Breast augmentation: physiological and pathological

Breast enlargement of endocrinologists is divided into physiological and pathological. In the first case it is a question of the natural process, in the second - about the disease associated with imbalance of hormones. Mammary glands - their size, structure and functioning characteristics - are in direct or indirect dependence on the development of the body of a whole group of hormones: estrogen, estradiol, progesterone, prolactin, pituitary hormones, hypothalamus, adrenal cortex, thyroid and pancreas.

[1], [2], [3], [4], [5], [6]

Causes of the breast augmentation

Physiological, that is, the natural causes of breast enlargement in women of reproductive age, are cyclical in nature, associated with menstruation. During pregnancy and lactation, a complete hormonal alteration of the organism takes place, which also affects the mammary glands. And in girls, the growth of the mammary glands lasts throughout the entire period of puberty.

All other cases of breast enlargement in women and men are usually caused by pathology or anomalies in the hormonal sphere. Pathological hypertrophy of the mammary glands can develop because of the proliferation of connective tissue, and in women with excessive body weight - due to the deposition of adipose tissue. Temporal enlargement of the mammary glands is possible during recovery from severe diseases that caused significant weight loss.

[7], [8], [9]

Forms

[10], [11]

Breast augmentation in women

The increase in mammary glands before menstruation (mastodynia or mastalgia) is noted by most women. This is also directly involved in steroid hormones: during the next maturation of the follicle, their release into the blood increases. The oestrogen produced estradiol promotes the growth of connective fibers and the increase in the ducts of the mammary gland. And progesterone, which produces the yellow body and the cortex of the adrenal glands, causes an increase in the number of glandular cells in the mammary glands of a woman. This process is reversible, and with the end of menstruation, everything comes to its original state.

Breasts can increase in women who use hormonal contraceptives or take medications containing certain types of hormones.

However, the increase and  pain of the mammary glands  may be a symptom of a disease such as diffuse mastopathy. In this case, the pain in the chest is longer and more intense than before menstruation, and can spread to the area of the armpit, shoulder and shoulder blades. As doctors say, patients complain of acute pain in the chest during movement and touch. At the same time, an imperative symptom is a slight palpation of the tissues (mainly in the upper part of the gland, towards the armpit). If you have these symptoms, you should immediately contact a gynecologist or mammologist who will conduct the examination and prescribe the treatment.

[12],

Breast augmentation during pregnancy

The process of increasing the mammary glands during pregnancy is the preparation of the woman's organism for breastfeeding the baby, that is, for the secretory activity prescribed by nature itself. In this process, the main role is played by hormones such as estrogen, progesterone, prolactin and placental lactogen (placental somatomammotropin). The last hormone is special, because it is produced only during pregnancy - the placenta.

In the mammary glands of the pregnant woman there are many changes: the volume of glandular tissue (which produces milk) increases, the alveoli grow in the dairy lobes, the excretory ducts expand, the number of milk ducts increases.

The increase in mammary glands during pregnancy continues almost during the entire period of gestation, although the breast of the future mother is ready for production by the 4th to 5th month of gestation.

[13]

Increased mammary glands in men

Despite the fact that mammary glands in men are rudimentary organs, they can also have a problem. This  gynecomastia  is a benign enlargement of the mammary glands in men, exceeding 2 cm in diameter. In clinical medicine, an independent disease gynecomastia is not considered, but is considered as a sign of other pathologies.

The main reasons for the increase in mammary glands in men are as follows:

• the use of certain pharmacological agents (estrogens, cardiac glycosides, phenothiazines, tricyclic antidepressants, etc.);
• inadequate production of the main male sex hormone testosterone;
• decreased production of androgens (hypogonadism);
• syndrome of hypercorticism (Itenko-Cushing syndrome with chronic excess in the body of hormones of the adrenal cortex);
• adrenal gland tumors, testicles or pituitary gland;
• hyperthyroidism (hyperfunction of the thyroid gland);
• acromegaly (disproportion of bone growth with excessive production of growth hormone growth hormone);
• alcoholic cirrhosis of the liver;
• chronic renal failure (with a violation of the balance of estrogens and androgens);
• Herpes zoster in the thorax;
• obesity (pseudo-gynecomastia).

As can be seen from the above list, in most cases, the increase in mammary glands in men is also associated with hormonal changes. Gynecomastia can affect one or both breasts, and in eight cases out of ten, it is precisely the bilateral proliferation of glandular tissue.

Breast augmentation in a child

The increase in the mammary gland in a child in the neonatal period has the form of swelling of the breast and should not cause concern. This is observed quite often - as in girls (more than 80%), and in some boys.

In pediatrics, this physiological phenomenon is called the infant hormonal crisis, which occurs due to the ingestion of mother estrogen into the bloodstream - through the placenta. Because of the increased secretion of pituitary hormones, the colostrum can have colostrum from its nipples.

