Mastopathy. Mastopathy: symptoms and treatment of breast pathology Mastopathy of 2 mammary glands, nipples retracted

This defect can seriously spoil a woman’s personal relationships and the joys of motherhood, give rise to a lot of unnecessary complexes and significantly reduce the quality of life.

Inverted nipples (sometimes called sunken, sunken or sunken nipples) are a feature of the development of the mammary glands, which often becomes both an aesthetic and a functional problem. But few people know that it is relatively easy to correct with the help of surgery, and sometimes even with conservative methods. Does this condition affect your ability to feed your baby? Can it cause cancer or other breast diseases? Which doctor should I turn to for help: a mammologist or a plastic surgeon? The site conducts a detailed educational program:

What does this defect look like and what are its causes?

WITH medical point In terms of vision, inverted nipples are considered to be those that do not protrude above the areola: they are located at the same level with it or are immersed deep into the tissue. This pathology can affect both mammary glands or only one of them; it is quite clearly visible visually and is easily detected even during self-examination. According to statistics, it is present in almost 20% of women and a small part of men.

To understand what leads to this condition, it is necessary to briefly understand the anatomy. The nipple is formed from the terminal sections of the milk ducts and smooth muscle fibers. Its natural convex position and elasticity are ensured by support from connective tissue. Normally, it is elastic, but in a special pathological condition - fibrosis - it grows and thickens. This leads to various kinds of deformations, incl. retraction and compression of the ducts, which can significantly impair their patency.

The initial causes of fibrotic processes and, as a result, the formation of inverted nipples can be:

• genetic disorders in which there is excessively active growth of connective tissue fibers and/or underdevelopment of the milk ducts;
• endocrine pathologies with similar consequences;
• mechanical impact on the tissue of the mammary glands as a result of injuries, as well as when wearing excessively pressing bras or other clothing.

Can inverted nipples cause breast cancer or mastopathy?

If a woman has had this defect since birth or puberty, it is not considered a cancer risk factor and does not increase the likelihood of developing other breast diseases. But a deformity that suddenly arose in adulthood requires mandatory consultation with a mammologist. Especially if at the same time one or more of the following symptoms are observed:

• any discharge from the nipple (white, dark, reddish, etc.);
• the appearance of ulcers and flaky skin on its surface;
• change in the shape of the mammary gland, the appearance of compactions in its tissues;
• increase lymph nodes in the axillary region, above and below the collarbone;
• pain in the breast area;
• unexplained loss of body weight, etc.

At the initial stages of the development of the oncological process, sunken nipples may be the only manifestation of pathology and sufficient reason for an early visit to the doctor.

You should not panic ahead of time: the above symptoms do not always indicate cancer. Quite often we are talking about a less dangerous benign mastopathy, or an areola abscess. However, these conditions, especially the latter, also require urgent medical consultation and examination. And only if there are none pathological changes will not be detected in the breast tissue, we can move on to the issue of aesthetic correction.

What should the treatment be?

Since the severity of the defect varies widely, clinical picture and the ways to correct the situation for each option will also be different:

• A small, barely noticeable sagging does not in any way affect the ability to feed and, in most cases, such breasts look quite attractive in appearance. Surgical correction is definitely not required here, good effect Massage techniques (including the Hoffman method) and manual stimulation can help.
• In more complex cases, the pathology can make breastfeeding difficult and also noticeably spoil appearance mammary glands, which for many can cause psychological complexes and difficulties in their personal lives. In these circumstances, treatment should begin with a consultation with a mammologist. It is still possible to get by with conservative means alone; in particular, good results can be achieved with the help of vacuum pads and other physiological techniques aimed at mechanical stretching of fibrous fibers. But it is just as likely that it will be possible to influence the situation only with the help of plastic surgery: only a doctor can give an accurate conclusion after a personal examination.
• The most problematic condition is with severe retraction. This does not look very aesthetically pleasing, feeding is almost always impossible, and fatty secretions and simply foreign particles of dust and dirt will accumulate in the cavity formed by the nipple, which is fraught with chronic inflammation, abscesses and other unpleasant complications. In this case, the only reliable method of correction is surgery.

What non-surgical methods can be effective?

With unexpressed fibrosis, it is quite possible to “straighten” excessively tight connective tissue cords without the help of a surgeon:

