Breast tissues undergo regular natural changes, which are caused by the specifics of the functioning of the female reproductive system (telarch, pregnancy, menarche, menopause, lactation). However, some structural modifications that occur in the fibrous (fibrous) and glandular breast tissues can be pathological and cause diffuse changes in the mammary glands. Experts say that such violations are characteristic of 45% of women in the reproductive period.
The causes of this pathology
Diffuse changes in the mammary glands affect:
- Parenchyma - the main functional glandular-epithelial breast tissue with fibrillar fibers of the milk ducts and alveoli.
- Stroma is a fibrous connective tissue that surrounds the ducts and divides the lobules.
- Adipose tissue protecting parenchyma.
With an increase in the number of tissue cells of the mammary glands or their decrease, as well as with dysplasia (developmental impairment), we can only talk about hormonal origin. The causes of diffuse changes in the mammary glands may be due to:
- Pathologies of the thyroid gland (it produces a synthesis of the hormones of triiodothyronine and thyroxine that regulate the material metabolism).
- Chronic inflammatory process (adnexitis) or an ovarian cyst that produces the female hormone estrogen.
- Diseases of the adrenal glands (their cortex synthesizes glucocorticoids).
- Pituitary insufficiency (it is responsible for the production of prolactin and luteotropic hormone).
- Obese. It leads to an increase in estrogen content. What it is will be discussed below.
- Pancreatic diseases that interfere with insulin production.
These are the main causes of burning in the mammary glands.
Experts attribute important importance to the appearance of diffuse changes for such reasons as menstrual irregularities, the first pregnancy over the age of 35, repeated abortions, the absence of postpartum lactation, late menopause, and hereditary predisposition. It should be noted that the pathogenesis of the factors listed above, in any case, is associated with hormonal imbalances.
It should also be noted that diffuse changes in the mammary glands occur in healthy women. For example, thanks to estrogen, the development of stroma, the deposition of fat cells and the growth of ducts are ensured. Progesterone with estrogen balance allows glandular tissue and lobular structures to grow, and promotes clearance and alveolar secretory changes. In women of reproductive age, during the menstrual cycle (at the end of the luteal phase), part of the alveoli and ducts of the mammary gland epithelial cells undergo replication and further apoptosis (physiological natural death) under the influence of progesterone. However, an increased level of estrogen in women and a lack of progesterone can disrupt this process and cause diffuse fibrotic change.
During pregnancy, placental lactogen, chorionic gonadotropin and prolactin stimulate the secretion of milk and lactation after childbirth. If a hormonal imbalance appears, the natural processes in the female breast tissue are disturbed. As doctors note, the most common pathological proliferation of certain cells occurs, they replace others. Such tissue structural changes in mammology are defined as dishormonal diffuse changes in the mammary glands.
About estrogen
This is the collective name of one of the groups of female sex hormones. They are produced in the ovaries in women, and in small quantities are formed in the testicles in men, as well as in the liver and cortex of the adrenal glands (both men and women). Sex hormones, in general, provide reproductive function.
In the body of a woman, sex hormones are always present. Their level and ratio depends on the period of her life. The main female hormones are estrogens. In the fetus, they are responsible for the formation of female genitalia; in childhood, they support the growth of genital organs. In adolescence, the amount of estrogen in the body increases. Due to their influence, secondary sexual characteristics are formed.
The highest estrogen levels are observed in women of reproductive age. At this time, her body undergoes periodic cyclic changes (menstrual cycle).
Symptoms of breast changes
The very first symptoms of such changes can manifest themselves in the form of increased discomfort in the chest, its hypersensitivity before the onset and during critical days. Many women do not pay attention to this, because after the completion of the next menarche all unpleasant signs pass.
However, consulting a mammologist will not be superfluous.
Doctors call these very characteristic signs of diffuse changes:
- Tension and heaviness in the mammary glands, which is often accompanied by swelling.
- Burning of the mammary gland, itching in the nipple area, their increased sensitivity.
- Small movable seals in the form of nodules in the texture of the breast tissue, which can be felt more strongly during menstruation.
- Aching pains of various strengths (intense pains can be given to the area of the shoulder blades, shoulder or armpit).