As a rule, by the end of the first month of a newborn's life, the swelling of the breast disappears by itself. In 2% of babies, breast enlargement persists for 3-6 months, in some cases up to 10 months.

[14], [15]

Increased mammary glands in girls

The physiological increase in mammary glands in girls begins at 8-11 years, a pathological increase can be observed at an earlier age - up to 8 years.

Such pathology in girls is explained by the  syndrome of premature puberty, which can manifest itself as a result of disorders of gonadotropic regulation, cysts or ovarian tumors, congenital hypothyroidism, and germ cell tumors. In addition, abnormal enlargement of mammary glands in girls can be the result of a congenital mutation of the gene responsible for the synthesis of estrogens in the body, or the use of hormone-containing drugs.

At the same time, the physical development of girls with this pathology corresponds to the age norms, but maturation of the bone system (bone age) can be 1.5-2 years ahead of peers.

Increased mammary glands in boys

Pubertal or juvenile gynecomastia is an increase in mammary glands in boys aged 11 to 15 years, that is, during puberty. According to endocrinologists, this pathology is manifested by a slight swelling of the areola (in the form of a nodule) and some hypersensitivity of the nipples and is detected in almost half of absolutely healthy boys.

The reason for the increase in mammary glands in boys has not been fully determined to date, but there is every reason to believe that it is associated with a temporary hormonal imbalance. During this period, the development of the anterior pituitary gland of the gonadotropic hormone foliotropin increases, while the ratio in the growing body of the male hormone testosterone and the female hormone estrogen is disrupted.

After the puberty period, the mammary glands in the boys come back to normal.

Diagnostics of the breast augmentation

In the diagnosis of abnormal breast enlargement, women are used:

• collection of anamnesis (including family history on a female line);
• visual examination with the determination of the amount of glandular tissue in the mammary glands;
• mammography;
• Ultrasound of mammary glands;
• radioisotope scanning of mammary glands;
• lymphography and phlebography;
• laboratory blood tests for hormonal status - immunochemiluminescent analysis (IHL) and enzyme immunoassay (ELISA).

Diagnosis of breast enlargement in men is carried out using methods such as:

• a blood test for testosterone, estradiol, adrenocorticotropic hormone and cortisol, thyrotropin, chorionic gonadotropin, and others;
• urinalysis on the level of nitrogen, urea, creatinine and hepatic transaminases;
• X-rays of light;
• CT of the brain and adrenal glands;
• MRI (for detection of pituitary adenoma).

Diagnosis of abnormal breast enlargement in a child includes:

• detailed history, physical examination;
• a blood test for the determination of hormone levels: estradiol, prolactin, testosterone, luteotropin (LH), follicle stimulating hormone (FSH), 17-hydroxyprogesterone (17-GPG), and dehydroepiandrosterone sulfate (DHEA-C). The analysis allows to confirm or exclude premature sexual development of the child or congenital dysfunction of the adrenal cortex;
• blood test for the markers of germ cell tumors (if there is a suspected presence of germinogenic tumor);
• X-ray of hands with a wrist joint (to determine the bone age);
• US of mammary glands, organs of small pelvis, adrenal gland and thyroid gland;
• CT and MRI of the brain and adrenal glands.

[16], [17], [18], [19], [20], [21], [22]

Treatment of the breast augmentation

Therapy of these pathologies involves influencing the causes that led to their occurrence. Therefore, treatment is aimed at the underlying disease and is determined individually for each patient.

With an increase in mammary glands before menstruation, non-steroidal anti-inflammatory drugs and diuretic (diuretic) drugs may be recommended. Nonsteroidal anti-inflammatory drugs help with pain, which many women experience during menstruation. Most often, doctors advise taking Ibuprofen (other trade names Ibuprom, Ibufen, Imet, Nurofen, Solpaflex, etc.) - on a tablet (200 mg) three times a day. This drug is contraindicated in case of acute gastric ulcer and ulcerative colitis, with violations of hematopoiesis, kidney and liver functions. And among the possible side effects are nausea, flatulence, constipation or diarrhea, dizziness, insomnia, and skin rash.

With an increase in mammary glands before menstruation due to edema of the breast tissue, a diuretic such as Veroshpiron (analogues Aldactone, Spironolactone, Veroshpiron, Spironol) can help, which can not be used in acute kidney failure. Tablets of 0.025 g take inside one piece 3-4 times a day. Possible side effects in the form of dizziness, drowsiness, dermatoses, lowering the sodium content in the blood and increasing the potassium content.

In the case of a significant increase in breast and its soreness in the premenstrual period, a doctor may be prescribed a progestogen topical application Progestogen, which contains the progesterone ovary's yellow body hormone. The product is available as a 1% gel (in a tube with a spatula-dispenser). The gel is applied to the skin of the mammary glands (with rubbing) twice during the day. The duration of the course of treatment is determined by the doctor. To date, the side effects of this drug have not been identified, and the contraindication to its use is individual hypersensitivity.

