As sensitivity, attention and knowledge increase, breast disorders in women are more easily recognized. Women are now more sensitive to breast shape changes, nipple collapse, hardness in the hand, discharge from the nipple, and changes in the breast skin. Even if these are not present, palpable lumps and pains make the person feel the need to go to the doctor. Breast cancer is a widely discussed and well-known topic. However, benign breast diseases, which are more common than breast cancer, are not well known. Among the dozens of disorders seen in the breast, two of the most confusing and common benign diseases are fibroadenoma and fibrocystic disease.
Let's look at the understandable anatomy first. There are basically three types of tissue in breast tissue; a) milk-producing tissue (glands and ducts), b) supporting connective tissue, and c) fatty tissue. Milk-producing tissue consists of round glands that produce this special liquid and a duct system that carries milk to the nipple. The supporting connective tissue starts from the chest wall and extends to the skin in strips and carries the milk-producing tissue. In this way, it helps shape the breast. Because it is carrier and shaper, it is harder than other tissues in the breast. Fat tissue fills the gaps in between and replaces other tissues, whose volume decreases with age.
The disease called fibroadenoma is benign lumps/growths in the supporting hard tissue of the breast. Its cause is not well known. However, there is data to suggest that retinoic acid and estrogen hormone have an effect at the molecular level (1). In ordinary life, they can be felt with smooth surfaces, like marbles. Although fibroadenomas are not malignant, they can cause fear because they feel hard to the touch. However, fibroadenomas have a smoother surface and are more mobile than other potentially malignant lumps. Pain is also not expected. There may be one or there may be so many that they fill the entire breast.
Although fibroadenomas are generally recognized by the examination of an experienced doctor, ultrasonography should be used to confirm this and show that there is no additional problem. Mammography is also used over the age of 40 for the same reasons. The current approach to fibroadenomas is not to intervene. There is no need to do anything, especially for those smaller than 1 cm. 1-3cm For sizes between 10 and 10 mm, the person's choice or the surgeon's suspicion may require biopsy. It is recommended to remove those larger than 3 cm. The main purpose of this is to pathologically confirm the diagnosis of the tissue removed. Of course, in some cases, large fibroadenomas can cause cosmetic problems. This situation alone is considered a sufficient reason for the removal of the masses.
Fibrocystic disease in the breast is mostly a disorder of the milk-producing tissue. It is defined as pain and palpable lumps affecting one or both breasts. In the word fibrocystic, “fibro” means hard tissue and “cyst” means fluid-filled sac. In other words, there are fluid-filled sacs formed by the mammary glands and ducts in the breast and hardness around them. Fibrocystic disease of the breast; It also has other names such as fibrocystic condition, breast dysplasia, diffuse mastopathy. This condition is very common and affects almost 2 in 3 women. This benign condition is not cancer; In fact, it is no longer considered a disease but a change of the breast. Although it can occur in all age groups, it is most common between the ages of 30-50.
This condition is very variable and sometimes masses and lumps may not be palpable. Pain may be temporary or periodic (premenstrual). Hormones that are effective during the menstrual period also affect the breast tissue, just like in the uterus. With these effects, the breast prepares for pregnancy and lactation, the cells of the mammary glands proliferate, blood supply increases, and the glands swell. Physically, swelling, pain and a feeling of heaviness occur in the breast. However, if pregnancy does not occur, these effects return. However, the process of loss of these unused cells does not occur through the expulsion of cells (menstrual bleeding) like the renewal process in the uterus. This situation is often more problematic in the breast and is accompanied by inflammation. Swelling and hardness in the breast; that is, a fibrocystic condition develops. This cyclical change in the breasts begins with the first menstruation. The effects of these changes accumulate over time, and fibrocystic disease generally becomes evident after the age of 30. This situation decreases after menopause, as menstruation ends. Fibrocystic disease affects both breasts, but sometimes it can be more intense in one breast than the other.
The biggest problem in fibrocystic breasts is that palpable masses can be confused with cancer-related growths. Fi The main method for diagnosing brocystic disease is palpable examination. The palpable lumps are generally rubbery in consistency, have a smooth surface like round rosary beads, and are mostly located in the upper outer quarter of the breast (close to the armpit). From time to time, they may have a more irregular surface and be harder. For some people, examination is not sufficient and special imaging methods such as ultrasonography and mammography may be required. Even a biopsy may be performed. As a result of the biopsy, changes in the cells can be seen more clearly. As a result of hormone stimulation, fibrocystic changes in the breast tissue may be extreme and the cells in the milk ducts may increase excessively. In this condition called hyperplasia, if the appearance of the cells under the microscope is distorted, atypical hyperplasia develops. Risk of developing breast cancer; It increased slightly in case of hyperplasia and moderately in atypical hyperplasia. The issue of which person will require a biopsy varies depending on examination findings and imaging methods.
Trying to correct findings such as pain and tenderness in the treatment of fibrocystic condition is important for the person's quality of life. For this reason, it is very useful to support the breast with a bra and wear a bra at night. Some painkillers significantly reduce breast pain. Partial benefits associated with the use of vitamin E have also been shown. Reducing caffeine consumption (coffee, tea, chocolate) is also sometimes helpful. Fibrocystic disease has a more severe course in some women with severe menstrual irregularities. In these cases, adjusting the hormone irregularity helps the symptoms disappear.
The first step in monitoring both fibroadenoma and fibrocystic disease is for the woman to examine herself every month, 3-5 days after the end of menstrual bleeding. In addition, a doctor's examination and breast imaging examinations appropriate to the individual should be performed at 6-month or yearly intervals.
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