- Soreness in the area of mammary glands.
- Highlighting transparent color from the nipples, if squeezed.
Many do not feel any of the signs listed above, and tightening in the chest is accidentally detected, since the manifestations of the symptoms of diffuse changes in the mammary glands are mostly periodic and are caused by the menstrual cycle.
Possible complications
There may be complications such as the formation of benign tumors of various sizes. The most dangerous complication is the malignancy of these tumors.
Although this pathology is benign in nature, in the presence of cancer of the reproductive system (mammary glands, ovaries, uterus), blood relatives cannot exclude serious consequences that require medical intervention. In general, with diffuse changes in the mammary gland, the prognosis is positive. However, one must take into account the possibility of the appearance of a malignant tumor arising against the background of such a pathology much more often than when it is absent.
Classification of forms of diffuse mastopathy
In accordance with clinical, x-ray and morphological tissue changes in the mammary glands, diffuse mastopathies are classified as follows:
- Adenosis is a diffuse pathology with a predominance of the glandular component.
- Diffuse mastopathy, in which the cystic component predominates.
- Fibroadenomatosis is a diffuse mastopathy in which the fibrous component predominates.
- Sclerosing type of adenosis.
- Fibrocystic mixed form of mastopathy.
When one or another clinical variant is determined, they proceed from the proportion of fatty, glandular, and connective tissue elements in mammograms.
Slightly expressed, sharply expressed and moderate diffuse mastopathy is distinguished according to the degree of changes present.
Diagnosis of diffuse changes in the mammary glands
Diffuse mastopathy is diagnosed on the basis of the results of a mammologist’s examination of the mammary gland, mammography, ultrasound, laboratory tests, biopsy and MRI of the mammary glands.
With diffuse mastopathy, external changes in the mammary glands are not determined. On palpation examination of the breast, different in size and length are established, painful, without clear boundaries of compaction with a lobed or granular surface. With diffuse mastopathy, seals are most often located in the upper outer quadrants of the glands.
The standard echographic picture, determined by ultrasound with diffuse changes in the mammary glands, is characterized by thickening of the glandular tissue, fibrotic changes in the interlobular septa and ducts, changes in glandular echo density, multiple formation of cysts, mismatch of the glandular structure to age, and ductectasia.
Mammography (panoramic radiography) with diffuse mastopathy finds tissue heterogeneity of the glands with small foci of densification, dense structure or cystic formations.
Thanks to mammography, it is possible to exclude the presence of tumors in the gland and determine the type of mastopathy.
If there are discharge from the nipples on the background of diffuse mastopathy, this may indicate the need for ductography, which usually determines the deformation of the milk ducts and cysts of different sizes. Examination of a smear obtained from the nipple makes it possible to differentiate diffuse mastopathy from other lesions - syphilis, actinomycosis, and mammary tuberculosis.
With concomitant genital and extragenital background, the analysis of sex hormones and thyroid hormones, liver enzymes, consultation of an endocrinologist-gynecologist, pelvic ultrasound is prescribed.
If the data of the previous diagnosis are doubtful, then a breast biopsy is performed, a cytological analysis of the biopsy, MRI, determination of the marker CA 15-3 in the blood.
Pathology treatment
To prescribe a course of therapy, a consultation with a mammologist is required.
With diffuse mastopathy, conservative treatment and dynamic observation are prescribed. It is advised to change the diet, include more dairy products and fiber, and limit animal fats. If the patient has intestinal dysbiosis, which disrupts the absorption of trace elements and vitamins, treatment by a gastroenterologist is required. Vitamin complexes, potassium iodide, homeopathy, dietary supplements, adaptogens, herbal remedies are prescribed. From non-hormonal therapy, enzymatic, sedative and diuretic drugs can be prescribed.
With diffuse mastopathy, it is recommended to increase physical activity, to connect psychotherapy and exercise therapy classes. Among physiotherapeutic procedures, the use of electrophoresis, laser therapy, galvanization, magnetotherapy, balneotherapy (mud therapy, climatotherapy, clay therapy, sea and mineral healing baths) is practiced.