Treatment of breast enlargement in men

Specificity of treatment of mammary gland enlargement in men (gynecomastia) also consists in eliminating the main reason why hormonal drugs are used. With male gynecomastia, ergot preparation Bromocriptine (Bromocriptine, Pradel, Parlodel) can be prescribed. This drug is designed to suppress lactation, as it inhibits the production of hormones in the anterior lobe of the pituitary gland, prolactin and somatotropin. With male prolactin-dependent hypogonadism, including with an increase in the size of the mammary glands, this drug is taken at 1.25 mg three times a day - after meals. Treatment can last from one month to six months.

Bromocriptine has side effects, which are manifested by dizziness, headache, nausea and vomiting, as well as weakness, pale skin and drowsiness. This drug is contraindicated in patients under the age of 15, with increased blood pressure, coronary heart disease, decompensated diseases of the cardiovascular system and gastrointestinal pathologies.

Used in androgen deficiency Clomifene (analogues of Clomid, Clostilbegit, Serofen, Serpafar) is an anti-estrogen of a non-steroidal structure that acts on the estrogen receptors of the pituitary gland. The drug is not prescribed for renal dysfunction and hepatic insufficiency, neoplasms of genital organs, pituitary dysfunction, and also with propensity to form blood clots. Among its contraindications are: dizziness and headache, drowsiness and retardation of reactions, nausea and vomiting, stomach pains, flatulence, alopecia (baldness). Clomiphene men are prescribed 50 mg 1-2 times a day.

In the treatment of mammary gland enlargement in adult males, the use of male sex hormones is rarely practiced, since the same testosterone provokes gynecomastia: it activates the adrenal enzyme atroamase, which converts testosterone to estrogen. However, intramuscular injections of testosterone may reduce the size of the hypertrophied male breast in the case of decreased production of androgens (hypogonadism). For example, increases the level of testosterone in the blood preparation Sustanon-250 (analogues Omnadren 250, Testanat) containing esters of this hormone. It is injected deep into the muscle in the amount of 1 ml - once every three weeks.

With negative results of hormonal therapy in men resort to surgical intervention to remove the affected breast.

Treatment of mammary gland enlargement in girls and boys

In the case of premature enlargement of the mammary glands in girls, drug treatment is not applied. It is recommended to observe the doctor and the examination (once a year). Also, you should temporarily refrain from any vaccinations.

As a rule, the increase in mammary glands in boys does not require treatment. But if juvenile gynecomastia is significant and does not go on for two or more years, it can be recommended to apply a tight bandage to the breast and, taking hormonal status of the patient into account, take hormonal preparations. Most often it is proposed (only for the endocrinologist) a drug that reduces the functions of the sexual glands, Danazol (synonyms Danoval, Bonzol, Danokrin, Danogar, Danol, etc.), which is available in capsules of 100 and 200 mg. Dosage for adults is 200-800 mg per day - in three divided doses; adolescents - from 100 to 400 mg per day. The drug can cause side effects, which are manifested by nausea, dizziness, headache, full or partial hair loss, acne on the skin, swelling. This remedy for the treatment of breast enlargement is contraindicated in porphyria, and in the presence of cardiac and renal insufficiency and diabetes mellitus is prescribed with caution.

With inefficiency of drug therapy for adolescent gynecomastia, subcutaneous mastectomy is possible. With extensive growth of fatty tissue, liposuction is used.

Prevention

In the majority of cases, prevention of breast enlargement is impossible, since the production of sex hormones, thyroid and pancreatic hormones, the hypothalamus, pituitary gland and the adrenal cortex is genetically determined.

However, it should be borne in mind that a healthy lifestyle - rational nutrition and exercise - partly contributes to the prevention of hormonal disruptions. So, regular exercise, including strength exercises, can increase the synthesis of testosterone in men. But stresses increase the level of cortisol, which can convert testosterone into estrogen.

You should be careful with food, rich in phytoestrogens. These include soy and lentils, nuts and sunflower seeds, oats and millet, cheese and beer. About the beer. The hops used in the production of this drink have a plant hormone similar to estrogen, a female steroid hormone. So the excessive use of beer is fraught with a violation of the hormonal status of men .

An increase in the mammary gland, which is not characteristic of the physiological state, sex or age, is a clear sign of the disease. To find out the specific cause of the pathology and its elimination, you should contact the medical institution. And in the arsenal of doctors there is a means to solve this problem.

[23], [24], [25], [26], [27], [28], [29], [30]

Forecast

The prognosis of mammary gland enlargement is positive, although hormonal imbalance can give an impetus to the development of other pathological processes in the body.

[31], [32]