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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.
Subtypes and variants
Nonproliferative breast lesions 
- Simple breast cysts: circumscribed fluid-filled lesions (blue dome cysts)
- Stromal fibrosis (no malignant potential)
- Apocrine metaplasia
Proliferative breast lesions (with or without cellular atypia) 
- Sclerosing adenosis
- Ductal epithelial hyperplasia (ductal hyperplasia)
- Radial scar
- Intraductal papilloma
General principles 
- Obtain a thorough medical history and perform a CBE in all patient
- Diagnostic workup should be guided by clinical findings.
- See also “Breast mass,” “Mastalgia,” “Nipple discharge,” and “Breast cysts” as needed.
Follow age-appropriate diagnostic workup for a breast changes are heterogeneous and include the following.. The imaging findings in fibrocystic
- Scattered calcifications
- Clustered microcysts 
- Simple or complicated cysts (see “Breast cysts” for details). 
- Distorted breast parenchyma 
- Focal asymmetry
- Architectural distortion
- Round or oval masses with circumscribed borders
- Symptomatic management 
- FNAC, or excision) (e.g., surveillance,
- Age-appropriate routine breast cancer surveillance is sufficient. 
Proliferative breast lesions with atypia (specifically atypical ductal hyperplasia) 
- Surgical excision, followed by close surveillance for breast cancer with CBE and imaging 
- Chemoprevention (e.g., tamoxifen, raloxifene, or aromatase inhibitors) can be considered for further risk reduction.