• Good results are achieved by a special massage technique - the Hoffman method, in which the problem area is kneaded with your fingers several times a day. Also, almost all doctors consider any other manual stimulation of sunken nipples useful, including during sex. However, you should be prepared for the fact that it may take quite a lot of time to correct the defect. The first positive changes with daily massage appear only after 6-8 months, and to obtain a lasting result it may take from 2 to 5 years.
• In addition to mechanical influences, it is necessary to “train” the nipple to the correct position. For this, special pads, correctors or an inversion syringe are used: when used, they create a vacuum of varying strength, pulling the tissue upward (in general, the principle of operation is similar to a breast pump). Such devices, like massage, must be used on an ongoing basis.
• According to a number of researchers, established breastfeeding has a noticeable positive effect. Of course, this option will only be possible if fibrous cords do not interfere with the patency of the milk ducts.
• Another option that some doctors cautiously recommend is inverted nipple piercing. Essentially, it provides a small but constant vector of force that will pull out the sinking area and keep it out, somewhat similar to massage techniques. This procedure is associated with a large number of difficulties: the puncture technique is not simple, healing will take much longer and is fraught with complications, and the very presence of metal jewelry in the chest is not to everyone’s taste. Nevertheless, the method really works and gives positive results - but it should only be used with permission and under the supervision of a doctor.
• In case of severe retraction, it makes sense not to waste time on massage and various vacuum devices, but to immediately start looking for a plastic surgeon. The operation we need is called, and it is best performed by those doctors who specialize in correction of the mammary glands - breast augmentation, lifting, etc. Surgical treatment may also be indicated for those who have tried conservative methods, but have not received the desired lasting effect from them.

How is the operation performed?

This defect can be corrected using plastic surgery using two techniques (the choice is made individually, during a face-to-face consultation):

• Microsurgical – in which the connective tissue bundles that hold the nipple in a retracted position are selectively suppressed. This is a low-traumatic option that fully preserves the ability for lactation and breastfeeding, but at the expense of the reliability of the result.
• Classic - here, in addition to the fibrous tissue, the milk ducts are also cut off, and the nipple itself is cut lengthwise and re-sutured in the process. This method is considered preferable for patients who do not plan to have children: it completely eliminates the possibility of recurrence of retraction, but the woman will no longer be able to breastfeed.

Regardless of the method, this operation is rarely performed in isolation, only to correct serious, extreme defects. But it is often combined with or - to eliminate slight retraction and other aesthetic problems with the nipple-areolar complex, for which it is not advisable to carry out a separate intervention. The whole process begins with several preliminary steps:

• consultation with a selected specialist, determination of indications for surgery and the most appropriate method of performing it;
• determining the type of anesthesia - both general and local can be used, depending on the scope of the intervention. If you only need to correct the position of the nipple, then local anesthetics will be more than enough. For more extensive manipulations, incl. combined with mammoplasty or areola correction, it is no longer possible to do without general anesthesia. Also, the choice in favor of the latter can be made if the patient has low pain threshold and/or the upcoming plastic surgery causes her unnecessary anxiety and worry;
• passing mandatory tests and examinations to identify possible contraindications;
• preparing the body: following the doctor’s recommendations on diet, intake medicines, quitting smoking and drinking alcohol.

The operation itself is carried out according to the following plan:

• anesthesia;
• making incisions in the areola area sufficient to free the nipple;
• intersection of ducts together with connective tissue cords during a classical operation or only cords during a microsurgical operation;
• stop the bleeding, apply internal and external sutures, bandage.

The procedure takes from 40 to 60 minutes. If “pulling” the nipples is only one of the stages of complex correction of the mammary glands, then the total duration of the intervention can increase to several hours.

Recovery period

After the surgeon has completed his part of the work, the patient is transferred to the recovery room or a regular hospital room, where she remains under the supervision of medical staff for several more hours. Then, with satisfactory health and absence early complications you can go home. During rehabilitation after plastic surgery of inverted nipples, the following restrictions must be observed:

• stop smoking for 2-3 weeks to improve tissue trophism, accelerate healing, and prevent the development of rough scars;
• for about 1-1.5 months, wear special protective pads that protect the intervention area from friction and other external influences;
• treat the area of ​​surgical incisions with antiseptic solutions;
• take antibiotics, antiviral and painkillers prescribed by the surgeon;
• exclude physical exercise and any actions in an inclined position;
• provide yourself with a calm environment, long leisurely walks in the fresh air, and a nutritious, varied diet.

• impact high temperatures on the chest area (this includes thermal procedures, heat from a stove or fireplace, sauna, bathhouse, etc.);
• early start of active sports and visiting the pool;
• taking medications or stopping them without first consulting a surgeon;
• visiting a solarium and spending a long time in the open sun topless for 4-6 months after surgery to prevent development.

On the days prescribed by the surgeon, the patient will need to come to the clinic for dressings and suture removal. During visits, you can also discuss with your doctor any questions regarding your condition, well-being and the characteristics of the recovery period.

Normally, already on the second or third day after the operation you can lead your normal lifestyle with minor restrictions, and after another 1-2 weeks you can return to full physical activity and sports. The final result of the plastic surgery and the appearance of the corrected nipples will be assessed in about 1 month, when the tissues at the site of the incision have completely fused and postoperative sutures have more or less formed.

Contraindications, possible complications and side effects

Correction of receding nipples is not carried out only in cases where any aesthetic operations in this area are excluded altogether:

• the patient's age is under 18 years;
• diseases affecting blood clotting;
• the presence of neoplasms in the mammary glands (if they are confirmed to be benign, plastic surgery is possible, but only with the approval of a mammologist);
• any acute diseases or chronic in the acute stage.

