Breast enlargement is the most common type of patient seen in outpatient clinics. Different patients have different symptoms, and different doctors have different ways of talking about them. The same diagnosis of lobular hyperplasia is made, but some say it is a normal phenomenon and women have this disease, while others tell you to be careful, it may turn into cancer. Treatment is also varied, including Chinese herbal medicine, massage, selenium supplementation, ancestral recipes, changing the mindset, regulating diet, exercising to lose weight, insisting on breastfeeding, etc. It is confusing and confusing. This confusion, first of all, comes from the doctor, the doctor’s confusion, from the confusion of the name of the diagnosis. The current official unified name for this disease in China is cystic hyperplasia of the breast, a concept that does not have an authoritative definition, but simply a half sentence: “The development to an advanced stage will be due to the formation of a large number of unequal cysts around the glandular ducts or the formation of papillary-like hyperplasia of the epidermis within the glandular ducts, accompanied by cystic hyperplasia of the milk ducts.” And many names had been used for cystic hyperplasia of the breast over the years, such as: cystic disease, cystic mastopathy, cystic hyperplasia, mastopexy, poor breast structure, chronic cystic mastitis of the breast, benign mastopathy, etc. Because the concept of cystic hyperplasia of the breast is vague and not accepted by all, doctors have different names for the disease, and treatment methods vary from the need for treatment to the need for open surgery. Patients can’t get a consistent conclusion when they go to the clinic, so of course they have doubts and go around to get a definite diagnosis and authoritative treatment. To clarify all this, let’s look at the nature of mastocytosis and the reasons for the appearance of clinical symptoms. Sex hormones are the driving force behind breast enlargement Breast cells have estrogen and progesterone receptors on their surface, and the presence of these hormones leads to the proliferation and development of breast cells. The levels of these hormones do not remain constant, but change cyclically, so that the breast cells are constantly undergoing changes of proliferation and rejuvenation. Causes of swelling and pain and lump formation In mammary gland hyperplasia, the tissue is congested and edematous, especially in young people, with strong hormone secretion, large ups and downs, and excessive hyperplasia, resulting in breast swelling and pain. At the same time, after breast enlargement, the rejuvenation is not complete and some hyperplastic tissue accumulates each time. Estrogen and progesterone act on the ducts and lobules of the breast, each with its own focus, and do not achieve a perfect balance, resulting in uneven hyperplasia. And the uneven distribution of the number of hormone receptors on the surface of the breast cells causes more active local hyperplasia. These are the causes of local lump formation and aggravation of pain. Classification First of all, breast hyperplasia without lump formation and with only symptoms of premenstrual swelling and pain, so-called simple breast hyperplasia, should be regarded as a physiological change rather than a disease, and most people’s symptoms can be relieved after the age of peak hormone secretion has passed, so there is no need for treatment. Cystic hyperplasia of the breast, or mastopathy for short, is a complex series of morphologically complex pathological changes that can be hyperplasia and cyst formation around the milk ducts, papillary hyperplasia within the milk ducts, cystic dilation of the milk ducts, epithelial hyperplasia of the lobular milk ducts and alveoli, or even a combination of multiple forms. The histologic classification and diagnostic criteria are now quite clear, but the clinical names are still quite confusing, and I personally believe that it is better to collectively call it cystic hyperplasia of the breast. Why? First, they have the same clinical features: pain, lumps, and nipple discharge. Second, what is the basis for artificially classifying the so-called lobular hyperplasia, fibroadenosis, and sclerosing adenopathy types from a mixture of various manifestations of cystic hyperplasia of the breast? How to define them? What is the guidance for treatment? No! Moreover, there is no progressive developmental relationship between them. Therefore, it is better not to use the name lobular hyperplasia in the future. Clinical manifestations 1. Breast swelling and pain: unilateral or bilateral breast swelling and pain or tenderness. Most patients are characterized by cyclic pain. It must be noted that non-cyclic pain does not negate the presence of lesions. 2. Breast lumps: often multiple, unilateral or bilateral, mostly in the upper outer quadrant; and the size and texture often change periodically with menstruation. The lumps are nodular in shape, varying in size, with poorly defined boundaries with the surrounding tissues, and are often painful to palpation. Mammography mammograms show a cotton ball-like or glassy appearance with blurred edges and increased density, or with cords of connective tissue traversing the area of the enlarged breast, and with cysts, irregular enhancement shadows with rounded translucent shadows. B-mode ultrasound, with a diagnostic accuracy of about 90% for breast masses, shows uniform hypoechoic areas at the site of hyperplasia, as well as non-echoic cysts, and B-mode ultrasound is convenient and non-invasive for follow-up of breast hyperplasia diseases. Because the level of detection technology varies greatly, it should be combined with clinical diagnosis. Needle aspiration cytology or biopsy can clarify the diagnosis. Treatment Since a few cases (2~3 %) can evolve into tumorigenic hyperplasia with cancerous potential, and breast cancer that may coexist with this disease is very insidious, for early detection of possible breast cancer, regular checkups are needed, with clinical breast physical examination every 2~3 months at a specialized breast surgeon, supplemented by ultrasound examination of both breasts, and annual mammography is feasible. If the breast swelling and pain do not affect normal life, you can not take any medication, the pain is obvious can be adjusted by Chinese medicine, but the effect is not exact. Ductoscopy is feasible for those with nipple overflow, and ductal excision biopsy of the lesion is feasible if abnormalities are found. If the cyst increases rapidly, abnormal echogenicity is seen in the cyst wall, or the echogenicity of the cyst wall is enhanced, and there is obvious blood flow signal around the cyst, needle aspiration cytology or biopsy can be considered to clarify the diagnosis. Restricted cystic hyperplasia of the breast should be reviewed within 1 week to 10 days after menstruation, and if the mass softens, shrinks, or subsides, observation can be continued. If suspicious, surgical excision and pathological examination should be performed. If there is atypical epithelial hyperplasia in the pathology report, and there are also high-risk factors such as contralateral breast cancer or family history of breast cancer, or if the lump is older and the hyperplasia of breast tissue around the lump is more obvious, simple mastectomy can be done.