Comparison of Surgical and Medical Management of Symptomatic Fibrocystic Breast Changes: A Prospective Pilot Study

Abstract

Background: Fibrocystic breast changes (FBC), a common benign condition affecting up to 50% of reproductive-age women, often present with mastalgia and nodularity. While medical management is first-line, surgical excision is considered for refractory cases. Aim: This single-centre pilot study prospectively compared outcomes between surgical and medical cohorts. Methods: From January 2023 to December 2023, 50 premenopausal women (aged 18–45 years) with symptomatic FBC were enrolled at S.C.B. Medical College and Hospital, Cuttack, Odisha, India. Patients were observed based on standard care: 10 underwent surgical excision for large cysts (>2 cm) or persistent symptoms, and 40 received medical management (lifestyle modifications + pharmacotherapy). Assessments included visual analogue scale (VAS) for pain, ultrasound, and quality-of-life (QoL) surveys at baseline, 6, and 12 months. Data were analyzed using descriptive statistics and chi-square tests. Results: Mean age was 32.4 ± 5.9 years. Surgical patients had larger cysts (mean 2.5 cm vs. 1.2 cm, p<0.01). At 12 months, symptom resolution (VAS reduction >50%) was 90% in the surgical vs. 75% in the medical groups (p=0.04). Recurrence was lower in surgical (10% vs. 25%, p=0.03). QoL improved similarly (mean +22 points both groups). No malignancies occurred. Surgical excision confers greater cyst resolution and reduced recurrence in symptomatic FBC patients with dominant lesions, while medical management remains appropriate for milder cases. Future research should target larger populations and extended follow-up to clarify best practices and oncologic safety for both strategies. Conclusions: In this pilot, surgical excision offered faster resolution for select FBC cases, but medical management sufficed for most. Larger trials are needed to confirm cost-effectiveness and long-term risks.