Also, a relative contraindication can be considered the patient’s desire to become pregnant in the future and carry out natural breastfeeding: even with the most gentle techniques, there is a small risk of damage to the milk ducts with subsequent disruption of lactation, therefore, in this case, the intervention, if carried out for aesthetic reasons, is advisable to postpone until completion GV.

In the first days after surgery, standard consequences of surgical injuries may be observed:

• swelling and hematomas;
• pain in the area of ​​surgical incisions;
• general weakness.

All these side effects go away on their own within 1-2 weeks.

More serious complications include:

• Subcutaneous bleeding - occurs when large vessels are damaged and cannot thrombose naturally. Requires repeated intervention to stop the bleeding.
• Development inflammatory process– possible in cases where an infection gets into fresh postoperative wounds (less often, if its source is located somewhere in the body, but was not identified during the preliminary examination). It is treated with an individually selected course of antibiotics.
• Impaired sensitivity of the nipple and/or areola - from excessive pain to complete numbness. The cause is damage nerve endings. However, when performing isolated plastic surgery, this complication occurs extremely rarely: it is more typical for operations during which glandular tissue is injured (breast augmentation and lift). Restoring innervation is a rather complex process; it occurs individually in all patients, so sensitivity in full can return either after a few weeks or months, or 1-2 years after surgery;
• Rough scarring. Normally, after correction of inverted nipples, the patient is left with only small stitches at the border with the areola. Problems may arise if, to stop other complications (for example, internal bleeding), the edges of the wound have to be pulled apart and sutured again several times, as well as if there is an initial predisposition to the appearance of or. For more details, see the article "".

In general, the risk of unwanted negative consequences from this operation is extremely low. And strict adherence to all the surgeon’s recommendations during the recovery period allows you to reduce their likelihood to almost zero.

How much does it cost to fix inverted nipples? Current prices

This operation is considered simple and one of the most inexpensive in plastic surgery. However, patient costs can vary widely. Firstly, depending on the status of the specialist and the clinic, and secondly, the price list may or may not include various services related to the operation: anesthesia, stay in the hospital room, examination (tests and instrumental diagnostic methods), dressings, etc.

- one of the most common diseases in women in the reproductive and reproductive systems. The disease is characterized by pathological proliferation of glandular tissues and the formation of compactions, and is most often manifested by pain and discharge from the nipples.

Oncological processes in the mammary gland can have similar manifestations, so patients are interested in how to distinguish these diseases and whether mastopathy can develop into cancer.

Types of mastopathy

Breast specialists distinguish two general groups of mastopathy: nodular and diffuse. In the diffuse form of the disease, pain manifests itself due to the proliferation of connective tissue and the enlargement of many small nodules at once under the influence of hormonal imbalance. Nodular mastopathy occurs as a consequence of an untreated diffuse form of the disease.

It can manifest itself as a fibroadenoma or cyst and, under the influence of risk factors, become malignant over time (lead to the appearance of a malignant tumor). As a rule, the likelihood of developing breast cancer in patients with mastopathy increases by 3-5 times compared to healthy women of the same age group.

Diffuse mastopathy occurs more often than nodular mastopathy. The disease develops due to hormonal imbalance (excess estrogen, prolactin with insufficient progesterone - this ratio is often observed in ovarian diseases or menopause, as well as in some other conditions). As the connective tissue grows, the patient begins to feel discomfort and tension in the glands; small nodules can be felt upon palpation. Most often, breast sensitivity increases, and pathological discharge from the nipples is observed.

Depending on the nature of hormonal disorders, mastopathy may be accompanied by constant fatigue, dry skin, menstrual irregularities and amenorrhea, irritability or apathy.

Diffuse mastopathy can be three types:

• (manifested by the growth of connective tissue);
• cystic (characterized by the appearance of fluid-filled cysts, in later stages may be accompanied by inflammation of the gland caused by congestion);
• fibrocystic (mixed).

In the absence of treatment, dense nodes with a diameter of up to 8-10 centimeters are formed. They may have the character of a cyst or fibroadenoma. Despite the fact that any of the listed pathologies increases the risk of developing breast cancer, leaf-shaped fibroadenoma is the most likely to develop. Medical practice shows that malignancy does not require any special conditions. The most likely risk factor is a hormonal surge (for example, during or menopause).

Pain with nodular and diffuse mastopathy

Pain during mastopathy depends not only on the stage, but also on the type of disease. The cause of pain is multiple formations and growths of connective tissue. They compress nearby nerves, which causes discomfort in the patient.

Chest pain with diffuse type mastopathy has a number of differences:

• increases in the premenstrual period, and after the end of the cycle disappears or decreases significantly;
• accompanied by breast swelling and increased sensitivity;
• is aching or pressing in nature;
• manifests itself as increased sensitivity or even soreness of the nipples, and in later stages – discharge from them.

