Finding a lump in the breast can be alarming and stressful for women. However, the vast majority of these findings suggest that 80 to 85 per cent of these lumps are non-cancerous.
Among the most common are breast cysts, which are simply fluid-filled sacs. For most people, these cysts are harmless and require no treatment. But 'benign' does not always mean it can be ignored. Sometimes a cyst keeps returning and begins to cause discomfort or other issues. In such cases, surgery may be recommended. Knowing the specific signs and symptoms that point toward surgery helps a patient take charge of their health.
When would doctors recommend surgery?
While most cysts respond well to simple monitoring or a quick drainage (aspiration), four specific signs often signal that it is time for surgical removal.
The cyst that keeps coming back
A doctor can usually drain a symptomatic cyst with a thin needle. In a perfect scenario, the cyst vanishes and stays gone. However, if that same cyst refills with fluid repeatedly, especially within just a few weeks, it becomes a chronic nuisance. Surgeons often choose to remove the entire cyst wall to stop this cycle of recurrence for good.
The cyst contains 'solid' components
In an ultrasound, a standard cyst looks like a clear bubble. A complex cyst, however, contains solid material or thick internal walls. If a biopsy of these solid bits shows 'atypical' cells, or if a doctor cannot 100 per cent rule out a hidden growth, they will recommend surgery.
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Presence of bloody fluid or discharge
The fluid inside a typical cyst is usually clear, yellow, or green. If a doctor performs an aspiration and finds bloody fluid, it is a red flag. Similarly, if a cyst is accompanied by spontaneous nipple discharge, surgeons prefer to remove the area to identify the exact cause of the bleeding.
Persistent pain or physical changes
Sometimes, surgery is simply about comfort. A very large cyst can cause a heavy, aching sensation or sharp, localised pain that disrupts daily life. If the cyst is too deep to drain easily or is large enough to visibly distort the shape of the breast, surgical removal offers a permanent fix that aspiration cannot provide.
What does the procedure involve?
If a patient and their doctor decide on surgery, the most common step is an excisional biopsy. This is usually an outpatient procedure, which means the patient can go home the same day.
During the surgery, the cyst and a small area around it are completely removed. Depending on the case-to-case basis, to make sure the patient doesn’t feel any pain, the area is numbed (local anaesthesia), or the patient is put into a deep sleep (general anaesthesia). After the cyst is removed, it is sent to a lab to be tested. This is a very important step because it clarifies whether the lump is cancerous or not. Most people recover quickly and return to a normal routine within a few days.
Benign cysts are common and do not increase the risk of breast cancer. However, no one has to live with a 'rebellious' cyst that causes pain or uncertainty. If a cyst refills repeatedly, shows complex features in an ultrasound, or causes distress, surgery is a straightforward and effective solution. Trusting intuition and paying attention is key. If a lump feels different or changes rapidly, taking immediate medical help is the best next step.
Authored by Dr Nanda Rajaneesh, MS (Surgery), FACRSI, FICS, MRCS, FAMS at Apollo Spectra, Bengaluru, Koramangala
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.
