Breast hyperplasia is a common disease in breast surgery, accounting for more than 80% of the number of patients in breast specialist outpatient clinics, which obviously affects women’s health. Breast hyperplasia, also known as breast dysmorphic disorder, is often named cystic breast hyperplasia in foreign countries, but for Chinese women, in nearly 10,000 cases of breast hyperplasia, the appearance of naked eye cysts is only 3%, microscopic cysts is only 20%, and cysts as the main lesion manifestation of breast hyperplasia is only 9%, so scholars suggest that the disease is formally named as “breast hyperplasia”. Therefore, some scholars suggest that the disease be formally named “breast hyperplasia”. I. Pathogenesis and Pathology of Mammary Hyperplasia Normal women’s mammary gland development and changes are regulated by sex hormones, and its glands and mesenchymal stroma repeat the process of hyperplasia and regeneration along with the changes of sex hormones in the women’s cycle (menstrual cycle). In the follicular phase, estrogen action causes hyperplasia of terminal ductal and vesicular epithelial cells of mammary glands, increased DNA synthesis and mitosis, proliferation of mesenchymal stromal cells, and water retention; in the luteal phase, estrogen and progesterone act together to promote the generation of ductal and vesicular structures in the normal mammary lobules, while progesterone regulates and antagonizes some of the effects of estrogen. It inhibits cell mitosis, attenuates interstitial reactions, and promotes renal water and salt excretion by counteracting the action of aldosterone in the distal renal units; at the end of the luteal phase, the alveolar epithelial cells are highly differentiated, and the glandular lobules can generate and secrete small amounts of fluid under the action of basal levels of prolactin; during the menstrual phase, the secretion of sex hormones decreases due to the feedback inhibitory effect of the hypothalamo-pituitary-ovarian axis, which is accompanied by the onset of the menstrual cycle During menstruation, sex hormone secretion decreases due to the feedback inhibition of the hypothalamic-pituitary-ovarian axis, accompanied by the onset of the menstrual cycle. This cycle repeats itself, maintaining the normal structure and function of the mammary gland. In women of childbearing age, ovarian secretion dysfunction caused by various reasons leads to estrogen dominance during the menstrual cycle, absolute or relative progesterone deficiency, or relative shortening of the luteal phase, and the breast tissue is under the dominant effect of estrogen for a long period of time, which leads to excessive hyperplasia and incomplete recuperation, resulting in the disruption of the normal mammary gland structure and causing the development of this disease. Patients may have higher than normal plasma estradiol content in the follicular phase, lower plasma progesterone concentration in the luteal phase, normal or increased estrogen, and lower than normal progesterone concentration in the luteal phase, which may be lowered to 1/3 of the normal or shortened luteal phase. Some patients may have menstrual disorders or previous ovarian or uterine disease. After menopause, the ovary secretion of hormones decreases sharply, and the lobular follicular structure of the mammary gland atrophies and is replaced by fat and connective tissue, with only the larger ducts retained, and breast hyperplasia tends to improve markedly at this time. However, if estrogen replacement therapy is applied after menopause, the lack of the coordinating effect of progesterone will easily lead to breast ductal epithelial cell hyperplasia. Breast hyperplasia in different periods of the disease, its lesions are characterized by different, so that the pathohistological changes in a variety of forms, the basic process is as follows: Initial stage: first caused by the subepithelial stromal reaction, connective tissue edema, fibroblasts proliferation, the volume of the breast parenchyma in the end of the luteal phase of the typical case can be increased by 15%, the patient appeared in the premenstrual period of breast swelling and pain. This is followed by hyperplasia of the glandular epithelial cells in the lobules of the mammary glands and secretion. If ovarian dysfunction is restored, the histologic changes may return to normal. Progressive stage: Lobular hyperplasia further develops, and the lobules increase in size and even merge with each other, resulting in irregular shape and deformation of the lobules. Some of the lobules are disorganized due to fibrous tissue proliferation, and some of the regional ducts are increased, densely packed, pressurized, with fibrous tissue proliferation, showing adenomatous changes, which are easy to be confused with breast tumors on clinical examination at this time. In this case, it is easy to be confused with breast tumor. Some of the ductal glands have fluid collection, which is also known as fibrocystic hyperplasia, which is a diffuse cyst. Chronic stage: due to the compression of blood vessels by fibrous tissue proliferation, degenerative changes in the breast lobules, atrophy and hardening of the ductal-alveolar system, hyaline degeneration of the interstitium, and dilatation of the surviving ducts or alveoli. Fibrous tissue is commonly encapsulated into the dilated ducts with epithelial cell hyperplasia. Some manifest as isolated larger cysts. It should be pointed out that the above processes often can not be separated, can be in the lesion at the same time the existence of progressive and degenerative changes, and thus the histological manifestation of a certain form of polymorphic changes. The