Update: December 2018
It is known that most women suffer from this pathology.
the peak of incidence is noted at the childbearing age (about
30 – 45 years). Cystic mastopathy is considered one of
the most common diseases in women, and the frequency of her
the incidence is 30 – 40%, in the case of the presence of concomitant
gynecological diseases in the representatives of the weaker sex
pathology reaches 58%.
Definition of term
Fibrocystic mastopathy or fibrocystic disease
call such benign dyshormonal pathology of dairy
glands, in which both proliferative and
regressive changes in their tissues, resulting in the formation of
abnormal ratio of epithelial and connective tissue
The structure and regulation of the mammary glands
The mammary gland belongs to the paired organs and is represented by three
types of fabrics. The main one is parenchyma or glandular tissue, in
which pass ducts of different diameters, glandular tissue
divided into segments and fractions (there are about 15-20). Slices and shares
separated by stromal or connective tissue, which is
breast carcass. And the third type of tissue is fatty,
the lobules, lobes and stroma of the mammary gland are immersed in it.
The percentage of parenchyma, stroma and adipose tissue directly
associated with the physiological state (age) of the reproductive
During gestation, the mammary glands reach
morphological maturity. Their size and weight increase,
the number of lobules and ducts increases, and in the alveoli
(morphomolecular unit of the breast) secretion begins
milk After giving birth due to the production of milk, the mammary glands still
more increase (in the ducts of the lobes are formed milky sinuses, in
which milk accumulates). And after cessation of lactation in
involution occurs in the mammary glands and the stroma is replaced by fatty
cloth. With age (after 40) replacement and parenchyma occurs
Both growth and development of the mammary glands are regulated
numerous hormones. The main ones are estrogen,
progesterone and prolactin. Also proven role in the regulation of development
mammary glands and somatotropic hormone. Major changes in
mammary glands under the action of hormones is subject to the parenchyma, and in
stroma is less affected by hormonal effects. From
the ratio of the content of these hormones and depends on the state
mammary glands. In violation of the hormonal balance and develops
мастопатия mammary glands.
Forms of mastopathy
In modern medicine there are a large number
classifications of the disease. Most comfortable in clinical
work is considered to be the following:
- with the predominance of the glandular component they talk about
- mastopathy, in which the fibrous component prevails
- mastopathy, in which the cystic component prevails;
- mixed form mastopathy;
- breast cyst;
- intraductal papilloma (roughly speaking, a wart in the milky
- breast hematroma;
In the case of the defeat of both mammary glands talk about bilateral
fibrocystic mastopathy, and with the development of the process in one
gland – about one-sided (for example, cyst of the left mammary
Depending on the severity of the clinical manifestations of the disease
may be mild, moderate and severe.
In addition, both diffuse and nodular mastopathy can be
proliferating and non-proliferating forms. Prognostic
fibrocystic mastopathy (FCM) is unfavorable
forms. In this case, proliferation of the milky epithelium occurs.
ducts that leads to the formation of intraduktivnyh papillomas or
proliferative changes in the epithelium of the inner walls of cysts that
leads to the development of cystadenopapilloma.
All described changes are fraught with malignant rebirths.
and dangerous occurrence of breast cancer.
A special form of the mammary gland at the end of the second
cycle phases, which is called mastodynia or mastalgia. Mammalgia
due to cyclic engorgement of the gland due to venous stasis
and stromal edema, which leads to a sharp increase and pain
breast cancer (more than 15%).
