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Mastopathy of the breast
Last reviewed: 04.07.2025

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Epidemiology
Mastopathy is one of the most common diseases in women: in the population, the incidence rate is 30-43%, and among women suffering from various gynecological diseases, it reaches 58%. The frequency of mastopathy reaches its maximum by the age of 45.
Causes mastopathies
Mastopathy is a benign disease. However, in some cases, this pathology may be an intermediate stage in the development of a malignant process. Since benign diseases and breast cancer have much in common in etiological factors and pathogenetic mechanisms, the risk factors for the development of mastopathy and uterine cancer are largely identical.
The state of the hypothalamic-pituitary system plays a huge role in the occurrence and development of dyshormonal diseases of the mammary glands. Disruption of the neurohumoral component of the reproductive cycle leads to activation of proliferative processes in hormone-dependent organs, including the tissues of the mammary glands, which are the target for ovarian steroid hormones, prolactin, placental hormones and, indirectly, hormones of other endocrine glands of the body. Numerous clinical observations confirm that benign diseases of the mammary glands in 70% of cases are combined with various disorders in the neuroendocrine and reproductive systems. A decisive role in the development of mammary gland diseases is given to progesterone-deficient conditions, in which excess estrogens cause proliferation of all tissues of the gland.
At the same time, mastopathy is often observed in women with ovulatory cycles and intact reproductive function. In this case, the decisive role in the occurrence of mammary gland pathology is given not to the absolute value of hormones in the blood plasma, but to the state of the receptors of sex steroids in the gland tissue, since the state of the receptor apparatus determines the occurrence of the pathological process. In unchanged mammary gland tissue, the number of receptors is minimal. Against the background of hormonal imbalance in some women, changes in the mammary glands may not go beyond the physiological norm, while in others, subject to activation of the receptor apparatus, they can turn into a pathological process with subsequent development of proliferative processes.
Liver diseases play an indirect role in the development of dyshormonal pathology of the mammary glands. As is known, enzymatic inactivation and conjugation of steroid hormones occurs in the liver. Maintaining a constant level of hormones in the circulating blood is due to their enterohepatic metabolism. Diseases of the hepatobiliary complex most often initiate the development of chronic hyperestrogenism due to slow utilization of estrogens in the liver. These data are confirmed by the high frequency of hyperplastic processes in the mammary glands in liver diseases.
Thyroid hormones (thyroxine, triiodothyronine) play an important role in the morphogenesis and functional differentiation of epithelial cells of the mammary gland. The effect of thyroid hormones on the mammary gland can be realized directly or through the effect on receptors to other hormones, in particular to prolactin. Thyroid pathology was detected in 64% of patients with various forms of mastopathy.
Symptoms mastopathies
The main complaint of patients with mastopathy is pain, which usually intensifies in the premenstrual period, sometimes from the second half of the menstrual cycle. The pain may be local and radiate to the arm or shoulder blade. Women also note painful areas of compaction in the tissue of the mammary glands.
Although pain is the main symptom of mastopathy, 10-15% of women do not experience pain, despite the fact that examination and palpation reveal the same changes as women experiencing severe pain. This may be due to different pain sensitivity thresholds, due to the level of endorphins in the central nervous system. The occurrence of pain is explained by compression of nerve endings by edematous connective tissue, cystic formations and their involvement in sclerotic tissue. About 10% of women note an increase in axillary lymph nodes and their sensitivity during palpation.
Where does it hurt?
Stages
There are three clinical phases of mastopathy:
- the first phase - age 20-30 years, the menstrual cycle is regular, but often shortened to 21-24 days; a week before menstruation, engorgement and soreness of the mammary gland appear, the gland hardens and becomes sensitive to palpation;
- the second phase - 30-40 years, pain in the mammary glands is constant and lasts 2-3 weeks before menstruation; individual painful compacted lobules with cystic inclusions are palpated in the gland;
- the third phase - age over 40-45 years, pain in the mammary glands is less intense and inconstant; multiple cystic formations are palpated, some reach 1-3 cm in diameter, contain a brownish-green secretion that appears from the nipple when pressing on the areola.
Forms
For clinical practice, a classification of fibrocystic mastopathy (FCM) is convenient, distinguishing diffuse and nodular forms of changes in the glands, which are reflected in radiographs during ultrasound scanning and morphological examination.
