Breast fibrosis

Fibrosis of the mammary gland is a pathology of its tissues, in which there is a proliferation and compaction of collagen and elastin proteins synthesized by fibroblasts and glycoprotein cells that form the matrix of connective tissues. These changes lead to the appearance of cicatricial neoplasms and the inevitable disruption of breast function. This process can develop in the connective tissues of any internal organ of a person. This article discusses fibrosis of the mammary gland in women, since this pathology has become a serious problem of women's health over the past half century.

[ 1 ], [ 2 ]

Causes mammary fibrosis

Before listing the causes of breast fibrosis, it is necessary to note the terminological “diversity” of modern mammology, which has become a monopoly in the field of all mammological diseases in women.

In essence, fibrosis (from the Latin fibra - fiber) is the process of formation of fibrous, i.e. connective tissue, and fibrous formation in the breast (as a result of fibrosis) should be called differently - as an option, fibroma, i.e. a tumor of connective tissue. However, doctors call both the pathological process of excessive formation of connective tissue and the formation itself fibrosis. In clinical practice, fibrosis of the mammary gland and pathological changes associated with this process can be called mastopathy (which includes all benign tumors and cysts in the breast), dyshormonal dysplasia, fibrocystic mastopathy, fibromatosis, fibroma, etc.

Today, the main causes of the disease are considered to be disturbances in the level and ratio of sex hormones (primarily estrogen and progesterone), which affect the stability of a woman’s hormonal system during menstruation, during pregnancy and breastfeeding, after repeated artificial termination of pregnancy, and during menopause.

Experts say that the disease can also begin due to constant stress, overwork, problems with the thyroid gland (hypothyroidism due to iodine deficiency) and pancreas (diabetes mellitus), exposure to certain toxic substances, the presence of inflammation of the uterus or ovaries. Genetic predisposition to this disease is not excluded.

In addition, the causes of the disease may be associated with radiation (for example, when undergoing a course of radiotherapy), and then a diagnosis of radiation fibrosis of the mammary gland is made. By the way, radiation therapy can cause fibrosis of the tissues of any organs.

However, domestic mammology has so far paid little attention to the biochemical mechanism of the fibrosis process, which is associated with the activation of the so-called transforming growth factor beta (TGF-β). TGF-β is an endogenous complex of antigen-specific peptide molecules (cytokines) that transmit signals between tissue cells. Lymphocytes, macrophages, fibroblasts, endothelial cells, etc. are capable of synthesizing the beta factor. TGF-β is involved in optimizing cellular metabolism and regulates growth and apoptosis (natural death) of cells, and also stimulates all intracellular processes under unfavorable circumstances (inflammation and other pathological effects). According to researchers, the activation of the growth factor beta underlies the disruption of intercellular "communication", which leads to the activation of fibroblasts and proliferation of connective tissue cells.

These processes are also the cause of a number of other diseases, for example, liver cirrhosis is associated with the formation of scar tissue and nodules that replace liver tissue and disrupt its function. Endomyocardial fibrosis is the result of myocardial infarction. There is also fibrosis of the lungs, mediastinum, and soft tissues of the retroperitoneal space.

[ 3 ], [ 4 ]

Symptoms mammary fibrosis

Key symptoms of breast fibrosis: the presence of individual painless lumps (0.2-0.3 cm or more in size) or compacted areas of various locations in the breast tissue; change in skin color over the affected area of the gland; a feeling of discomfort in the glands; liquid discharge from the nipple (transparent or slightly colored).

Often there is a feeling of heaviness and “bursting of the chest from the inside”, minor pulling or aching pains, which become stronger before the onset of menstruation and can radiate to the shoulder and armpit area.

In the clinical picture of the cystic form of the disease, there is more significant pain in the nodes when palpated, as well as a slight increase in the formations, as well as the axillary lymph nodes before the onset of menstruation.

[ 5 ], [ 6 ], [ 7 ]

Forms

Fibrosis of the mammary gland has varieties - depending on the scale of the process of proliferation of connective tissue cells and its specific localization relative to the anatomical structures of the gland.

When pathological changes in the fibrous tissue of the breast are concentrated in a limited point, doctors state focal or local fibrosis of the mammary gland. Or - in another terminological interpretation - localized. In focal, most often in the upper quadrant of the gland, a dense fibrous node of 2-3 cm of oval or round shape is formed - one or more. This type of disease is considered to be only the initial stage of a larger process of pathological proliferation of fibrocytes, which can develop, as they say, in breadth and depth - especially in the absence of therapy. If the process has affected a significant part of the gland or even the entire breast (that is, fibrous tissue has displaced glandular and fatty tissue), then this is diffuse fibrosis of the mammary gland.

Nodular fibrosis of the mammary gland is basically no different from local or focal fibrosis, since it develops as a separate node. And cystic fibrosis is associated with the formation of cysts - capsules with walls containing contents. Cysts in the breast are usually retention, that is, they arise as a result of narrowing or complete blockage of milk ducts.

Periductal fibrosis of the mammary gland (or plasmacytic fibrosis) involves the formation of collagen fibers around the milk ducts. This type is typical for patients of climacteric age.

Ductal fibrosis of the mammary gland is a ductal fibrosis that affects only the ducts and does not damage the tissues of other areas of the breast. And when a periductal perivascular type of pathology is diagnosed, this means that excessive formation of connective tissue occurs not only around the ducts, but also around the lymphatic and blood vessels.