Nodular mastopathy can also be determined by a number of characteristic pain signs:

• the pain does not go away throughout the entire cycle; as the disease worsens, it becomes more acute;
• unpleasant sensations radiate to the shoulder, armpits, back, forearm area;
• the pain is usually aching in nature, but in acute form may become stabbing;
• increased sensitivity turns into painful discomfort (even with a light touch or pressure of underwear on the chest, aching pain appears);
• the nipple area becomes very painful.

Benign formations are usually mobile relative to surrounding tissues.

It is very important to carry out differentiated diagnostics in order to distinguish it from breast cancer and increase the chances of successful treatment in the presence of a malignant disease.

Differences in symptoms between breast cancer and mastopathy

Some signs of breast cancer are similar to the symptoms of mastopathy, but others (in combination with hardware techniques) still allow for differentiated diagnosis.

The success of early diagnosis of cancer may depend on how the chest hurts during mastopathy and what symptoms accompany this condition.

How to distinguish mastopathy from cancer using diagnostic methods

If mastopathy causes breast pain and all symptoms indicate the absence of cancer, the doctor still recommends that the patient undergo a series of additional research. Differential diagnostic methods make it possible to determine the location, size and shape of formations in the breast.

In rare cases, mastopathy turns into breast cancer (the incidence of malignancy is every tenth case with diagnosed leaf-shaped fibroadenoma), so the specialist must determine what is more justified: removal of the tumor, registering the patient with oncology, or prescribing conservative therapy.

If a lump is detected in the breast (either on your own or during an annual examination), you must undergo a mammogram (breast x-ray). As a rule, mammography is prescribed for women over 35 years of age, because in young patients, the mammary gland is sensitive to the effects of gamma rays. They are recommended to replace x-rays of the gland ultrasound diagnostics. Benign nodes on ultrasound have smooth contours, while a malignant tumor has an uneven relief.

If malignancy is suspected, the patient undergoes a biopsy of tumor tissue (taking a sample to study the degree of cell differentiation). To diagnose cancer, an analysis is also performed for the main tumor marker of the mammary gland (Ca 15.3) and a contrast study of the glandular ducts.

If an oncological diagnosis is confirmed, an ultrasound of the regional and abdominal region and radiography are prescribed chest, allowing to study the extent of distribution and stage of the disease. The neoplasm is examined for sensitivity to progesterone and estrogen, prescribing hormone-lowering therapy if necessary.

In the case of diagnosed mastopathy, the opposite is true: after the study hormonal levels the patient is prescribed replacement therapy synthetic analogues of deficient hormones (most often progesterone).

Regardless of whether the breast hurts due to mastopathy, if a lump is detected, you should immediately contact a mammologist. Based on the results of tests and studies, he will be able to accurately determine the degree of malignancy of the process and prescribe adequate treatment.

Many women turn to specialists with complaints about deformation of the nipples of the mammary glands. This pathology manifests itself in 8 - 10% of the mammologist’s patients. With this disease, the nipple of one or both mammary glands in a woman is at the same level as the areola or even pulled into the mammary gland.

Read in this article

Causes and mechanism of formation of an inverted nipple

Such pathology of the mammary glands can be congenital or acquired. Among the main reasons for this problem, experts consider the following:

• features of sexual development;
• hereditary predisposition;
• abnormal growth of the milk ducts;
• breast injuries;
• wearing tight underwear for a long time;
• various breast diseases.

Diseases of the mammary glands occupy a special place in the occurrence of the problem. Past mastitis, especially with a purulent component, often causes deformation of the mammary gland, which may involve retraction of the nipple into the areola. Papillomas of the milk ducts of the female breast also quite often lead to a similar pathology.

And, of course, breast cancer leads to breast deformation and the formation of an inverted nipple. In the medical literature, such a pathology is called.

The mechanism of occurrence of the pathological process in the mammary gland is quite simple. All the main milk ducts of the female breast end in the area of ​​the nipple and are attached to it using connective tissue. Under influence various diseases The connective tissue is replaced by fibrous or sclerotic formations, which leads to increased tension and retraction of the nipple into the mammary gland. If this condition is congenital, then the length of the connective tissue fibers is initially shorter than in the normal mammary gland.

Inverted nipples cause a lot of problems for any woman. On the one hand, breast deformation brings aesthetic discomfort to the patient, which often leads to a decrease in a woman’s sexual function, the development of various hormonal disorders, and sometimes to severe psycho-emotional breakdowns. On the other hand, such a pathology often causes various inflammatory diseases female breasts due to swelling of the areola and the development of areas of maceration.

In addition, inverted nipples will definitely create a problem during lactation. This pathology usually leads to the cessation of breastfeeding, since the child cannot fully suck the nipple, and pumping with this disease gives the young mother pronounced painful sensations. All this can lead to the development of lactostasis and lactation mastitis.

Types of inverted nipples and their diagnosis

Modern plastic surgery considers two types of inverted nipples:

• Inverted nipples that are caused by external physical force or trauma are called inverted nipples. This pathology is physiological in nature and does not require specific treatment. Usually, under the influence of erotic caresses or breastfeeding, hidden nipples independently take on a normal shape.
• Tightly inverted or primary inverted nipples are another matter. This is mainly a congenital pathology in which the nipples do not extend beyond the level of the areola. This disease requires special treatment using surgical or non-surgical methods.