Etiological factors and the mechanism of disease development
caused by hormonal imbalance. Leading role in shaping
mastopathy is given to conditions in which there is a shortage
progesterone, ovarian dysfunction and / or absolute or
relative hyperestrogenism. This is due to the fact that estrogens
promote proliferation of the epithelium in the alveoli, milky passages,
increase the activity of fibroblasts, which causes proliferation and
stroma. Also in the mechanism of the formation of the disease matters and
hyperprolactinemia and excess prostaglandins (cry mastodynia, and
then mastopathy). For the development of hormonal imbalance
action needed provoking factors. But even with their
the existence of mastopathy does not develop immediately, since they need
prolonged influence (several years) and “layering” of one factor
another. Such provoking factors include:
- early menarche (early puberty, up to 12 years, leads to
rapid hormonal adjustment that affects the state
- late menopause (cessation of menstruation after 55 years also
unfavorable for mammary glands due to prolonged
hormonal effects on their tissue);
- abortion (sharp hormonal decline after abortion
miscarriage leads to hormonal disorders and development
- pregnancy and childbirth were absent altogether;
- short lactation period or categorical refusal to feed
- heredity (benign and malignant
breast diseases in women on the maternal line);
- age (over 35);
- stress as the cause of endocrine pathology;
- bad habits;
- breast injuries, chest compression is cramped and uncomfortable
- inflammatory processes of the mammary glands;
- hormone-dependent gynecological diseases (disorders
cycle, anovulation and infertility, myoma, endometriosis);
- iodine deficiency;
- pathology of the liver, thyroid gland;
- obesity (adipose tissue performs the function of estrogen depot, and their
excess leads to hormonal disorders);
- hypothalamic and / or pituitary tumors (disruptions in the production of FSH and LH
lead to hyperestrogenia);
- irregular sex life or dissatisfaction with sex,
which contributes to the stagnation of blood in the pelvic organs and, as a result,
causes ovarian dysfunction and hormonal imbalance.
With mastopathy, the symptoms and their severity depend not only on
forms of the disease, but also on the emotional state and nature
women and from existing associated pathologies. In the clinic
mastopathy is dominated by the following signs:
- Mammalgia или болезненность chest
Pain syndrome can be of different nature and intensity.
In the initial stage of the disease, chest pains appear on the eve of
menstruation that many women regard as premenstrual
syndrome. The pain can be dull, aching or acute so that
breasts impossible to touch. Pain syndrome due to stagnation
blood in the veins and tissue swelling and is described by patients as
chest engorgement. Also, women note an increase in
mammary glands (edema). After menstruation, the pain disappears, but
as the pathology progresses, the pain becomes permanent,
only its intensity changes depending on the phase of the cycle.
Severe pain has a negative effect on psycho-emotional
condition of the woman. In addition to sleep disorders lability is noted
psyche, irritability, aggressiveness and
- Discharge from the nipples and the presence of seals / formations in
Discharge from the nipple characteristic, but not mandatory symptom
mastopathy. The intensity and color of the discharge also vary.
Fromделяемое может быть незначительным и появляться только при сжатии
the nipple or occurs independently, as evidenced by the spots on
underwear. The color of the discharge may be whitish or transparent.
or greenish, which indicates the accession of a secondary infection.
Появление выделений из chest свидетельствует о вовлечении в процесс
milky ducts. Prognostic неблагоприятным признаком является
the appearance of brown or bloody discharge that is inherent
It is more often diagnosed in young women, while
palpations are determined by enlarged and painful mammary glands with
rough hardness and pronounced lobulation, as well as small
Nodal is the next stage in the development of the disease, which
occurs in the absence of treatment of the diffuse form of pathology.
Palpation of the mammary glands allows you to feel the fingers
individual or separate areas of compaction or cysts. Pockets
the seals are palpable as dense knots with no clear boundaries with
pronounced lobulation. Nodes can reach impressive sizes
(up to 6 – 7 cm). In case of formation of a breast cyst
elastic formations are rounded or oval with
explicit boundaries that are not associated with surrounding tissues.
Diagnostics заболевания начинается со сбора анамнеза и жалоб.
After the survey, the patient doctor examines and
palpation of the breast. При осмотре уточняются контуры chest,
the presence / absence of asymmetry of the mammary glands, skin tone and
venous drawing, position of nipples and whether there is any deformation.
