FIBROCYSTIC

DISEASE
OF THE
BREAST
DESCRIPTION
Also called benign breast
disease.
It is characterized by
palpable lumps in the
breasts that change in size
and tenderness during
different stages of the
menstrual cycle.
The swellings are very
common among normal,
healthy women between 20
and 50 years of age.
The incidence of fibrocystic
disease increases with advancing
age until menopause occurs. It is
rare in postmenopausal women not
receiving hormonal replacement.
ETIOLOGY
Although the exact cause of
the disease is unknown, it
appears that estrogen is at
least partially responsible.
 Imbalance in the normal
estrogen to progesterone
ratio

Excess of estrogen exposure

and a reduction of
progesterone exposure

Fibrocystic changes
or physiologic
nodularity of the
breast

FIBROCYSTIC BREAST DISEASE

Fibrocystic changes may
proceed through several
clinical stages or may
present in only one form.
 Clinical stages of Fibrocystic
changes
Stage 1 • Premenstrual fullness and tenderness in
both breasts.
• Symptoms usually resolve after
menstruation and then recur before the
next menstrual period in a cyclic fashion.
Stage 2 • Multiple nodular areas can be felt in both
(20’s-30’s) breasts.
• These areas feel like small marbles and
occur with fullness and soreness.

Stage 3 • Microscopic or macroscopic cysts appear

(35-55) suddenly associated with pain, tenderness,
or burning.
• They are usually three-dimensional, smooth,
mobile, and well delineated.
STAGE 1
STAGE 2
STAGE 3
 CLINICAL
MANIFESTATIONS
• Tenderness in the breasts,
especially near menstruation, is the
main symptom.
• Palpable lumps that increase in
size during the menstrual cycle are
common.
• Intermittent, shooting breast pain
(mastalgia) or a dull ache.
Symptoms often resolve
after menopause in the
absence of estrogen
supplementation.
COMPLICATIONS
Lesions that are
proliferative and show
atypical cells may
progress to cancer.
This progression is
especially a risk for women
with a personal or family
history of breast cancer.
DIAGNOSTIC TOOLS
Biopsy is indicated in the
following situations:
–No fluid is aspirated
–The mammogram
shows suspicious
findings; and
–The cytology of the
aspirated fluid reveals
malignant cells
POTENTIAL NURSING
DIAGNOSIS
 ACUTE PAIN r/t nodular, granular
breast mass compression on nerve
endings
 ANXIETY r/t change in health status,
threat of death, interpersonal
transmission
 DEFICIENT KNOWLEDGE r/t lack
of exposure/ unfamiliarity with
information resources, information
misinterpretation, cognitive limitation/
anxiety
MEDICAL-SURGICAL
MANAGEMENT
Drug Therapy
Hormonal manipulation
is the main focus of drug
therapy. Oral
contraceptives can
suppress oversecretion of
estrogen, and progestins
may be used to correct
luteal insufficiency.
Danazol (Danocrine), a
synthetic androgen, may
help reduce the symptoms
by suppressing estrogen
formation in the ovaries.
Use of vitamins C, E, and
B complex.
(Mild) Diuretics may be
prescribed to decrease
premenstrual
engorgement.
Cysts may be drained in
cases of severe pain.
Diet Therapy
Clients are counseled to eliminate
or avoid foods containing
xanthine (e.g. coffee, cola,
chocolate, and tea) from the daily
diet, particularly premenstrually, to
reduce symptoms.
Reduce dietary fat to 15% or
less of dietary intake.
 NURSING
INTERVENTIONS
Reassure that
the disease
itself does not
lead to breast
carcinoma.
Advice patient to discontinue
smoking to decrease the
occurrence of fibrocystic lesions.
Encourage the client to continue
prescribed drug therapy and
monitor the effectiveness of these
interventions.
Suggest
supportive
measures, such
as the use of
aspirin, mild
analgesics or
limiting the salt
intake before
menses.
Local application of ice or heat
may provide temporary relief of pain.
Recommend
the client to
wear a well-
padded,
supportive bra
day and night for
a week except
bathing.
Promote the practice of
BSE and teach the
procedure when
necessary.
OUTCOME
EVALUATION
Acute Pain
o The patient is able to report that the
pain has been relieved or
alleviated following interventions.
Based on pain rating scales, the
patient’s pain has decreased.
o The degree to which the patient is
able to assist in the management
of the pain through anxiety
reduction is assessed.
Anxiety
o The patient should be assessed for
behaviors that would indicate
adjustment to the diagnosis of
fibrocystic breast disease.
o The patient should verbalize fears
and concerns and be able to
identify one way to cope with the
diagnosis of fibrocystic breast
disease.
o The extent to which the patient
displays appropriate coping
behaviors should be noted.
o If the patient is unable to talk about
the diagnosis and communicate
concerns, the nurse should explore
further interventions to assist the
patient.
Deficient Knowledge
o The patient should verbalize an
understanding of the content
presented by repeating the
information, particularly the disease
process, treatment, and medications
for pain.
o The nurse must determine if the
patient is willing to comply with
recommendation for treatment and
if her or she is capable of being
compliant with the recommended
regimen.
o The patient should be able to
discuss the possible diagnostic
tests that may be performed.
o If further teaching is required at
time of discharge, the appropriate
referrals should be made to
continue education.
References:
 Handbook of Pathophysiology 3rd ed. by Corwin, E.J.
( Lippincott Williams & Wilkins, 2008)
 Medical-Surgical Nursing: Critical Thinking for Collaborative
Care 5th ed. by Ingnatavicius, D.D. & Workman, M.L. (Elsevier
Pe Ltd. ,2006)
 Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions,
and Rationales 11th by Doenges, M.E., Moorhouse, M.F., &
Murr, A.C. (F.A. Davis Company, 1985)
 Pathophysiology: Concepts of Altered Health States 7th ed.
By Porth, C.M. (Lippincott Williams & Wilkins, 2005)
 Textbook of Medical-Surgical Nursing 9th ed. Vol. 2 by Bare,
Brenda G. & Smeltzer, Suzanne C. (Lippincott Williams &
Wilkins, 2000)
 Internet resource: http://women.webmd.com/tc/fibrocystic-
breasts-topic-overview