi/wbaa035 . | Open in Read by QxMD
  9. Cho SH, Park SH. Mimickers of Breast Malignancy on Breast Sonography. Journal Ultrasound Med. 2013; 32 (11): p.2029-2036. doi: 10.7863/ultra.32.11.2029 . | Open in Read by QxMD
  10. Choe J, Chikarmane SA, Giess CS. Nonmass Findings at Breast US: Definition, Classifications, and Differential Diagnosis. RadioGraphics. 2020; 40 (2): p.326-335. doi: 10.1148/rg.2020190125 . | Open in Read by QxMD
  11. Cheung H, Parker EU, Yu M, Kilgore MR, Lam DL. Radiologic and Pathologic Correlation for Benign Breast Processes. Curr Breast Cancer Rep. 2021; 13 (4): p.381-397. doi: 10.1007/s12609-021-00438-8 . | Open in Read by QxMD
  12. Moy L, Heller SL, Bailey L, et al. ACR Appropriateness Criteria ® Palpable Breast Masses. J Am Coll Radiol. 2017; 14 (5): p.S203-S224. doi: 10.1016/j.jacr.2017.02.033 . | Open in Read by QxMD

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