Classification of mastopathy
- Nodular fibrocystic mastopathy
- Diffuse fibrocystic mastopathy:
- with a predominance of the glandular component (adenosis),
- with a predominance of the fibrous component;
- with a predominance of the cystic component;
- mixed form
Diffuse and nodular fibrocystic mastopathy can have both proliferating and non-proliferating forms. With proliferation, intraductal papillomas develop in the epithelium lining the milk ducts; cystaden papillomas develop in the epithelium lining the walls of cysts. In this case, atypical and malignant changes in the proliferating epithelium may develop.
The criterion for determining the subtype is the ratio of connective tissue, glandular components and adipose tissue.
A special form of mammary gland pathology is distinguished in the premenstrual period - mastodynia, or mastalgia - cyclic engorgement of the gland caused by venous congestion and swelling of the stroma; the mammary gland increases in volume by more than 15%.
[ 24 ], [ 25 ], [ 26 ], [ 27 ]
Fibrocystic mastopathy with a predominance of the glandular component (adenosis)
Morphologically, this form of fibrocystic mastopathy is characterized by highly differentiated, non-encapsulated hyperplasia of the glandular lobules.
Clinically, it manifests itself as pain, engorgement, and diffuse compaction of the entire gland or its part. The boundaries of the compactions smoothly pass into the surrounding tissues. Pain and engorgement increase in the premenstrual period. Adenosis is observed in young girls at the end of puberty, as well as in women in the early stages of pregnancy as a transient condition. X-ray examination reveals multiple shadows of irregular shape with unclear boundaries, which correspond to areas of hyperplastic lobes and lobes. Sometimes, with an extensive process, the shadows capture the entire gland.
[ 28 ], [ 29 ], [ 30 ], [ 31 ], [ 32 ]
Fibrocystic mastopathy with fibrosis predominance
Morphologically, this form is characterized by fibrous changes in the interlobular connective tissue, proliferation of intraductal tissue with narrowing of the lumen of the glandular duct up to its complete obliteration.
The clinical picture is characterized by pain, and when palpating the gland, dense, stringy areas are determined. Fibrous processes predominate in women of premenopausal age. The radiographic picture of this form of fibrocystic mastopathy is layers of dense, homogeneous areas with pronounced stringiness. Radiographs have a "ground glass" appearance.
Fibrocystic mastopathy with a predominance of the cystic component
The morphological picture of the cystic form of fibrocystic mastopathy is characterized by the presence of multiple cysts formed from atrophied lobules and dilated ducts of the gland. Fibrous changes in the interstitial tissue are also characteristic. However, proliferative processes in the epithelium lining the cyst wall may occur in cysts, with the formation of papillary formations.
As with other forms of fibrocystic mastopathy, the characteristic clinical sign is pain that intensifies before menstruation. Radiographically, fibrocystic mastopathy with a predominant cystic component is characterized by a large-mesh pattern, which shows multiple clearings with a diameter of 0.3 to 6 cm with clear contours. The color and consistency of the cystic contents vary. The fluid is partially resorbed by histiocytes. Calcification of cysts is observed in 25% of patients. Calcification, like bloody contents, is considered a sign of a malignant process.
All three diffuse forms of fibrocystic mastopathy in their pure form are rare. Much more often in clinical practice we have to deal with a mixed form of mastopathy, in which all the above-mentioned morphological changes are expressed: hyperplasia of lobules, sclerosis of intralobular and interlobular connective tissue and atrophy of the alveoli with expansion of ducts and their transformation into cystic formations.
Nodular form of fibrocystic mastopathy
This form of fibrocystic mastopathy is characterized by the changes described above, but of a local nature in the form of single or several nodes. When palpated, individual seals without clear boundaries are determined, not fused with the skin, increasing in size the day before and decreasing after the end of menstruation. With this form of fibrocystic mastopathy, the pain is most pronounced, the pain radiates to the shoulder, shoulder blade. Sometimes the axillary lymph nodes increase in size.
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Treatment mastopathies
Diuretics
Cyclic mastopathy, as one of the manifestations of premenstrual syndrome, especially if it is accompanied by swelling of the hands and feet shortly before menstruation, can be relieved with mild diuretics (for example, herbal teas). It is also advisable to limit the use of table salt during this period.
