Breast Cyst Aspiration

When a discrete breast mass is first discovered, a determination of solid or cystic must be made to assist with further evaluative decisions. A rapid determination can be made with one of two methods. Ultrasound can be used to identify a cystic or solid mass rapidly with minimal discomfort to the patient. If ultrasound is not available or if a therapeutic intervention is needed for drainage of a palpated cyst, a breast cyst aspiration can be performed.

The patient can be placed in a recumbent position and the skin over the breast cleansed. The mass is stabilized between the thumb and index and middle fingers on the nondominant hand. Anesthesia can be used locally, but most women feel minimal discomfort. A 1.5-inch, 20- to 23-gauge needle is attached to a 10- to 30-mL syringe. The skin is punctured and the end of the needle directed into the mass with continuous suction on the syringe. The fluid of a cyst is aspirated completely before the needle is removed. Fluid should be sent for pathologic evaluation. Straw- to green-colored fluid is usually benign, and bloody brown to red fluid is more suspicious for malignancy. If bloody fluid is obtained in an atraumatic aspirate or if a lump remains, the patient should be referred for a core needle or open biopsy. (See Tuggy Video: Breast Cyst Aspiration.)

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