Breast enlargement is the most common breast disease among women. With the development of society and the accelerated pace of people’s life, the incidence of breast cancer is also increasing. Many women are worried about the development of breast cancer because of breast enlargement and breast masses detected in their daily checkups. Is breast enlargement a prelude to breast cancer? A: No. Mammary gland hyperplasia is caused by endocrine disorder and unbalanced hormone secretion in the body, mainly due to the abnormal increase of estrogen secretion and the relative decrease of progesterone, which decreases the protective effect on the breast gland and therefore produces abnormal breast structure. Mammary gland hyperplasia is a non-tumor, non-inflammatory disorder of the breast structure, which is caused by excessive proliferation of the breast and incomplete replenishment. About 70% to 80% of women of childbearing age have different degrees of breast enlargement, but most of them are simple breast enlargement, which manifests as breast swelling and pain, lumps, and changes with the menstrual cycle, and after the end of menstruation, the estrogen level decreases, breast discomfort is significantly reduced, and lumps are reduced. However, there is a kind of breast hyperplasia which is pathologically called cystic hyperplasia. The end of the ducts of this kind of hyperplasia are highly dilated to form cysts, and the epithelial cells of the breast ducts may be papillary hyperplasia, and papillomas are formed in the ducts. In addition to cystic hyperplasia, atypical hyperplasia can easily appear. The chance of carcinoma increases significantly in moderate to severe atypical hyperplasia, and carcinoma occurs in about 3-4% of cystic hyperplasia combined with atypical hyperplasia. What is the obvious difference between cystic hyperplasia and other breast growths? A: Generally, the difference can only be seen in pathological sections after surgery, but it is usually difficult to detect clinically. Further examination is needed to confirm. The vast majority of people who have mastocytosis do not need to panic, but basically belong to simple hyperplasia. If you are a woman who is suffering from breast enlargement, how can you prevent it? A: First of all, we need to know the causes of mastocytosis, after suffering from mastocytosis, to eliminate some mastocytosis occurrence factors. A very important triggering factor for mastocytosis is emotional changes, the stability of the cerebral cortex affects the function of the entire hypothalamic pituitary and ovarian gonadal axis, anxiety and tension, stress, work strain, irregular life, staying up late, etc. are all likely to cause mastocytosis. The treatment of mastocytosis is generally based on self-regulation, supplemented by supplementary medication, adjusting one’s emotions and changing bad habits. Try to eat less high-energy, high-fat fast food, but also try to avoid some stimulating food such as particularly spicy food, strong coffee, strong tea, eat more light food, from their own perspective to relieve and change. Secondly, if you have breast enlargement, you should check yourself regularly. If you find a lump, or if there is something different from usual, such as the lump does not shrink after the end of menstruation; the texture is hard, such cases should be promptly checked in the hospital. In addition, increased exercise can prevent breast enlargement, and you can also take Chinese herbs that soothe the liver and regulate the qi, softening and dispersing the knots to regulate. The main manifestation of mammary gland hyperplasia is pain, and dimples are alert to breast cancer. A: The main clinical manifestations of breast hyperplasia are lumps and pain in the breast, individual patients have nipple overflow and menstrual disorders. Self-examination of breast lumps is characterized by one or more lumps in one breast, mostly in the upper outer quadrant, because there are more glands in the upper outer quadrant, and the lumps are lumpy or striated, hard but not particularly hard, with unclear borders and painful to touch. Learn to self-examine to have this feeling. If the lump is located in the superficial part of the gland, the tumor will often invade the small ligament connected between the gland and the skin, causing the ligament to shorten and a small depression on the skin surface, which is clinically called the dimple sign. Therefore, when you look at yourself in the mirror, you should observe whether the skin surface appears to be dimpled or not. In advanced breast cancer, there is often edema on the local surface, like orange peel, because the subcutaneous lymphatic vessels are filled with cancer cells, which makes the skin edematous, but there is no edema in the hair follicle area, so the whole breast skin has an orange peel-like appearance. If the tumor grows behind the nipple, the nipple will be gradually shortened and sunken, and finally all the nipple will be concave because the lump grows