In diffuse mastopathy, regulatory hormone therapy is aimed at eliminating hormonal defects and may include the appointment of gestagen (dydrogesterone, progesterone, etc.), thyroid hormones, and the correct selection of contraceptive methods. All of these remedies will help level out estrogen levels. What is it is now clear.
To reduce the feeling of tension and soreness in the mammary glands, a gel containing progesterone is applied topically.
When is surgery required?
If drug treatment of diffuse changes in the mammary glands within six months has not had an effect, then they resort to surgical intervention - remove the seals. During the operation, the following methods can be used:
- Resection. Under it, excision of the inflamed area is assumed. The resulting tissue is then sent for histological analysis to exclude breast cancer.
- Sclerosis. It is used for the cystic form of diffuse changes. By this method is meant the introduction of a sclerosing substance, leading to the overgrowth of defects in the mammary gland.
- Surgical (operational) therapy of multiple formations is not carried out: it is possible to remove or excise the breast tissue through nucleation only when diagnosing oncology. If there are diffuse changes, then monitoring of the state of the glands and conservative treatment are prescribed. The patient is registered with a mammologist. Every six months she undergoes a survey.
Folk therapy
Among the folk methods used in the treatment of pathological diffuse fibrotic changes in the mammary gland, external agents and herbal therapy in the form of decoctions that are used internally can be distinguished.
The first category includes compresses from infusions of a number of medicinal plants: red clover, clover, St. John's wort, cuff and wormwood. And although the first two plants contain phytoestrogens, it is not entirely clear how they act in the form of compresses.
In addition, popular treatment has become popular with compresses from cabbage leaves, grated raw beets, propolis with lard, aloe with honey (compresses are usually applied overnight on the chest).
Herbal treatment contains recommendations for taking a soothing infusion of valerian (five grams of roots per 200 milliliters of boiling water), a decoction of a mixture of equal amounts of peppermint and motherwort (a glass spoon of a tablespoon of the mixture), a decoction of caraway seeds and fennel seeds (an equal amount of ingredients are mixed, taken 1 tablespoon per glass of water) - twice a day, 100 milliliters. Fennel is most often used for flatulence and bloating, and its use in diffuse breast pathology can be explained by the presence in the fruit of the plant of essential oils, which are composed of fatty unsaturated acids, including oleic and linoleic. The fruits of caraway, akin to fennel, are used to improve digestion. They are also rich in terpene compounds, phenol carboxylic acids and oils.
How dangerous is mastopathy?
Can diffuse changes in mastopathy cause breast cancer? This question is very worried about women who are faced with a similar problem. Mastopathy itself does not cause malignant transformation and is not considered a precancerous type of condition. However, the factors provoking the appearance of this disease are common with oncological pathologies. There is a certain similarity of these diseases in morphology. There are statistics that show a combination of benign formations with malignant tumors in half of all cases, but the probability of transformation of the non-proliferative form of mastopathy into cancer is less than one percent.
But diffuse mastopathy can develop into a nodular, which in essence is the next stage. With this type of formation of nodes occurs continuously. It does not depend on the female menstrual cycle. That is why women with diagnosed diffuse mastopathy should undergo examinations at the mammologist every six months. It is necessary to regularly check the level of female hormones estrogen.
Prevention and advice for diffuse mastopathy
The key to effective prevention and timely diagnosis of diffuse mastopathy is the periodic examination of a mammologist with a series of instrumental studies. It is necessary to treat gynecological diseases and related genital pathologies in time.
An important role belongs to the regular examination by a woman of the state of her mammary glands. Particular attention should be paid to the appearance of seals and soreness, spots on the skin of the chest, a change in the shape of the mammary glands, discharge from the nipples. It is advisable to choose the right bra so that it does not squeeze the chest, protect the mammary glands from shock, pressure, injuries. During breastfeeding, nipple cracks, mastitis, lactostasis should not be allowed. To prevent mastopathy, modern contraceptive methods should be used and abortion should not be allowed.
If there is diffuse mastopathy, this is a contraindication for mammoplasty, the use of local wraps and hot compresses on the chest, visits to baths and saunas, tanning in the sun and in a solarium.