Diffuse changes in the breast

The tissues of the mammary glands are subject to constant natural changes caused by the peculiarities of the functioning of the female reproductive system (thelarche, menarche, pregnancy, lactation, menopause). However, certain structural modifications common in the glandular and fibrous (fibrous) tissues of the breast can also have a pathological character, causing various qualitative and quantitative disorders diffuse changes in the mammary gland. According to experts, such changes occur in at least 45% of women of childbearing age.

These pathologies have a code according to ICD 10: disease class – XIV (diseases of the genitourinary system); N60-64 diseases of the mammary gland.

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Causes diffuse breast changes

Diffuse changes in the mammary gland affect the parenchyma, the main functional epithelial-glandular tissue of the breast with alveoli and fibrillar fibers of the milk ducts, the stroma, the connective fibrous tissue surrounding the ducts and separating the lobules, as well as the adipose tissue that protects the parenchyma.

An increase in the number of cells in mammary gland tissue (proliferation), their decrease and, of course, developmental disorders (dysplasia) have an exclusively hormonal pathogenesis.

The causes of diffuse changes in the mammary gland may be related to:

• with chronic inflammation (adnexitis) or ovarian cysts (which produce estrogen),
• with diseases of the thyroid gland (which synthesizes the hormones thyroxine and triiodothyronine that regulate metabolism),
• with pathologies of the adrenal glands (the cortex of which synthesizes glucocorticoids),
• with pituitary insufficiency (the pituitary gland is responsible for the production of luteotropic hormone and prolactin),
• with diseases of the pancreas (impairing insulin production),
• with obesity (leading to increased estrogen levels).

Gynecologists attribute an important role in the occurrence of diffuse changes in the mammary gland to such factors as irregular menstrual cycles, multiple abortions, first pregnancy after 35 years, lack of lactation after childbirth, late menopause, and genetic predisposition. Although the pathogenesis of all the adverse effects of the listed factors is still associated with hormonal disorders.

It should be taken into account that changes also occur in healthy mammary glands. Thus, estrogen ensures the development of the stroma, the growth of ducts and the deposition of fat cells; progesterone, balanced by estrogen, promotes the growth of glandular tissue, lobular structures (lobules), the formation and secretory changes of the alveoli. In women of reproductive age during the menstrual cycle - at the end of the luteal phase - under the influence of progesterone, some of the epithelial cells of the ducts and alveoli of the mammary glands undergo replication and apoptosis (natural physiological death). But excess estrogen and progesterone deficiency can disrupt this process, provoking diffuse fibrous changes in the mammary gland.

During pregnancy, human chorionic gonadotropin (hCG), placental lactogen and prolactin stimulate the development of alveoli and milk ducts; prolactin, cortisol, somatropin and oxytocin regulate the lactation process and milk secretion after childbirth.

When a hormonal imbalance occurs, natural processes in the tissues of the female breast are disrupted. As experts note, most often, pathological proliferation of some cells and their replacement by others begins. In mammology, such structural changes in tissues are defined as dyshormonal diffuse changes in the mammary glands.

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Symptoms diffuse breast changes

The first signs of such changes may be felt as an increased feeling of discomfort in the chest and its hypersensitivity before and during menstruation. Most women do not pay attention to this, since after the end of the next menarche, the unpleasant sensations pass.

Mammology specialists note the following most characteristic symptoms of diffuse changes in the mammary gland:

• heaviness and tension in the glands, often accompanied by swelling or "engorgement";
• burning in the mammary gland, itching in the nipple area and their increased sensitivity;
• small, mobile, nodular lumps in the texture of the breast tissue that may become more noticeable during menstruation;
• breast pain;
• aching pain of varying intensity (intense pain may radiate to the armpit, shoulder or shoulder blade area;
• clear discharge from the nipples (when pressing on them).

Many people do not have any of the listed symptoms, and breast lumps are discovered by chance, since the manifestations of signs of diffuse changes in the mammary gland are most often periodic and associated with the menstrual cycle.

Possible complications of dyshormonal diffuse changes in the mammary glands include the formation of benign tumors of various sizes, and the most dangerous is the malignancy of these tumors.

Despite the benign nature of this pathology, if blood relatives have cancerous tumors of the reproductive system (uterus, ovaries, mammary glands), the consequences can be very serious and require the intervention of oncologists.

In general, the prognosis is positive, but one should take into account the possibility of developing breast cancer, which occurs much more often against the background of diffuse changes in the mammary gland than in the absence of such changes.

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Forms

In medicine, diffuse processes in the tissues of various organs do not mean a single, clearly localized structural change, but multiple inclusions in a continuous array of one tissue of elements (foci or nodes) of another tissue that has a different cellular structure and functions (diffusio - in Latin "spreading, spreading").

When diffuse fibrous changes in the mammary gland are diagnosed, this means that there has been a growth (proliferation) of fibrous (connective) tissue cells. These may be diffuse changes in the parenchyma of the mammary glands (diffuse fibromatosis), as well as in the lobules of the gland (fibroadenosis).

Doctors can detect multiple diffuse changes in the glandular layer of the mammary glands (parenchyma) in the form of clear and fairly dense to the touch fibroepithelial nodes, and then a diagnosis is made of either diffuse focal changes in the mammary gland, or diffuse mastopathy, or nodular dyshormonal dysplasia.