directly behind the nipple, and when the ligament is invaded during infiltration, it will pull the nipple inward; if the lump grows around the areola it will pull the nipple toward the affected side, which will show as nipple skewing and asymmetry of both nipples. When touched, breast cancer lumps are very hard, even if they are small, but they feel different from the general lumps of breast enlargement, which are very hard, with unclear borders and poor mobility. Generally, the early clinical manifestation of breast cancer is a painless lump, a hard lump without any pain. If it continues to grow, persistent pain occurs when the locally advanced lump invades the pectoralis major muscle or invades the tissues around the chest wall, and many advanced patients need morphine-based painkillers, which is usually hard to tolerate, but is usually not felt in the early stage. In contrast, mastopexy often starts with sensory pain, which manifests as tingling, vague pain, silky pulling discomfort, localized swelling and pain, sometimes radiating from the shoulders to the back, and sometimes itching and pain around the nipples. During self-examination, you should routinely check the armpit or above the collarbone, and if you touch the enlarged lymph nodes, you should go to a specialist hospital in time because some breast cancers have lymph node metastasis in the armpit and above the collarbone as the first symptom, which is called occult breast cancer, and you often need to find the primary lesion with the help of ultrasound, mammogram and MRI. Self-examination is usually performed 3-7 days after the end of menstruation. Some breast cancers are accompanied by nipple discharge, which is often bloody. There was a patient who went to a beauty salon for breast beauty and the beautician pushed out blood and water, and she was diagnosed with breast enlargement at other hospitals. Later, she came to our hospital and underwent ultrasound examination, there were no clear masses in both breasts, so we gave her a surgical biopsy and saw that the lesion was extensive. We cannot rely on self-examination alone for identification, but we should also go to hospital for examination. If you are not sure, you must go to the hospital and ask a specialist for an examination. In some medical check-up centers, the general surgeon examines the breast, which is not professional and less experienced. Many patients say that the doctor said that the check-up done six months ago was fine, but six months later they feel that their breasts are growing bigger and bigger. The process of breast cancer development is relatively long, so we suggest that women should go to a breast specialist clinic for breast examination. What are the examination items? A: First of all, we will do a mammogram for preliminary judgment, and further ultrasound, mammogram, and MRI, and if cancer cannot be excluded, we will do a pathological diagnosis by puncture. Cystic hyperplasia should be treated actively. High-risk groups need to be examined more frequently. A: The five-year survival rate of early stage breast cancer can reach over 90%. How to stop the development of cystic hyperplasia to breast cancer? A: In addition to the factors mentioned earlier such as strengthening exercise, changing lifestyle habits, avoiding overwork and mood swings, other treatments are also needed. Some lumps have breast hyperplasia for many years, but the lumps do not change significantly with menstrual cycle and are hard in texture. Ultrasound examination reveals blood flow around the lumps or unclear borders, or mammography reveals abnormalities in the lumps with burrs and calcifications, so if breast cancer is suspected, puncture pathology examination is needed. In addition, surgical biopsy of the suspicious lesion is also a good way to remove atypical breast growths. There are also some patients who have a clear family history of breast cancer, or have heavy breast enlargement. 10% of breast cancer is hereditary, and if there are mutations or abnormalities in BRCA1 and BRCA2 genes, the risk of breast cancer is 60% to 80%. Genetic testing is not particularly well developed in our country, but in the United States, it is reimbursed through basic health insurance, and patients under 40 years old or with family history can be tested for free. In the United States, the test is reimbursable through basic medical insurance and is free for patients under 40 years old or with family history. In China, the test is basically conducted by biologics companies, and there is no uniformity in reliability and quality control. In addition, the targeted drugs for breast cancer treatment in China are also very lagging behind, the most advanced foreign drugs are used, we are still in clinical trials, and it may take years for us to use them. This genetic test is necessary, if the test finds that there is indeed a mutation in the gene, the risk of breast cancer is extremely high, and can be prevented and blocked by oral medication or surgery. Preventive