Mammology

Fibrocystic mastopathy: symptoms and treatment

Marina Virko
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Oleg Gluz

Non-inflammatory breast conditions are quite common, among them mastopathy is particularly worth mentioning. According to statistics, it occurs in 50-80% of women of childbearing age. Fibrocystic mastopathy or fibrocystic breast changes is an overgrowth of connective tissue and formation of abnormal foci. The disease is benign, but under certain circumstances it can turn malignant.

What is it about?

Fibrocystic mastopathy is an abnormal condition in which there is an incorrect ratio between connective tissue and epithelial components with formation of benign masses. The appearance of lumps is accompanied by a nagging pain. The condition has several types. Some of them increase the risk of breast cancer up to five times. Therefore, women affected by the disorder should regularly visit a doctor and undergo examinations.

If breast mastopathy is suspected, a breast care specialist should be consulted. If your primary care facility does not have one on staff, a gynecologist can take care of the issue.

Mastopathy types

According to the generally accepted classification, fibrocystic mastopathy can be diffuse or nodular. Each of these two types includes several varieties. Their features determine the disease course, risks, and treatment approaches.

In diffuse mastopathy, changes occur in the entire gland, often on both sides. Depending on their nature, specialists distinguish between different variants:

  • fibrous (mastopathia fibrosa): characterized by an overgrowth of connective tissue lining the ducts of the gland from the inside, which replaces the thin layer of epithelium.
  • сystic (mastopathia cystica): increased growth of the glandular cells, which results in the production of a large amount of fluid, leading to the formation of multiple small cysts.
  • fibrous cystic (mastopathia fibrosa cystica): a mixed form that occurs most often. Both connective tissue cells and glandular cells multiply too much. Therefore, examinations reveal both cysts and lumps.
  • fibroadenomatous (mastopathia fibroadenomatosa): characterized by tumor-like overgrowth of glandular cells (adenomatous hyperplasia) in the gland ducts, which can be filled with blood, pus, or secretion.

Nodular mastopathy are single benign masses, which can represent intraductal papillomas, lipomas, lipogranulomas, localized fibroadenomatosis (fibroadenomas). Compared with the diffuse variant, it is considered less favorable.

Mastopathy type has a direct relation to its treatment strategy. If you doubt the diagnosis made by your primary care provider after examination, you can use a second opinion service to get remote advice from leading European experts.

Causes

The main reason of mastopathy occurrence is hormone imbalance where abnormal levels of estrogen and progesterone play the key role. Thyroid hormone and prolactin disorders are secondary causes.

Also, there are certain risk factors, i.e.,:

  • early menarche;
  • late menopause;
  • abortions;
  • lack of pregnancies;
  • giving up breastfeeding;
  • metabolic disorders (obesity, diabetes);
  • frequent stresses;
  • endocrine system disorders;
  • liver diseases;
  • inappropriate use of hormone therapy drugs;
  • genetic predisposition;
  • infertility;
  • late sexual debut;
  • frequent inflammation of the genitalia.

Mastopathy symptoms

Mastopathy can be detected by its characteristic manifestations:

  • Painful glands;
  • Colostrum or transparent fluid discharge from the nipples (color can vary from yellow to brown);
  • Tissue thickening;
  • Lumps felt at palpation.
The severity of the pain syndrome may vary depending on both individual features and the disease type. It may intensify on different days of the cycle, but some women suffer from it constantly. Therefore, one should not rely on this sign alone.

In addition to the above, tissue swelling and breast volume increase are possible. With progression, clinical signs of mastopathy become more expressed.

Mastopathy diagnosis

To make a diagnosis it is not enough to consider only symptoms and examination results. It is important to differentiate mastopathy from breast cancer, fibroadenoma, severe premenstrual syndrome, and so on.

The following examinations are made for mastopathy diagnosis:

  • 2-view X-ray of the mammary glands (mammography). It is performed on the 6th or the 7th menstrual cycle day;
  • Ultrasound breast scan (preferably in the first phase of the menstrual cycle);
  • Breast thermography aimed at detecting areas of increased thermal activity (foci of hyperthermia can indicate cystic mastopathy);
  • Needle biopsy;
  • MRI of the mammary glands;
  • Hormone level tests.

Mastopathy management

Mastopathy can be treated both with conservative methods and surgery. The former ones are used much more commonly. Surgical treatment of mastopathy is indicated if there are larger cysts, or lumps not responding to drugs.

Drug therapy is prescribed by a breast care provider. For mastopathy, the first-line medications include:

  • Anti-inflammatory drugs of the nonsteroidal group;
  • Antidepressants and sleeping pills;
  • Iodine preparations;
  • Diuretics.

Vitamins, trace elements, and homeopathic drugs can be prescribed as a supplement.

In difficult cases, hormone therapy is used. Carefully selected medications will help to relieve pain, swelling, and normalize the endocrine system and gastrointestinal tract function. The treatment is aimed at reducing the lump size or stop their growth.

It is also necessary to revise the diet and the lifestyle, as well as select the proper clothes.

In some situations, a surgical procedure is required. It is indicated when:

  • Larger lumps associated with notable discomfort are detected too late;
  • The lumps grow too fast;
  • There are signs of malignancy, which is subsequently confirmed by biopsy.

In the course of the operation, a breast segment including the mass is removed. The procedure lasts 40-50 minutes and is performed under anesthesia. After the surgery, antibiotics, analgesics and vitamins are given. Hormonal therapy is used to reduce the risk of recurrence.

Mastopathy management necessarily involves therapy of the underlying disease, which had caused the hormone imbalance that led to abnormal changes in tissue structure.

Second opinion

A second opinion is an opportunity to get a consultation with leading European breast care specialists without leaving home. All issues are taken care of at a distance. The expert selection is based on individual complaints and existing diagnosis. This way it becomes possible to refer the case to the doctor who has the largest experience in a particular field.

In the case of mastopathy, a second opinion can be needed while determining the diagnosis, if the patient has doubts regarding the suggested examination plan. Besides, the consulting provider can review the diagnostic findings and make relevant conclusions.

After a mastopathy diagnosis has been made, an expert second opinion is also important. It may help to find out whether the treatment strategy has been chosen correctly, i.e., if the recommended procedures really make sense.

External advice may also be helpful as soon as the therapy is completed. It will help to make an effective rehabilitation and follow-up plan to prevent the relapse of the disease.

Mastopathy is a particularly common disease that needs particular care, even if the symptoms are mild and not troublesome. With proper therapy at the initial stage, it is possible to stop the process of tissue changes and reduce the risk of life-threatening complications.

References

  1. Mastopathy. Histological forms and long-term observations, K Prechtel, 1991.
  2. Mastopathy--its hormonal conditions and therapy, A Warenik-Szymankiewicz, 1992.
  3. Endocrinological aspects of fibrocystic mastopathy, A Angelia, 1982.

 

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