Nonsteroidal anti-inflammatory drugs are recommended to reduce cyclic mastalgia by taking them a week or a few days before the next menstruation, when the most severe pain in the mammary glands occurs, but this cannot be recommended as a permanent and long-term treatment method.
Products that improve blood circulation
It is recommended to use vitamin P preparations (ascorutin) or products containing this vitamin (citrus fruits, rose hips, black currants, chokeberries, cherries, raspberries) to improve microcirculation and reduce local swelling of the mammary gland.
Complex, natural products
Currently, many different complex herbal remedies with vitamins, antioxidants and microelements are offered for the treatment of both mastopathy and premenstrual syndrome, including cyclic mastalgia (vetoron, klamin).
Sedatives
The mammary glands are an organ that reacts very sensitively to psycho-emotional stress. Troubles at work or at home, chronic dissatisfaction, fatigue, anxiety, depression - all this can cause, maintain or increase pain. Depending on the psycho-emotional state of the woman, it is advisable to include sedatives in the complex treatment of mastopathy, initially giving preference to mild herbal preparations (tincture of motherwort, valerian, etc.), if necessary - more potent sedatives.
Choosing a bra
Women with cyclic or constant mastalgia should definitely pay attention to this item of women's clothing, since both completely ignoring it and wearing a bra of the wrong shape or size can cause chronic deformation of the breast, its compression or overload of the ligamentous apparatus, especially in women with large and drooping breasts. Often, when these causes are eliminated, pain in the mammary gland decreases or even completely disappears.
Breast massage for mastopathy
The female bust basically consists of glandular tissues, which are densely covered with numerous blood vessels, lymphatic system, sebaceous and sweat glands. Oddly enough, it is this area of our body that is maximally protected.
Using new-fangled cosmetic products, daily antiperspirants, people do not even think that they are clogging the outlet pores for a long time. Therefore, the lymphatic system is not able to remove toxins, decay and processing products from the human body. But where can they go, naturally they begin to accumulate in neighboring tissues, that is, in the tissue structures of the breast. Often, such a development of events can lead to the formation of pathology, one of which is quite capable of becoming mastopathy, the percentage of manifestations of which is quite high today.
Therefore, in order to reduce the risk of its development or, in case of its diagnosis, gynecologist or mammologist prescribe breast massage for mastopathy, which is one of the methods of complex treatment that allows a woman to get rid of this problem.
This massage has a lymphatic drainage effect. This allows activating blood flow, lymph flow, preventing the occurrence of stagnation.
It is precisely the stagnation of processes that, in most cases, is the catalyst for the formation of various types of neoplasms.
In light of the development of the disease, normal lymph flow is especially important. After all, lymph is the "sewage cleaner" of the body, which cleans it, removing all the garbage, while simultaneously disinfecting. It is thanks to lymph that our breasts are protected from invasive flora and other negative effects.
As for mastopathy, there can be no talk of self-treatment for this disease. Therapy should be comprehensive and prescribed by a qualified specialist, after the woman has undergone an examination and has a complete picture of the disease.
It is worth immediately reassuring women that this disease has long been treated favorably. Therefore, the main thing is not to start the process and to carry out treatment in a timely manner, seeking help from a mammologist.
Today, there is no single system of therapy that would fully satisfy and satisfy the point of view of all doctors. Complex protocols for treating this disease, including medication and physiotherapy, are also different. The method of massage in the treatment of this pathology is also involved in this dispute.
Therefore, today the use of massage in the treatment of mastopathy is controversial. Some specialists believe that such an impact on the breast with existing mastopathy can become a catalyst for the degeneration of existing benign neoplasms into cancerous structures. And such a risk is quite high. Therefore, they believe that they have no right to risk the health and life of a woman.
Others refute this opinion, proving the beneficial effect of physiotherapy measures in relieving the problem associated with mastopathy.
It is worth reminding once again that the treatment of this disease should be comprehensive. At the same time, if the doctor has decided to prescribe massage in the treatment protocol, then you should not engage in amateur activities and self-medication. Such a treatment procedure should only be done by a professional!
This therapy is quite long, so you need to be patient to cope with the disease. But it's worth it.
It is worth offering one of the massage methods that is acceptable in this situation. Sequence of actions:
- You need to sit down, relax, calm down, adjust your breathing and drive away any thoughts. Relaxation is an additional plus of this procedure.