Next is the palpation of the mammary glands (always in the first
phase of the cycle) in two positions: standing and lying, as some
formations may not be palpable in one position. Besides,
The doctor squeezes the nipples and determines the presence / absence of discharge from
them, and also palpates regional lymph nodes (axillary, sub-and
The instrumental methods of diagnosis of mastopathy include:
The essence of this method lies in the radiological
исследовании chest. Mammography shown to women from the group
significant risk for breast cancer as well as all women
35 and older when taking honey. inspection. Held
breast radiography in the first half of the cycle (day 7–10)
and necessarily in 2 projections (straight and side). To the merits
mammography include high information content (up to 97%),
the ability to identify not palpable formations.
- Breast ultrasound
This examination is shown for women younger than 35 years old, and also for
pregnant and breastfeeding. The advantages of the method are
safety and safety, high resolution,
the possibility of examining breast implants either with existing
травме и/или воспаления chest, возможность осмотра регионарных
lymph nodes. Of the disadvantages of the method: it is impossible to inspect the dairy
the gland as a whole, but only a “slice”, low informativeness with fat
перерождении chest, субъективная оценка снимков (зависит от
qualifications and experience of the doctor).
- Needle biopsy
If a suspicious area is detected (seals or cavities
education) is carried out fine needle puncture of the nidus
followed by histological examination of the contents.
- Study of the hormonal status
Primarily determined by the level of estrogen and progesterone,
when hyperprolactinemia is suspected, prolactin levels, and
The hormones of the adrenal glands and thyroid gland are under investigation.
- Ultrasound of the pelvic organs
Held для исключения заболеваний яичников и матки.
- Blood chemistry
Hepatic enzymes, blood sugar and other indicators are being investigated.
to exclude concomitant extragenital diseases.
Besides, из дополнительных способов исследования молочных
glands are used (if necessary) ductography (study
milk ducts), pneumocystography
education), laser and digital mammography, thermography,
Magnetic resonance imaging.
If mastopathy is detected, treatment should be carried out in
mandatory and its tactics depend on a number of factors:
the age of the patient, the form of the disease, the presence of concomitant
pathology, interest in pregnancy or contraception.
Cystic mastopathy implies treatment as
conservatively and surgically.
Patients are treated only with conservative treatment.
diagnosed form of diffuse mastopathy, and after
Consultations with an oncologist. Conservative therapy is carried out
non-hormonal and hormonal drugs.
Assigned to vitamin A, which has an anti-estrogenic effect,
Vitamin E, the enhancing effect of progesterone, vitamin B6, reduces
the content of prolactin, vitamins PP, P and ascorbic acid,
strengthen the vascular wall, normalizing microcirculation and
уменьшающие отек mammary glands. Besides, все перечисленные
vitamin preparations improve liver function where inactivated
estrogens and generally beneficial effect on the tissues of dairy
- Iodine preparations
Apply iodomarin, iodine-active, normalizing work
thyroid gland and involved in the formation of its hormones (see
symptoms of iodine deficiency, drugs).
- Sedatives and biostimulants (adaptogens)
The appointment of sedatives (motherwort, valerian,
peony tincture) normalizes the psycho-emotional state of the patient,
improve sleep and increase resistance to stress. Adaptogens
(Eleutherococcus, Radiol Pink) stimulate the immune system, normalize
metabolic processes in the body, improve the function of the liver and brain
Mastodinone, cyclodinone or remens are used, which
have a beneficial effect on hormonal balance, eliminate pathological
processes in the mammary glands, reduce the concentration of prolactin.
Administration of drugs such as indomethacin, nise, or
Diclofenac not only reduces pain by suppressing
synthesis of prostaglandins – “pathogens” of pain, but also relieve swelling and
нагрубание mammary glands.
Diuretic препараты (лазикс или растительные мочегонные
agents: lingonberry leaf, kidney tea, phytolysin) contribute
decrease in swelling in the mammary glands and reduce pain.