Diagnosis of this pathology begins with examination of the mammary gland. A woman can determine the presence of inverted nipples on her own, but she should immediately seek advice from a specialist.

Upon further examination, the main question for the mammologist will be to conduct a differential diagnosis of the independent occurrence of inverted nipples from the manifestation of an oncological process in the patient’s mammary gland. For this, an ultrasound is required. mammary gland, if necessary - cytological examination breast tissue and discharge from a damaged nipple.

Only after receiving a certain negative oncological prognosis, the woman is faced with the question of treating inverted nipples.

Treatment of inverted nipples

Correction of inverted nipples can be surgical or non-surgical. If experts determine that surgery is not yet indicated for a woman, special attachments are used on the affected nipple to solve this problem. Such devices are attached to the skin of the breast, air is pumped out using a pump, and negative pressure is applied to the affected nipple. The attachment is worn under underwear for several days. The woman, with the help of specialists, periodically removes this device to perform toileting of the mammary glands and check for the absence of cracks in the nipple area.

The method is based on the effect of suction on the connective tissue of the mammary gland, which lengthens and leads to the nipple emerging above the surface of the mammary gland. Doctors recommend this method of treatment if a woman is diagnosed with a hidden type of nipple or in preparation for surgical treatment for breast correction.

In 30% of cases, such a pathology requires a prompt solution to the issue. Before the operation, the patient is prescribed a full range of examinations, including cytology and histology of the mammary gland.

In addition, it is determined whether there are any contraindications for surgical intervention and general anesthesia from other organs and systems female body, identify the possibility of occurrence allergic reactions at the patient.

The choice of surgical intervention method depends on the woman herself. If in the future the patient expects the birth of a child and breastfeeding, the surgeon resorts to an operation where, under the control of a microscope, the connective tissue at the base of the areola is minimally dissected and the inverted nipple is released. Such an operation gives a positive effect only in 75%-80% of cases, but it avoids traumatic damage to the milk ducts and preserves the woman’s ability to breastfeed her child.

In the case when the patient does not plan pregnancy and lactation in the future, the incision is made directly under the affected nipple to a sufficient depth, and a large mass of connective tissue is dissected. In this case it is possible to achieve positive result in 95% of cases. As a result, unfortunately, feeding the baby will not be possible, since the main milk ducts leading to the nipple are also intersected.

Consequences of the operation and rehabilitation period

Such operations are usually performed in a day hospital, and the patient remains under the supervision of medical personnel for the first day. The state of the woman’s vital functions is monitored, and if necessary, painkillers and anti-inflammatory drugs are used.

On days 2–3, the patient is discharged home, and she is given appropriate recommendations on how to adhere to the regimen. The following are strictly prohibited:

• mechanical irritation of the operated gland,
• application of thermal procedures to the surgical site,
• various fatty ointments and creams.

If hematomas or areas of tissue compaction occur at the site of the mammary gland incision, experts recommend limiting the use of heparin ointment or “Rescuer” ointment.

The appearance of postoperative scars on the mammary gland is one of the complications of this surgical intervention. Damage to the nerve endings is possible, accompanied by a decrease or complete absence of sensitivity in the operated nipple.

Like any other Plastic surgery on the mammary gland, correction of inverted nipples can have positive and negative consequences for a woman’s health. Therefore, before deciding on surgery, the doctor must provide the future patient with all information about possible consequences, and only then will a woman be able to make the right choice.

Definition

Mastopathy is a benign disorder of the breast of a pathological nature. This disease has a significant impact on the health of many women and in some cases can lead to the development of breast cancer.

The disease begins with the proliferation of connective tissue and the formation of small nodes. Women often ignore these symptoms and go years without seeing a doctor. Thus triggering the disease.

Occurs in every second woman. Due to the wide distribution expressed pain syndrome, due to the fear of women who have discovered in the mammary gland nodular seal, which can be malignant or turn into cancer, much attention is paid to this disease.

Causes

The causes that contribute to the occurrence of dishormonal hyperplasia of the mammary glands (mastopathy) can be conditionally grouped into several groups.

State of the neuropsychic sphere. The connection between mental and nervous problems and mastopathy is obvious. Disharmony developing under the influence of various stressful situations can be a direct prerequisite for the development of a pathological process in the mammary glands. This kind of situation arises in cases where a person’s needs do not correspond to his adaptive capabilities. The conflict being main reason strong emotions, manifests itself when it is impossible to find a way out of the current situation. Usually, when studying neuropsychic disorders, more attention is paid to the body's reaction than to the source of negative emotions. Meanwhile, identifying and studying specific conflict situations helps to better understand the main causes of those negative emotions that contribute to the development of mastopathy.

When analyzing an emotional situation, the unusualness, suddenness of its occurrence and redundancy of motivation are taken into account. Of great importance in the development of negative emotions is the duration of the existence of stressor conflicts, as well as the uniqueness of the conditions against the background of which their effect is manifested.

