Fibrocystic breast condition (sometimes called fibrocystic complex) is the most common type of benign breast disorder. It was previously referred to as fibrocystic breast disease. Fibrocystic breast condition is a catch-all diagnosis that is used to describe the presence of multiple, often painful, benign breast nodules. These breast nodules vary in size and blend into surrounding breast tissue. However, the histologic changes responsible for the breast nodules could belong to one of several different categories.
The College of American Pathologists has categorized the types of fibrocystic breast condition according to the associated increased risk for subsequent invasive breast cancer and the particular histologic (microscopic) change that is present. These types include the following: no increased risk (nonproliferative changes, including microcysts, adenosis, mild hyperplasia, fibroadenoma, fibrosis, duct, apocrine metaplasia, and gross cysts); slightly increased risk (relative risk, 1.5 to 2; proliferative changes without atypia, including moderate hyperplasia and
papilloma); moderately increased risk (relative risk, 4 to 5; proliferative changes with atypia or atypical hyperplasia); and significantly increased risk (relative risk, 8 to 10; ductal and lobular carcinoma in situ).
The monthly variations in the circulating levels of estrogen and progesterone are thought to account for most fibrocystic breast changes. Although the exact contribution of each hormone is not well understood, it is believed that an excess amount of estrogen over progesterone results in edema of the breast tissue. At the onset of menses, hormone levels decrease and the fluid responsible for the breast edema is removed by the lymphatic system. All the fluid in the breast may not be removed, and eventually, the fluid accumulates in the small glands and ducts of the breast, allowing cyst formation.
Nursing care plan assessment and physical examination
Elicit a reproductive history. Women with a fibrocystic breast condition often have a history of spontaneous abortion, shortened menstrual cycles, early menarche, and late menopause. Patients are frequently nulliparous and have not taken oral contraceptives. Cyclic, premenstrual breast pain and tenderness that last about a week are the most common symptoms. With time, the severity of the breast pain increases, and onset occurs 2 to 3 weeks before menstruation. In advanced cases, the breast pain can be constant rather than cyclic.
Fibrocystic breast changes usually occur bilaterally and in the upper outer quadrant of the breast. A woman may appear with gross nodularity or with one or more defined lumps in the breast. The abnormality may be described as a hardness or a thickening in the breast. The areas are usually tender and change in size relative to the menstrual cycle (becoming more pronounced before menstruation and decreasing or disappearing by day 4 or 5 of the cycle). Approximately 50% of patients have repeated episodes of breast cysts.
The breasts should be inspected in three positions: with the patient’s arms at her side, raised over her head, and on her hips. Instruct the patient to “press in” with her hands on the hips to contract the chest muscles. Compare her breasts for symmetry of color, shape, size, surface characteristics, and direction of nipple. Women with deep or superficial cysts or masses may have some distension of breast tissue in the affected area, but often, no changes are noted on examination. Dimpling, retraction, scaling, and erosion of breast tissue indicate more serious breast conditions, and none of these disfigurations is usually found in fibrocystic breast condition.
Palpate the breasts in both the sitting and the supine positions. Use the pads of the three middle fingers to palpate all breast tissue, including the tail of Spence, in a systematic fashion. Breast cysts are filled with fluid and feel smooth, mobile, firm, and regular in shape. Superficial cysts are often resilient, whereas deep cysts often feel like a hard lump. Cystic lesions vary from 1 to 4 cm in size, can appear quickly, are often bilateral, and occur in mirror-image locations.
To conclude palpation of the breasts, gently squeeze the nipple. About one-third of women with advanced fibrocystic change experience nipple discharge. Nipple discharge in benign conditions is characteristically straw-yellowish, greenish, or bluish in color. A bloody nipple discharge often signals the presence of ductal ectasia or intraductal papillomatosis and should be further evaluated.
Finding a lump or irregularity in the breast is distressing. The almost “overnight” appearance of cysts can make a woman doubt the validity of a recent negative physical examination or mammogram. In addition, the pain associated with advanced fibrocystic changes can be debilitating. Assess the patient’s prior experience with breast problems and her use of coping strategies.
Nursing care plan primary nursing diagnosis: Pain (acute, chronic) that is related to edema, nerve irritation, and a pinching sensation in the breast.
Nursing care plan intervention and treatment plan
The physician will attempt a fine-needle aspiration (FNA) of a breast mass that appears to be cystic. Once the fluid is removed, the cyst collapses and the pain is relieved. Medical therapies may be used in an effort to decrease breast nodularity and relieve breast pain and tenderness.
Women who are undergoing evaluation for a breast lump need support and understanding, especially if it is the patient’s first experience with the condition. Encourage the patient to express her feelings. Explain the purpose and procedure of diagnostic studies and surgical techniques (FNA, excisional biopsy). Encourage patients to request information as to the exact nature of a benign breast lump (such as whether it was nonproliferative or proliferative), and explain the actual risk for malignant breast disease that is associated with the various histologic changes. Advise the patient to wear a brassiere that offers good support. Assess the amount of caffeine and salt present in the diet. Help the patient identify foods that are high in these substances and adopt measures to reduce their dietary intake.
Nursing care plan discharge and home health care guidelines
Leave the Band-Aid in place for 24 hours; report any pain, warmth, severe ecchymosis, or drainage. Emphasize to patient that it is not uncommon for more cysts to form. Leave the dressing in place until the sutures are removed; clean the site gently with soap and water once sutures are removed; teach the patient how to empty the drains if any are present. Explain the purpose, action, dosage, desired effects, and side effects of all medications that have been prescribed by the physician. Women with gross cysts or solid masses in the breast are often seen every 6 months for repeat physical examinations.
Assess the patient’s knowledge and performance of breast self-examination (BSE); reinforce and teach BSE technique as indicated. Explain the importance of adhering to the follow-up visit schedule as recommended by the physician and to the American Cancer Society’s recommendations for screening mammography: first screening by age 40; mammography repeated every 1 to 2 years from age 40 to 49; mammography repeated every year over age 50.