Overview

• Simple breast cysts are a common cause of breast lesions identified on examination or imaging.

• Peak incidence (of simple cysts): 35–50 years of age; most common in premenopausal women

• Maybe asymptomatic (detected incidentally)

• Single or multiple breast masses

• May be tender

• Variable size (microcysts, gross cysts, clusters) and texture (smooth, soft, firm)

• Usually mobile

Cystic and solid breast masses cannot reliably be distinguished on physical examination alone.

• Follow age-appropriate breast imaging for a palpable breast mass.

• Use targeted ultrasound to evaluate any masses identified on mammography. [1][5][6]

• Tailor further management based on imaging findings.

  • Simple breast cyst: no further diagnostic evaluation [1][4]

  • Complex breast cyst: ultrasound-guided core needle biopsy or excisional biopsy to rule out concomitant malignancy

  • Complex breast cyst: surveillance, therapeutic aspiration, or biopsy depending on clinical concern for malignancy

• Ultrasound is the preferred modality for differentiating between cystic and solid breast masses.

• Biopsy is recommended for all breast cysts with suspicious features (e.g., doppler flow, thick septations or walls, solid components).

• Cytological evaluation is recommended if bloody fluid is obtained on therapeutic or diagnostic aspiration.