Emotional stress can lead to hormonal changes that affect the development of mastopathy.

There is evidence that mastopathy and cancer can begin soon after stress, which activates a genetic predisposition and “triggers” the development process, including a malignant tumor.

Factors of reproductive, sexual, endocrine nature. Among the numerous causes leading to the occurrence of mastopathy, reproductive dysfunction is quite common. However, if the general causal dependence of mastopathy on these disorders is indisputable, then there is no consensus in assessing the role of one or another specific factor in the triggering mechanism of local tissue changes.

The reproductive function of a woman is closely related to complex rhythmic processes in the nervous and endocrine systems, united according to the principle of feedback by the hypothalamus. Physiological changes in the mammary glands are strictly dependent on these processes. It is not surprising, therefore, what importance is attached to reproductive function in the occurrence and development of mastopathy. Violation of it with a decrease in the compensatory capabilities of the body can lead to the development of excessive cell proliferation in the mammary glands.

Link detected increased risk diseases of the mammary glands with early onset of menstruation and late cessation. This risk, according to some authors, increases even more in the absence of childbirth and a large number of induced and spontaneous abortions. Anovulatory cycles in women childbearing age are an unfavorable factor.

The risk of mastopathy increases under the influence of unfavorable pregnancy factors - absence or late pregnancy, limited or excessive number of births, absence, short or very long period of breastfeeding.

The strongest direct connection was determined for such a factor as average age by the time of the first birth - the older this age, the higher the risk of breast diseases such as mastopathy and cancer. For nulliparous women, the risk of the disease is higher than for those who gave birth for the first time before the age of 30, but lower than for those who gave birth for the first time after 30 years. The age at which the first birth occurred is of greater importance for mastopathy and breast cancer than the number of births.

It is assumed that the active proliferation of mammary epithelial cells during pregnancy and breastfeeding can lead to the appearance in a woman’s body of antibodies against breast cancer cells, therefore, the earlier the first pregnancy develops, the faster this immunological protective mechanism comes into effect.

It is noted that modern women in developed industrial countries are characterized by an earlier appearance of menstruation, lower fertility, later cessation of menstruation and a decrease in the period of breastfeeding, which could not but affect the incidence of mammary glands. Conversely, factors that protect a woman from breast cancer and mastopathy are early castration, early first pregnancy, first male child, and long-term breastfeeding.

However, we must remember that mastopathy cannot be cured only through childbirth followed by long-term breastfeeding.

The close connection between the development of mastopathy and gynecological pathology. Mastopathy in gynecological patients is detected in 36-95%

Numerous epidemiological studies in patients with mastopathy reveal a significantly higher incidence of diseases than in the general population. thyroid gland- up to 50% or more. Among these diseases, autoimmune thyroiditis is almost more common than others.

Obvious hormonal dependence of breast diseases, as well as long-term and increasingly widespread use hormonal drugs in medical practice has served as the basis for a large number of studies examining the effect of taking these drugs on the risk of developing subsequent breast cancer.

Nutritional factors. Just as the tongue is a “mirror” of the stomach, so the condition of the mammary glands is the “mirror” that reflects the functional activity of all organs and systems of the body. Therefore, nutrition, which plays an important role in the life of the whole organism, actively influences the course of pathological processes in the mammary glands.

Rational nutrition is scientifically based nutrition in practice healthy people, taking into account a person’s needs for energy and nutrients depending on his work activity, gender, age, living conditions, physiological characteristics and helping to increase the body's resistance to various harmful factors.

Food is considered not only as a source of energy and plastic substances, but also as a complex pharmacological complex. A balanced diet, or more correctly, a balanced diet, should serve only to benefit a person, without harming his health. However, in practice, people do not eat properly for various reasons.

In the Japanese scientific literature there is interesting information about the miraculous effect of a number of vegetables on curbing the appearance and development of malignant tumors. The most useful in this regard were carrots, onions, cabbage and eggplants, which contain substances that suppress the development of dangerous cells. Their use in various (even after heat treatment) forms prevents the occurrence of cancer.

Thus, nutrition can, through its effect on metabolism, both cause unfavorable changes in the mammary glands and affect the successful outcome in the treatment of mastopathy, therefore, advice on correcting nutrition must necessarily take place when treating women with this disease.

Other factors. Other factors include:

• genetic predisposition to breast cancer and mastopathy (it should be remembered that it is not a specific disease that is inherited, but the structural features of the breast tissue);
• hepatopathy (previous infectious and serum hepatitis, biliary dyskinesia, cholelithiasis);
• adverse anthropogenic and social impacts (long-term contact with carcinogens, work in the zone of exposure to high energies - microwave, EHF, ionizing radiation);
• individual characteristics and habits (abuse of foods high in methylxanthines - coffee, tea, chocolate, smoking, alcohol abuse);
• poor water and air quality, i.e. environmental factors;

frequent physical injuries to the mammary gland, wearing tight bras;

• excessively bright light;
• physical inactivity.