This is the main link of conservative treatment, it is
prescribing the following groups of drugs:
Acceptance of urozhestan, duphaston, norkolut, pregnant and others
drugs in the second phase of the cycle reduces the synthesis of estrogen and
normalize the level of progesterone, which is beneficial to
течении mastopathy. The duration of the reception gestagennyh funds
is at least 4 months. Local use is also possible.
progestin (progestogel) – application of the gel on the surface of the dairy
glands twice a day for at least 3-4 months, which contributes
the absorption of 90% progesterone by breast tissue and eliminates
- Prolactin production inhibitors
Parlodel inhibits prolactin secretion and is administered when
Treatment андрогенами (метилтестостерон, даназол, тестобромлецид)
held by women after 45 years on 4 to 6 months in
continuous mode. Androgens ингибируют выделение ФСГ и ЛГ
pituitary, suppress their effects on the ovaries and inhibit the production
Tamoxifen and other drugs in this group are taken.
continuously for 3 months.
- Combined oral contraceptives
Reception of Marvelon, Rigavidon and other contraceptives
drugs shown to patients under 35 years old with anovulation and disorder
second phase of the cycle.
Surgical treatment is indicated in the detection of nodular mastopathy.
(fibroadenomas or cysts) and consists either in carrying out
sectoral resection of the breast (removal of the pathological
очага вместе с сектором chest) либо в энуклеации (вылущивании)
tumors / cysts. Indications for surgery are: suspected cancer
data of histological examination punctate, rapid growth
fibroadenomas, recurrence of a cyst after a previously performed puncture.
Is pregnancy allowed for mastopathy?
Pregnancy has a positive effect on the course of mastopathy,
as the changed hormonal background (increased secretion
progesterone) during gestation, not only suspends
disease, but contributes to complete recovery.
Can I breastfeed with mastitis?
Not only possible, but necessary. Lactation is prevention
заболеваний chest, а в случае мастопатии способствует нормализации
processes in the tissues of the mammary glands (increases the growth of the epithelium
glandular tissue that inhibits the proliferation of pathological cells
Is it possible to use folk treatment for mastopathy?
Yes, use the methods of folk treatment for this disease.
possible, but only when combined with drug treatment and after
consult a doctor.
What methods of folk treatment are used for mastopathy?
One of the effective ways of folk therapy is
use fresh cabbage. Can attach fresh cabbage leaf
со срезанными прожилками к chest на ночь, обмотав полотенцем, а
You can twist cabbage and pumpkin (1: 1) through a meat grinder, obtained
evenly distribute the mass over the mammary glands, wrap
polyethylene, and then with gauze and leave the compress for 2 hours.
Such treatment relieves pain and inflammation, reduces swelling in dairy
glands and held courses for 7 – 14 days.
What is dangerous mastopathy?
Complications of mastopathy include relapse of the disease after
drug treatment, which is possible with
undiagnosed hormonal disorders, suppuration and rupture
cysts of the breast and the degeneration of fibroadenomas into cancer
less than 1% in nonproliferative form and reaches 32% in patients with severe
fibroadenoma proliferation). Therefore, nodular mastopathy is necessary
treat on a mandatory basis by surgery, without delay.
Is it possible to sunbathe with mastopathy?
Sunbathe, as well as other thermal procedures
(visiting the bath or sauna) with this disease is prohibited.
It should be remembered that in any form of mastopathy a woman enters
high-risk group for breast cancer, and insolation and any
другой вид «нагрева» chest способствует переходу диффузной
mastopathy in the nodal or malignancy of a benign tumor
Is it necessary to follow a diet?
Yes, when mastopathy should follow the principles of treatment
food, which excludes the intake of chocolate, coffee, tea and cocoa due to
high content of methylxanthines in them, which are not only
increase pain, but also contribute to the progression
diseases. The diet should be rich in fresh vegetables and fruits.
(sources of vitamins and coarse fiber, which improves the function
intestines), grain and bran products, dairy and
seafood (sources of calcium and iodine), vegetable oils
How to prevent the disease?
To prevent the development of mastopathy, you must adhere to
- to refuse from bad habits;
- wearing comfortable, according to the size of the linen;
- rejection of abortion;
- avoid stress (if possible);
- adhere to the principles of breastfeeding;
- регулярно проводить самообследование chest и проверяться у
- избегать травм chest;
- stick to regular sex life.