Click here to view next page of this article

 

Fibrocystic Breast Changes

Fibrocystic changes represent an exaggerated physiologic response to a changing hormonal environment and include painful breasts (i.e., mastodynia), and lumpy breasts. The peak incidence occurs between 30 and 50 years of age and may be the result of excess estrogen stimulation in the absence of cyclical corpus luteum formation and the production of fibrocystic breast disease. The fact that breast tenderness often occurs premenstrually suggests that progesterone may play some role in the development and symptomatology of cystic disease.

Most women experience fibrocystic changes. To label this condition a disease is inappropriate. Physical examination usually reveals irregular thickening, particularly in the upper outer quadrant. If a dominant mass is discovered, physical examination alone may be misleading, and the diagnosis should be confirmed.

Symptomatology may include discomfort, particularly preceding menses, and physical examination reveals a generalized lumpiness or tenderness, especially in the upper outer quadrant or central portion of the breast. This is not unexpected because in the mature woman.

Many treatment regimens have been proposed for symptomatic relief of fibrocystic changes. None is 100% effective. It has been noted that the relief of symptoms is directly proportional.

Because of the chronicity and severity of the pain, a subcutaneous mastectomy had been recommended. The patient was 20 years of age. Initial discussion with the patient revealed that she was hostile and did not want to discuss the possible reasons for the condition, only the proposed treatment. As the interview progressed, the patient became more and more agitated and eventually admitted that she was a victim of sexual molestation by her father.

Conservative treatment has for many years included salt restriction, symptomatic pain relief with analgesics, and a well-fitted bra. It has been suggested that the restriction of methylxanthines could reduce the symptomatology associated with benign breast conditions; however, the evidence linking methylxanthines with breast symptomatology has been challenged by a number of investigations. Patients and some physicians have erroneously extended this relation to the development of breast cancer. A number of vitamin therapies have been recommended, but none is effective. More recently, the use of danazol (Danocrine) has been approved by the Food and Drug Administration (FDA). As a last resort, danazol may be used.

Nipple discharge may be spontaneous or provoked. Inappropriate lactation (i.e., galactorrhea) with or without amenorrhea may be caused by a decrease in the hypothalamic pituitary inhibiting factor.

In summary, discharge from a nonlactating nipple occurs in about 5% of women.

Treatment