Symptoms

Syndrome of palpable nodular formation in the mammary gland. Of the benign diseases, this syndrome most often manifests itself as fibroadenoma, cyst, nodular mastopathy, lipoma, and less often - leaf-shaped adenoma, different kinds granulomas, galactoceles, etc.

Of the malignant processes, tumors of epithelial origin (various types of cancer) are most often detected, and much less often - tumors of a connective tissue nature (varieties of sarcomas).

Fibroadenoma is the most common benign tumor mammary gland. This is a dense, mobile, non-skin formation with clear contours, without the involvement of the regional lymphatic system.

The cyst is usually associated with dishormonal processes, stagnation of secretions in dilated ducts with subsequent blockage. As a rule, multiple cysts are bilateral. Their sizes vary from 0.5 to 6-8 cm. Solitary cysts develop in a fairly short period of time (2-4 weeks) against the background of existing diffuse mastopathy. On palpation they are defined as round, quite clear, slightly tense and painful voting formations without skin symptoms (in rare cases, a symptom of umbilification is noted). At aspiration biopsy a liquid is easily obtained, the centrifuge of which is examined.

Localized (focal) mastopathy does not have a clear definition in the literature. Its frequency is about 16% of all cases of mastopathy. It develops as a consequence of untreated diffuse mastopathy and is usually unilateral. Clinically, it is characterized by the presence of a fairly clear dense elastic movable compaction of a spindle-shaped or other shape, not fused to the skin and underlying tissues, with a cyclical nature of the flow. The cyclical nature of the process acts as a leading differential diagnostic feature. Cytologically, proliferation of the glandular epithelium is detected varying degrees expressiveness. Surgical treatment in the scope of standard sectoral resection of the mammary gland with urgent histological examination. Detection of small cancers T1a-c during morphological examination is an indication for expanding the scope of intervention to radical mastectomy according to Madden for central and medial localization of the lesion, or radical resection of the mammary gland with axillary-subclavian lymphadenectomy for external localizations of the process. When performing organ-preserving operations, an urgent morphological examination of the cutting edges of the gland tissue is mandatory.

Leaflet fibroadenoma accounts for about 3% of all fibroadenomas. It usually occurs in women of reproductive age from intraductal fibroadenoma. In most cases, leaf-shaped fibroadenoma is benign. Clinically, leaf-shaped fibroadenoma is little different from ordinary fibroadenoma. A tumor larger than 5 cm may have a lobular or layered (leaf-like) structure; the subcutaneous vascular pattern above the tumor may be enhanced.

Galactocele is a variant of a retention cyst and occurs during lactation due to blockage of one of the milk ducts. It is usually localized in the areolar region and is defined as a clear, moderately painful, round formation that is denser than a cyst. The skin and areola are unchanged. When punctured, colostrum or creamy contents of white or yellow color are obtained. The benign nature of the process upon cytological examination involves the evacuation of the galactocele with the introduction of small amounts of air and ethyl alcohol into the cavity in order to obliterate the cyst. Galactocele of a recurrent nature dictates the need to perform an economical sectoral resection of the mammary gland, mainly from a para-areolar incision.

Granulomatous lesions of the mammary gland (lipogranulomas, inflammatory pseudotumors of various origins) account, according to our data, for 0.55% of all breast diseases, up to 1.8% of benign conditions and about 7.6% of formations suspicious for breast cancer. In most cases, granulomatous processes, simulating breast cancer, are not diagnosed before surgery. Clinically they manifest themselves in the form of dense formations with unclear contours, in some cases with swelling and retraction of the skin, enlargement of the axillary lymph nodes, which increases the resemblance to a malignant process.

Lipoma is a fatty formation of the mammary gland that occurs in women over 40 years of age, defined as a round or oval mobile node of elastic consistency with clear contours, not associated with the skin and without interest.

Clinical differences in nodular formations of the mammary gland require additional examination of the patient in an equipped medical institution in order to exclude breast cancer.

Diagnostics

A comprehensive examination includes the collection of anamnestic data, an initial examination, and research possible violations hormonal and metabolic parameters, if necessary, instrumental examination (ultrasound, mammography, etc.) and puncture biopsy, re-examination.

The medical history includes previous and concomitant diseases, gynecological and reproductive diseases, sexual history, social and everyday characteristics, character and temperament traits, signs of neurasthenia, diseases on the father’s and mother’s side. Information related to the possible development of mastopathy is recorded in the outpatient card. It is clear that finding out the causes of the disease is of extreme importance, since treatment of mastopathy can be successful only after eliminating all causes (if possible) or at least reducing their impact on the patient.

Examination of a patient with mastopathy includes a general examination and palpation of the mammary glands.

A thorough examination allows, based on some external signs, to obtain a preliminary understanding of the characteristics of the patient’s endocrine and metabolic status.