relationship between breast hyperplasia and breast cancer Clinical, pathological and epidemiological studies have shown that carcinoma of benign breast diseases is one of the important causes of breast cancer, and its mechanism is still unclear. Mammary hyperplasia is one of the most common benign breast diseases, and its relationship with breast cancer has always been emphasized. As early as the middle of the last century, many scholars have suggested that cystic hyperplasia of the breast is associated with breast cancer through the results of coexistence studies of paraneoplastic lesions and clinical retrospective investigations. The most important literature includes the results of more than 10,000 cases with a follow-up of 17.5 years published by Duppont and Page et al. in 1985 in the New England Journal of Medicine. Their conclusions clearly suggested that: 1. there is little chance of cancer in the following lesions, such as cysticercosis, ductal dilatation, sclerosing adenopathy, sclerosis, and fibroadenomatosis; 2. biopsy findings of mild epithelial hyperplasia and sweat glandular metaplasia are not significant below the age of 45 years; and 3. the rate of carcinoma of the breast atypical hyperplasia is increased by a factor of 4.7 compared to the control group, and the rate of breast cancer is increased by almost 10-fold in cases where there is a family history of breast cancer. The relationship between breast epithelial hyperplasia and atypical hyperplasia and the occurrence of breast cancer was confirmed. This was followed by further comparison of women with different pathomorphologic lesions defined by biopsy with women of the same age who had not taken breast biopsies, using the rate of development of invasive breast cancer over 10 to 20 years of follow-up as the risk level. Classify cystic hyperplasia of the breast according to histologic type into cysts, sweat gland chemosis, adenopathy, sclerosing adenopathy, inflammation, calcification, intraductal papillomas and/or epithelial hyperplasia; non-proliferative lesions, such as cysts, sweat gland chemosis, adenopathy, sclerosing adenopathy, or inflammation were found to be not at an increased risk for breast cancer when compared with the general population; those with ductal epithelial hyperplasia of the breast without atypical hyperplasia include generalized, moderate hyperplasia, the risk is mildly increased (the risk of breast cancer is 1.5-2 times that of the control group); those with epithelial atypical hyperplasia, including ductal atypical hyperplasia and lobular atypical hyperplasia, the risk is poisonously increased (the risk of breast cancer is 4-5 times that of the control group); whereas carcinoma in situ, including lobular in situ and ductal in situ carcinoma, the risk of invasive carcinoma is highly increased (the risk of the risk of breast cancer was 8-10 times higher than in the control group). The relationship between cancer of benign lesions and atypical hyperplasia was clarified, with the development of normal breast epithelium – generalized hyperplastic epithelium – atypical hyperplastic epithelium – Carcinoma in situ – invasive carcinoma. Clinical manifestations and diagnosis of mammary hyperplasia Patients are mostly women of childbearing age, and the incidence rate is higher in 30-40 years old. The main manifestations are breast pain, pressure pain, limited thickening of the gland or formation of lumps. Initially, it may be in one breast, mostly in the upper outer quadrant of the breast, and then it gradually develops into multifocal, and can develop in both breasts. The course of the disease is often long, and the initial stage is often related to menstruation, manifesting as increased pain before menstruation, gradually decreasing after menstruation, and the breast pain gradually loses its regularity after a certain degree of development. Some patients may have nipple discharge, mostly bilateral multiple breast ducts discharge, the discharge can be watery, yellow plasma, milky or cloudy, need to be differentiated from breast cancer or nipple discharge caused by intraductal papilloma of the breast. 40-60% of the patients are accompanied by irregular menstruation, early menstruation, dysmenorrhea, menstrual flow, or ovarian cysts. In addition, breast pain in most patients is often triggered and aggravated by dramatic psychological and emotional changes such as quarrels and anger. After menopause, the breast glands shrink and are gradually replaced by fatty tissue, and the symptoms and signs of most patients can be relieved. The clinical diagnostic standard of breast hyperplasia is not uniform, at present, the clinical diagnosis of breast hyperplasia is generally based on women with obvious breast pain, lump-like thickening of the breast or accompanied by multiple ductal nipple overflow. Auxiliary examination is the means to further clarify the diagnosis, mainly including color ultrasonography, mammography and selective mammography, and fiberoptic ductoscopy is also optional for those with nipple discharge. Pathologic puncture biopsy of suspicious lesions is performed to rule out breast cancer. Pathomorphologic diagnosis of breast hyperplasia remains the gold standard for clinical diagnosis. It should be pointed out that for female patients over 40 years old, especially those with limited thickening or lump-like changes in the breasts, breast hyperplasia cannot be easily diagnosed, and it is necessary to carry out the above examinations to exclude breast cancer before diagnosing breast hyperplasia. Treatment of breast hyperplasia The treatment of breast hyperplasia mainly includes the following four aspects: psychological treatment; drug treatment; surgical treatment; follow-up observation. 