mastectomy is also possible in foreign countries, but in our country it is not yet legally approved. The American actress Jolie had her breasts implanted after total mastectomy, and the shape of her breasts basically did not change, and the risk of breast cancer recurrence was greatly reduced. For the high-risk group, some patients have menstruation before the age of 12, or some patients have menopause later, which means that hormones have been acting in the body for a long time and continue to act on the breast, and the breast is the target organ of estrogen, so these patients belong to the high-risk group. Women who have had breast radiotherapy when they were young are also at high risk; genetic factors, obesity, diabetes, smoking and alcohol consumption may also increase the risk of breast cancer on the opposite side. In terms of blocking the occurrence of breast cancer, normal people can be examined once a year, but those who are at high risk can be prevented by shortening the time of physical examination and increasing the frequency, twice a year. How often do you recommend breast exams for the general population? A: According to the age, overseas women over 40 years old should have mammogram once a year. Compared with foreign women, women in our country have smaller and denser breasts, so ultrasound examination may be more common. In general, medical checkups start at the age of 35 or above, and are mainly based on manual diagnosis and ultrasound examination by doctors. The breast cancer of Yao Beina was developed in her 20s, and nowadays there are quite a lot of young breast cancers in the clinic, so medical examination should be started from 30 years old or even earlier. Breast cancer treatment needs comprehensive assessment Three years after surgery is the peak period of recurrence What is the conventional treatment of breast cancer? A: Conventional treatment is usually surgery, chemotherapy, radiotherapy, endocrine therapy, targeted therapy, but the specific treatment should be combined with the age, stage and molecular subtypes of different patients. Now more and more detailed, according to the molecular subtype, divided into hormone sensitive, triple negative and Her2 positive type. The treatment strategy is standardized and individualized according to the patient’s age, stage and tumor biological characteristics. Whether patients need neoadjuvant therapy, whether they need surgery, what kind of surgery, breast-conserving surgery or total excision, or whether they need plastic surgery, in addition to standardization and individualization, we need to fully communicate with patients and finally formulate treatment strategies. Besides surgery, chemotherapy, radiotherapy, endocrine therapy, targeted therapy and other conventional treatments, Chinese herbal medicine and immunotherapy are also available. What is the recurrence rate of breast cancer patients after radiotherapy? A: Lymph node metastasis is the most important prognostic factor among all breast cancer recurrence. Generally, 30-40% of breast cancer patients will have recurrence, which is related to the patient’s stage, molecular biological characteristics and age, as well as the degree of standardization of treatment. Even if the brain metastases, it is possible to carry out gamma knife, surgery, radiotherapy to control the disease. The risk of recurrence is different for each person according to different characteristics, but regardless of the factors, one to three years after surgery is the peak of recurrence. Enhanced follow-up, enhanced treatment, hormone receptor-positive patients can be treated with endocrine therapy, most of which can be controlled and delayed to postpone the emergence of metastatic recurrence. Breast-conserving treatment is related to the condition and the patient’s wishes Breast reconstruction complications need to be considered in advance What kind of people are suitable for breast-conserving treatment? A: It has to do with the disease. We usually choose those with early stage of disease, the smaller the tumor and the larger the breast for breast-conserving surgery. The size of the breast must be suitable, at least medium size. It is very difficult to conserve breast if the breast is too small, and the patient must have a strong desire to conserve breast, and the tumor should be less than three centimeters, but this is not absolute. In addition, breast tumors located in the periphery of the breast and the distance between the areola and the breast must be at least two to three centimeters, and it is very difficult to preserve the breast if it grows under the areola or nipple. Some tumors are widely distributed along the ducts, and large calcifications or continuous calcifications are not acceptable. Before breast conservation, MRI is done to evaluate the breast as a single focal point, if it is two or more focal points, it is possible to remove it through one incision, if it is in different quadrants it is a contraindication to breast conservation. In addition