For example, when examining the skin, attention is paid to color, pigmentation, and elasticity. Velvety, elastic skin indicates normal or increased estrogen saturation. Dry, rough, pale skin gives an idea of ​​either hypofunction of the thyroid gland, or a decrease in the level of ovarian hormones, or severe vitamin deficiency. The presence of age spots suggests liver dysfunction or dysfunction of the adrenal glands.

Examination of the mammary glands must be done carefully. Initially, inspection and palpation are performed in a standing (or sitting) position, and then lying on your back.

When examining the mammary glands, attention is paid to their size and symmetry, the condition of the skin, nipples and the presence of discharge from them.

Every woman knows the size of her mammary glands well. If one gland has significantly increased in size for no apparent reason and for a relatively a short time- this should be a reason for an in-depth examination of the woman. A slight asymmetry in the size of the mammary glands may also be a variant of the norm, which is quite common.

The skin of the mammary glands should not have any protrusions (tubercles), pits (or retractions), redness, swelling (in the form of a “lemon peel”), the contours of the breast are usually smooth, without deformation.

The nipples should not be deviated to the left or right, down or up, or inverted (although if both nipples have been flat or inverted all their lives, then this may be normal). If one nipple begins to retract, such a woman should definitely be referred for a consultation with an oncologist.

Pronounced pigmentation of the areola indicates, together with other external signs, estrogen saturation, while the pale pink color of the areola indicates insufficient estrogen saturation.

Deformity, "symptom of umbilification or platform", nipple retraction are warning factors for the presence of a tumor.

Normally, there is no discharge from the nipples. Most often they appear with certain hormonal disorders (for example, increased level prolactin, etc.), with mastopathy, intraductal cystadenopapilloma or intraductal cancer, ectasia of the milk ducts and sometimes with intraductal inflammation. The discharge may be whitish, yellowish, greenish, brown, gray, bloody, liquid or thick. If discharge appears for the first time, it is necessary to take an analysis of the discharge (cytological examination). Bloody discharge is especially alarming regarding the presence of cancer. Such women are sent to the hospital for in-depth examination and often for surgical treatment. To check for discharge, lightly press on the nipple with two fingers (squeezing motion).

When palpating the mammary glands in a standing position, the patient’s hand should be located on the belt area and relaxed. The upper parts of the glands are palpated, including the armpits on both sides and the supraclavicular areas. IN horizontal position The entire mammary gland is palpated - sequentially in quadrants, including behind the areola and nipple, as well as the inframammary fold. Palpation is carried out with two distal phalanges of the fingers from the periphery to the center, moving along all quadrants (clockwise or counterclockwise).

In the presence of local compactions, further examination of the mammary glands using ultrasound (especially in young people) and mammography is indicated.

X-ray diagnostics is one of the leading methods for establishing a diagnosis (detection of cancer), especially if the tumor is small.

The accuracy of mammographic diagnosis ranges from 75-95%, false-positive results are 9-17%, false negatives are 12-24%. The high percentage of false negative results is due to the fact that in young women, especially during lactation, nodules and tumors are difficult to distinguish against the intense dense background of the gland. On this basis, a number of researchers consider it even inappropriate to perform mammography in women under 30 years of age. It is very difficult to detect a tumor against the background of mastopathy. Under these conditions, a tumor node is detected in no more than 50% of cases. The average tumor size detected by mammography is 0.5-1 cm.

Ultrasound diagnostics. Unfortunately, ultrasound is practically not applicable for screening, since it does not detect small tumors.

Thus, the sonographic characteristics of normal and abnormal tissues are such that they can be used for no more than the discrimination between cystic and solid tissue and for selection purposes for invasive procedures.

Ultrasound and palpable tumors. According to ultrasound data, it is possible to identify a pathological focus in the mammary gland, its location, shape and size. However, ultrasound is effective only in young women whose glandular tissue is well developed and whose mammary glands are dense. As a rule, ultrasound plays a supporting role and is used in conjunction with mammography.

For palpable formations, when no fluid is obtained by puncture, but which are still suspected as cysts (either a thick wall or a very mobile cyst that is difficult to get into), a puncture biopsy under ultrasound guidance is used.

Biopsy. The role of puncture biopsy in hyperplastic processes of the mammary gland is great. A biopsy is performed with a thin needle. From the contents, smears are prepared on glass for cytological examination. In 80-85% of cases, cytological examination of punctates makes it possible to correctly diagnose. Some authors believe that the correct diagnosis can be made in 96% of cases, and in dishormonal hyperplasias, cytological examination allows one to characterize the severity of epithelial proliferation and atypia and indicate the presence of a cystic cavity.

Prevention

Treatment of mastopathy is a complex and multifaceted task. The main question is: is it possible to completely cure mastopathy? This issue is connected with the fact that mastopathy in some cases is an optional precancerous disease, which dictates the need for drug treatment and periodic monitoring. Taking into account the well-known saying that “the treatment of mastopathy is the treatment of the underlying disease,” it should begin with identifying the reasons that led to the development or clinical manifestation of mastopathy. This is achieved by conducting a non-systemic survey that affects the state of various systems.