Stromal fibrosis of the mammary gland is a pathological proliferation of fibrous tissue itself – the stroma, which supports and connects the parenchyma and adipose tissue. In addition, fibrous tissue “partitions” pass through the adipose tissue, connecting the skin with the glandular capsule.

Linear, which is also called interlobular or stranded fibrosis of the mammary gland, is the result of proliferation of interlobular connective tissue and intraductal tissue, often with the formation of cysts. When detecting this type of pathology, mammologists feel dense strands in the breast of patients, and they clearly see them on a mammographic image. And in this case, the doctor's verdict: stranded interlobular linear fibrosis.

In cases where connective tissue replaces adipose tissue cells, involutional fibrosis of the mammary glands is determined, which is more typical for older women.

Depending on the severity of the symptoms of the disease, a distinction is made between moderate and severe degrees of disease severity.

[ 8 ], [ 9 ], [ 10 ]

Diagnostics mammary fibrosis

In modern mammology, the following diagnostic methods are used:

• palpation of the chest and regional lymph nodes;
• mammography (x-ray of the breasts);
• general blood test;
• blood test for hormone levels;
• ultrasound examination (ultrasound);
• computed tomography (CT);
• Doppler sonography (examination of blood vessels and blood flow in the chest);
• chromoductography (X-ray of ducts with contrast agent);
• biopsy with histological examination of the obtained tissue sample.

[ 11 ], [ 12 ]

Treatment mammary fibrosis

Treatment of the disease is carried out based on the specific type of fibrosis and its etiology. An important role in the choice of treatment methods is played by the age and individual characteristics of the woman's body, in particular, the presence of inflammatory processes in the uterus and ovaries and endocrine disorders. Preference is given to conservative therapy, although the possibility of surgical intervention is not excluded.

Treatment of focal, as well as treatment of local fibrosis of the mammary gland - as well as almost all other types of this disease - is carried out with the help of hormonal drugs.

For example, Duphaston (Dydrogesterone), which contains a synthetic analogue of the female sex hormone progesterone, is used for a deficiency of this hormone. This hormonal agent neutralizes the activity of estrogen, which plays a leading role in cyclic changes in breast tissue. The standard dose is 10 mg (one tablet) per day, which is taken for 14 days of each menstrual cycle.

Tamoxifen (Zitazonium, Yenoxifen, Nolvadex, Cytofen), which blocks endogenous estrogen receptors, is also an anti-estrogenic drug. This medication is prescribed to women during menopause for breast cancer, endometrial cancer, and to women of reproductive age for infertility due to egg immaturity.

In the treatment of various pathological neoplasms in the breast, the external use product Progestogel is used - a gestagenic drug containing the hormone of the corpus luteum of the ovary (progesterone) and reducing swelling of fibrous tissues of the breast. The gel is recommended to be applied to the skin of the breast (rubbing until completely absorbed) - twice a day.

As for the drug Bromocriptine (Abergin, Ronalin, Parlodel), which reduces the synthesis of prolactin and somatropin, it is contraindicated for premenstrual syndrome and benign breast pathologies.

Mastodinone is often prescribed for the treatment of diffuse fibrosis of the mammary glands - a liquid homeopathic preparation - an alcohol tincture of iris, cyclamen, tiger lily and strychnine-containing vomit nut (chilibukha). Doctors prescribe taking 30 drops twice a day, the course of treatment is three months.

In case of iodine deficiency and hypothyroidism, Potassium iodide (Iodex, Iodbalans, Iodomarin, etc.) is prescribed – one tablet once a day. In order to normalize liver function, hepatoprotective drugs are used (Carsil, Gepabene, Essentiale, Architol, etc.). Vitamins A, C, E and B vitamins are also prescribed.

In case of breast swelling, herbal diuretics are recommended. And to relieve nervous tension, the doctor should prescribe a mild sedative.

Surgical intervention - excision of nodes and cystic formations by sectoral resection - is performed quite rarely and only if they are of significant size. There is a method of enucleation of the pathological formation (nucleation).

In order to successfully combat the pathology, it is very important to monitor the normal functioning of the intestines to prevent the reabsorption of estrogens, which are metabolized by the liver. Therefore, it is best to exclude animal fats from the diet and consume more plant fiber (i.e. vegetables and fruits).

But the treatment of breast fibrosis with folk remedies, for example, with cabbage leaves or ointment with celandine juice, proposed by some healers, has no therapeutic effect, since this pathology is multifactorial, and alkaloids, flavonoids and phytoncides of medicinal plants known to herbalists do not cope with them.

Prevention

Today, it is not possible to prevent the occurrence of the disease. Although every owner of breasts can detect this pathology in a timely manner herself - if she conducts regular self-examination of the breasts (in the first two weeks of the menstrual cycle).

If you want to reduce your risk of developing breast fibrosis, do not postpone having children until "after 30", do not abuse the termination of unwanted pregnancies, as well as hormonal contraceptives. And after the birth of the child, breastfeed him for at least 12 months.

Give up bad habits and take care of your health.

[ 13 ], [ 14 ], [ 15 ], [ 16 ]

Forecast

The prognosis of the disease is favorable, since this pathology, according to doctors, does not degenerate into oncology. Although, in fairness, it should be noted that in the presence of any breast diseases, a woman risks facing a frightening diagnosis. And this probability is almost five times higher than in women with healthy breasts.

It should also be kept in mind that almost every third case of women seeking medical help for mastopathy is diagnosed as fibrosis of the mammary gland.

[ 17 ]