to these, intraoperative margin freezing should be done. If the surrounding tissues to be sutured are free of cancerous negative margins, breast conservation can be done, if the tumor is widely distributed intraoperatively, the tumor is particularly extensive and cannot be breast conserved, then total excision plus reconstruction can be chosen. After all, breast reconstruction is a foreign body, will it cause any harm to the body? A: Not in general. There are two types of reconstruction, one is prosthesis reconstruction, which is more commonly used in clinical practice, and the other is autologous tissue reconstruction. We often take the latissimus dorsi, abdominal wall, gluteus maximus, including skin fat tissue, muscle filling breast, but there is a possibility of complications, so we need to have full communication with the patient. In addition, there are two kinds of prosthesis reconstruction: immediate reconstruction is to put in the prosthesis at the end of the breast surgery, and if the patient needs radiotherapy, the prosthesis is not put in at that time to avoid complications such as contracture of the prosthesis after the radiotherapy, and an expander can be buried during the surgery, and water is pumped into the expander after the radiotherapy, and the prosthesis is taken out and put in after six months, which can be done twice or more times. The prosthesis may be ruptured, infected, displaced, etc. Ageing may result in sagging of the healthy side of the breast and asymmetry of the affected side, requiring further surgery to adjust the situation. Autologous tissue reconstructive surgery is more complicated, the operation time is longer, and the postoperative recovery is slower. The abdominal wall is weak after the abdominal wall tissue is taken, and if the repair is not good, abdominal wall hernia may easily occur. The latissimus dorsi muscle transplantation is often combined with prosthesis for reconstruction because the amount of muscle is not enough, and the power of climbing and rowing will be weak after transplantation, and some patients have complications such as hematoma, infection and scarring in the reconstructed area. Post-operative psychotherapy is very important and has a significant role in group rehabilitation What are the main aspects and important roles of psychotherapy for breast cancer patients? A: In addition to the lack of drugs and examination methods in our country compared with foreign countries, the psychological care for patients is also relatively lacking. Although the patients are cured, they have to undergo a lot of treatments, such as high treatment cost, fear of recurrence and metastasis, and young patients have no children, etc. Many patients have different degrees of depression, insomnia, anxiety, fear, frustration, low self-esteem, and the loss of breast affects the life of husband and wife. Surgeons treat patients, but far from the purpose of the patient’s body and mind at the same time recovery, in foreign countries to do better. We are now paying more and more attention to the patient’s psychology. If the patient has special trust in the doctor, and the doctor has a high sense of responsibility, compassionate and sympathetic to the patient, and careful and patient, the patient’s psychological pressure will be greatly released, and will cooperate with the treatment. Very often it is also necessary to communicate with the patient’s family, especially the husband, which is especially important to support the patient’s recovery throughout the postoperative period. In addition, medical staff should improve their own sense of responsibility and awareness, so that patients can achieve psychological and physical recovery at the same time. Many patients are particularly grateful to us after treatment, feeling that they have lost their breasts but have the whole world, and that they have been working hard before, but because of the disease, they have a better relationship with their relatives and friends around them and live happily. In addition, patients have a herd mentality, and group recovery is also very important for patients. Many doctors choose the latter because of the hassle of waiting for intraoperative pathology results for breast conservation and axillary surgery, while total breast excision is relatively simple and convenient, but in fact many patients with total excision can be breast conserved. The psychology of a breast-conserving patient is completely different from that of a patient with a total mastectomy, as the breast is still in good shape and her psychological pressure is significantly reduced. Breast-conserving surgery must be based on systemic therapy and radiotherapy. Small hospitals do breast-conserving surgery, but chemotherapy is not available, nor is radiotherapy equipment, and that certainly does not work. Breast-conserving surgery must be guaranteed by comprehensive treatment, which requires doctors to be responsible to patients from the treatment point of view and technically.