Is surgery necessary ever if a fibrocystic breast disease?

Not a disease: Fibrocystic changes refer to a spectrum of benign variations seen within breast tissue. It is not a "disease" and in and itself does not significantly impact risk (breast density and nodularity may impact the ability and siensitivity of screening however and mammographic density has been identified as a risk marker).

Usually not: Our methods for imaging the breast (digital mammogram, ultrasound, mri) have improved greatly. We can distinguish a fluid filled cyst from a solid mass. If a solid mass needs to be biopsies, then a core needle biopsy can be done to provide a diagnosis. If there is a fluid filled cyst that is painful, a needle aspiration is done. Surgery should not be the first option.

Sometimes: If the tissue looks concerning for a cancer or if the pt has pain or other symptoms which make removal necessary.