A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height. Gynecological examination Inspection of the mammae (breasts), right and left; nipple (breast), right and left, and skin [crusting of secretions in the area of the nipple/mammillae due to galactorrhea? /diseased breast milk … Mastopathy: Examination
1st order laboratory parameters – obligatory laboratory tests. Histologic (fine tissue) examination is indicated, including: In mammary sonography (ultrasound examination of the breast; breast ultrasound) – in the case of unclear focal findings. In mammography (X-ray examination of the breast) – in the case of microcalcifications. In the case of galactorrhea (abnormal breast milk discharge), … Mastopathy: Test and Diagnosis
Therapeutic target Pain relief Therapy recommendations Hormone-free phytotherapeutics (herbal medicine) should be used alongside non-drug therapies at the start of treatment Hormone therapy (progestins, oral, transdermal (“through the skin“) or vaginal (e.g., vaginal suppositories); prolactin inhibitors (dopamine agonists)) for cyclic (premenstrual (“before menstruation“) mastodynia (cycle-dependent feelings of tension in the breasts or breast pain). Estrogen-progestin … Mastopathy: Drug Therapy
Obligatory medical device diagnostics. Mammary ultrasonography (ultrasound examination of the breast; breast ultrasound). Optional medical device diagnostics – depending on the results of the medical history, physical examination and mandatory laboratory parameters – for differential diagnostic clarification. Mammography (X-ray examination of the breast). Magnetic resonance mammography (MRI of the breast; breast MRI).
In cases of mastopathy with lump formation, surgery with excision of the lump should be discussed. If grade III mastopathy (according to Prechtel) occurs repeatedly, a subcutaneous mastectomy (removal of the breast) should be performed.
The following symptoms and complaints may indicate mastopathy: Leading symptoms Fine- to coarse-grained, often pressure-sensitive nodules in the breast (frequently in the upper outer quadrant) [palpation findings (palpation findings): diffuse induration; feels bumpy and nodular; usually bilateral] Mastodynia – feeling of tension or pain in the mamma (breast); occur cycle-dependent with a maximum in the … Mastopathy: Symptoms, Complaints, Signs
Pathogenesis (development of disease) The cause of mastopathy is thought to be a shift in the estrogen-progesterone balance resulting in relative hyperestrogenism (relative predominance of estrogen action). Etiology (Causes) Biographic causes Hormonal factors Endocrine, nutritional and metabolic diseases (E00-E90). Estrogen stimulus, unspecified. Hyperprolactinemia – excessive prolactin levels. Hyperandrogenemia – androgen levels too high. Deficiency of … Mastopathy: Causes
General measures Wearing a well-fitting bra Regular checkups Regular medical checkups Nutritional medicine Nutritional counseling based on nutritional analysis Nutritional recommendations according to a mixed diet taking into account the disease at hand. This means, among other things: Daily total of 5 servings of fresh vegetables and fruits (≥ 400 g; 3 servings of vegetables … Mastopathy: Therapy
The following are the most important diseases or complications that may be contributed to by mastopathy: Neoplasms – Tumor diseases (C00-D48). Breast carcinoma – in grade III mastopathy (according to Prechtel), the risk of developing breast carcinoma (breast cancer) is as high as four percent Prognostic factors The cumulative incidence of breast carcinoma increases significantly … Mastopathy: Complications
Classification according to Prechtel Degree according to Prechtel Histology Frequency in % Risk of carcinoma Simple mastopathy (grade I) Simple mastopathy: nonproliferative lesions. 70 % not increased Simple proliferative mastopathy (grade II) Proliferative lesions without atypia: simple proliferative mastopathy such as adenosis, epitheliosis, papillomatosis 20 % 1.3 to 2-fold increased Atypical proliferating mastopathy (grade III)* … Mastopathy: Classification
The medical history (history of the patient) represents an important component in the diagnosis of mastopathy. Family history Is there a history of frequent breast disease in your family? Social anamnesis Current medical history/systemic history (somatic and psychological complaints). Have you noticed any lumps in the breast? Do you experience any pain in the breast? … Mastopathy: Medical History
Neoplasms – tumor diseases (C00-D48). Benign neoplasms in the breast area such as fibroadenoma (consist of proliferated connective tissue surrounding the glandular lobules, often growing in small nodules; most common in younger women (15 to 30 years of age); another peak age is 45 to 55 years)[palpation (palpation examination): usually 1-2 cm in size, painless, … Mastopathy: Or something else? Differential Diagnosis