- With the pads of the large, middle and index phalanges, begin to make circular spiral movements, which first move clockwise and then in the opposite direction.
- At the same time, try to arouse love for yourself and direct it to the massaged area. Try not to lose this state during the three to five minutes during which the massage is performed.
- At the same time, you should imagine the fact that the disease is leaving the body and recovery is coming. Believe me, the result of such work will pleasantly surprise you.
- It is necessary to direct your request to the central part of the brain, where the pituitary gland is located, which controls the production of hormones, maintaining hormonal balance.
- Imagine light energy that penetrates and heals. Continuing to massage, it is worth directing this "solar flow" to the ovaries. Such measures will not be in vain. And soon you will be able to notice a positive shift in the course of the disease.
It should only be noted again that self-medication should not be done, as this approach to therapy can lead to a deterioration in the woman's health. The procedure should be performed by a specialist, and the method described above is permitted for use at home only with the permission of the attending physician.
Hormonal therapy for mastopathy
Hormone therapy is aimed at reducing the excessive stimulating effect of estrogens on breast tissue, and less often, at correcting dysprolactinemia or hypothyroidism.
Antiestrogens
To provide a stimulating effect, endogenous estrogens must bind to specific cell receptors. In the case of relative hyperestrogenism, antiestrogens (tamoxifen, toremifene), blocking estrogen receptors in target tissues (including the mammary gland), do not allow estrogens to bind to receptors, reducing their biological activity.
Some patients may experience increased pain and swelling of the breasts during the first weeks of treatment, which can be explained by the partial estrogenic effect of antiestrogens; in rare cases, this may require interruption of treatment.
[ 37 ], [ 38 ], [ 39 ], [ 40 ]
Oral contraceptives
Correctly selected and used oral contraception provides permanent suppression of steroidogenesis and ovulation, suppression of ovarian androgen synthesis, as well as estrogen receptors in the endometrium, equalization of excessive fluctuations in cyclic hormones, long-term protection against the development of ovarian and endometrial cancer. Symptoms of mastopathy often decrease or even completely disappear within the first two months, but objective results can be expected no earlier than 1-2 years after the start of oral contraception. At the same time, in some women, pain in the mammary glands and other symptoms of mastopathy may even increase during the use of oral contraceptives. Then it is necessary to switch to another type of contraception or change oral contraceptives.
Gestagens
The therapeutic effect of gestagens in the treatment of premenstrual syndrome and fibrocystic mastopathy is associated with the suppression of functional pituitary-ovarian connections and a decrease in the proliferation-stimulating effect of estrogens on mammary gland tissue. In recent years, the use of progesterone derivatives has increased - medroxyprogesterone acetate (MPA), since they have more pronounced gestagen properties, moderate antiestrogenic activity and minimal or virtually absent androgenic action. Gestagens are especially indicated for patients with established luteal phase insufficiency and the resulting relative hyperestrogenism, anovulatory bleeding, uterine myoma.
Androgens (danazol) as estrogen antagonists are used to treat mastopathy. Danazol's action is based on its ability to inhibit the synthesis of gonadotropic hormone (proven in experiments with laboratory animals) and some essential enzymes in ovarian steroidogenesis. The drug has a progestogenic and weak androgenic effect.
Prolactin secretion inhibitors
These drugs (bromocriptine) are prescribed only to patients with hyperprolactinemia.
Gonadotropin-releasing hormone analogs
The use of gonadotropin-releasing hormone (GnRH) analogues significantly reduces the level of circulating estrogens and testosterone. In addition, the presence of receptors for estrogens and progesterone in breast cancer tissue suggests that GnRH specifically affects (autocrine or paracrine) the growth of breast tissue cells.
Conservative therapy of FCM requires long courses (3-6 months). However, already 1 year after the end of treatment, a relapse of the disease occurs in 60-70% of cases. Therefore, the search for new methods of prevention and therapy of this disease remains relevant.
[ 41 ], [ 42 ], [ 43 ], [ 44 ]
Surgical treatment of mastopathy
In case of cystic fibrous and other forms of nodular mastopathy, sectoral resection of the mammary gland with urgent histological examination of the node is indicated so that if signs of malignancy are detected in the removed specimen, a radical operation can be performed immediately.
In cases where cytological examination reveals proliferating fibroadenomatosis, the method of choice is simple mastectomy. This form of mastopathy should be considered as an obligate precancer.
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