If the structural type of pathology is accurately determined (which can be glandular, fibrous, cystic and combined), then either diffuse cystic changes in the mammary gland or diffuse fibrous cystic changes in the mammary glands will be determined.

We have already discussed this terminological diversity in the articles Fibrosis of the mammary gland and Diffuse fibroadenomatosis of the mammary glands.

If a mammologist says that a patient has moderate diffuse changes in the mammary glands, this means a moderate degree of diffuse mastopathy.

Separately, it is necessary to note the so-called diffuse involutional changes of the mammary glands. What is it? These are natural age-related (involutio in Latin means "coagulation") structural modifications of breast tissue in women during the postmenopausal period - when the synthesis of sex hormones decreases and the reproductive function of the female body fades. Such changes are characterized by an increase in the volume of adipose tissue in the mammary glands due to a reduction in the glandular part, as well as a decrease in the lobular structures of the breast and compaction of their fibrous membranes. See also - Involution of the mammary glands.

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Diagnostics diffuse breast changes

Diagnosis of diffuse changes in the mammary gland is carried out by mammologists, who examine patients and examine the mammary glands and nearby lymph nodes by palpation.

After the examination, instrumental diagnostics mammography (X-ray of the mammary glands) is mandatory.

To determine the general state of health and find out the level of hormones, it is necessary to take tests: a general blood test and a test for the level of hormones in the blood plasma (for maximum reliability of the results, the test is taken taking into account the phase of the menstrual cycle). By the way, the levels of not only sex hormones (estrogen, progesterone, prolactin, etc.) are determined, but also hormones of the thyroid and pancreas. And if their level does not correspond to the norms, then an endocrinological examination may be required.

Frequently used instrumental diagnostics include ultrasound of the mammary glands, and less commonly used X-rays with the introduction of a contrast agent into the mammary ducts (ductography) and thermography. Computed tomography (CT) may be required, and color Doppler sonography may be used to determine the condition of the blood vessels of the mammary glands.

To exclude oncology (if there is a risk of malignancy), differential diagnostics are necessary, which is carried out by fine-needle aspiration biopsy of the altered tissue and cytological examination of the obtained sample.

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Treatment diffuse breast changes

The etiological treatment of diffuse changes in the mammary gland practiced today does not have one scheme for all cases and is prescribed only individually - based on the results of the examination.

Typically, treatment includes taking:

• antioxidant vitamins (A, C, E), vitamins B6 and P;
• iodine-containing drugs;
• preparations based on phospholipids, in particular linoleic acid or lecithin, which promote the regeneration and stabilization of cell membranes.

In case of diffuse fibrous changes in the mammary gland, hormonal medications are often used:

• Dydrogesterone (Duphaston) is an analogue of progesterone (taken 1 tablet for 14 days during each monthly cycle);
• Medroxyprogesterone acetate (Methylgesten, Provera, Clinovir, Luteodion, etc.) acts like endogenous progesterone and is used in case of deficiency of this hormone;
• Toremifene (Fareston) – acts on estrogen receptors in mammary gland tissue and blocks the influence of this hormone;
• Diphereline (Decapeptyl) is an analogue of endogenous gonadorelin (hypothalmic hormone), suppresses ovarian function by reducing estrogen synthesis; administered intramuscularly.

In case of menstrual cycle disorders and diffuse fibrous proliferation of mammary gland parenchyma cells – to reduce prolactin levels and eliminate sex hormone imbalance – homeopathy offers medicines based on the fruits of the tree-like shrub Vítex agnus-castus (sacred vitex or common chaste tree) – Cyclodinone and Mastodinone, in the form of tablets or drops for oral administration.

Traditional treatment of diffuse changes in the mammary gland

Among the folk methods that are used in the treatment of diffuse pathological changes in the tissues of the mammary gland, it is worth noting external remedies and herbal treatment in the form of decoctions for internal use.

The first category includes compresses from infusions of medicinal plants such as sweet clover, red clover, wormwood, lady's mantle and St. John's wort. And although the first two plants contain phytoestrogens, how they act in the form of compresses is unclear.

In addition, folk treatment with compresses of raw grated beets, cabbage leaves, lard with propolis, honey with aloe is popular (compresses should be applied to the chest at night).

Herbal treatment includes recommendations to drink a calming infusion of valerian roots (5 g per 200 ml of boiling water), a decoction of a mixture of equal amounts of motherwort and peppermint (a tablespoon of the mixture per glass of water), as well as a decoction of fennel and caraway seeds (1:1) - 100 ml twice a day. Fennel is usually used for bloating and flatulence, and its use in this pathology can be explained by the presence of essential oils in its fruits, consisting of unsaturated fatty acids, including linoleic and oleic. The fruits of caraway, a relative of fennel, used to improve digestion, are also rich in oils, phenolic acids and terpene compounds.

Surgical, i.e. operative treatment of multiple formations is not performed: only single fibrocystic nodes can be excised or removed by nucleation (and even then not in all cases), and if oncology is suspected. In case of diffuse changes, conservative therapy and monitoring of the condition of the mammary glands are prescribed - with outpatient registration with a mammologist and examinations every six months.

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Prevention

Prevention consists of regular (once a month) examination and palpation of women's mammary glands, and if lumps are detected, a visit to the doctor. There are no other methods yet, although you can find recommendations (obviously very old) that clearly do not take into account the fact that diffuse changes in the mammary gland have a hormonal etiology.

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