1, psychological treatment Traditionally, it is believed that women with breast pain are often accompanied by neurotic manifestations. For some breast pain is slight, signs are not obvious but show very nervousness of breast hyperplasia patients, can be given psychological appeasement treatment. Such patients often attach great importance to breast diseases, often doubt whether they suffer from breast cancer, such patients can be given the appropriate auxiliary examination to relieve the patient’s concerns, and to explain the knowledge related to breast hyperplasia, to dispel the cancer psychology, often with good results; there is also a part of the patient should be due to the family and husband and wife relationship is not harmonious, often angry, over-anxiety, this part of the patient must be instructed to try to restrain their emotions, more outdoor activities and more anxiety. This part of patients must be instructed to restrain their emotions, participate in outdoor activities and social activities, maintain a calm mind, learn self-psychological regulation, and if necessary, be given medication to regulate the function of plant nerves. 2, drug treatment Clinical for different conditions of breast hyperplasia patients to give targeted active treatment, and close monitoring and follow-up, in order to prevent and early detection of breast cancer. Commonly used drugs include the following categories: (1) Traditional Chinese medicine: Chinese medicine analysis of breast hyperplasia mainly includes liver depression and stagnation of qi, phlegm and stagnation of stagnation of phlegm, deficiency of liver and kidney, and dislocation of Chong Ren. Traditional Chinese medicine for the treatment of this disease includes medicines that regulate Chong Ren, detoxify the liver, activate blood circulation and remove blood stasis, soften the hardness and disperse the knots, relax the tendons and collaterals, and dissipate the knots and relieve the pain, etc., which are often used according to the specific conditions of the patients and often have some curative effects. (2) Vitamin drugs: Vitamin A, B, C, E can protect the liver and improve liver function, thus improving the metabolism of estrogen. Vitamin A, B, C and E can protect the liver and improve liver function, thus improving the metabolism of estrogen. Vitamin A, B, C and E can protect the liver and improve liver function, thus improving the metabolism of estrogen. Vitamin E can prevent peroxidation of important cellular components and plays an important role in maintaining the normal function of epithelial cells. At present, vitamins are often used as adjuvant drugs in the treatment of breast hyperplasia, but there are data showing that their efficacy is not higher than placebo. (3) Hormonal drugs: 1) Triamcinolone acetonide has estrogen-like activity, as a competitor of estradiol to compete for the estrogen receptor of the target cells and make estrogen lose its effect on the target cells without affecting the plasma estrogen level. It has an inhibitory effect on the growth of breast atypical hyperplasia cells, and has a good curative effect on breast hyperplasia. However, the drug can cause menstrual disorders and increased vaginal discharge, and should be used under the guidance and observation of a doctor. 2) Bromocriptine is a semi-synthetic ergot alkaloid derivative with dopamine activity. It can inhibit the synthesis and release of prolactin, and can act directly on the anterior pituitary gland, relieving the action of prolactin on gonadotropins and prompting the cyclic release of luteinizing hormone, etc. It is effective in the treatment of breast hyperplasia. The drug often causes nausea, vomiting, severe cases of postural hypotension, need to be used under the guidance of a specialist. 3) Methyltestosterone, danazol and other androgenic drugs, can counteract estrogen, inhibit ovarian function, and play a certain therapeutic role in breast hyperplasia. (4) Other drugs: 1) asparagine tablets, originally analyzed and extracted from fresh asparagus, and then synthesized, the active ingredient is asparagine, clinically proven to have a therapeutic effect on some of the breast hyperplasia. 2) Iodine preparations, its role is to stimulate the anterior pituitary gland, the production of luteinizing hormone in order to promote the luteinization of the ovarian follicular capsule, regulating and reducing the level of estrogen, thereby treating breast hyperplasia. 3) Evening primrose oil, containing the active ingredient gamma-linolenic acid (GLA), an essential fatty acid (EFA), is effective in relieving breast pain, but its action is very slow, taking effect after two months of treatment, but noticeable results will not be realized until four months after administration. It is more commonly used in women with moderate pain and who wish to continue taking oral contraceptives. (5) Methods of medication and precautions: The treatment of breast hyperplasia is generally preferred to a combination of medication based on traditional Chinese medicine or proprietary Chinese medicines and supplemented with vitamin-based medicines. Generally speaking, the selected drugs should not only relieve the symptoms, but also achieve the purpose of adjusting the body’s cyclic hormone balance and preventing the development of hyperplastic lesions. Therefore, the medication time should be 2-3 months as a course of treatment, continuous use of medication, to be completely relieved of symptoms, the main signs of breast hyperplasia disappeared, auxiliary examination suggests that the lesion is better or subsided can be discontinued. Application of triamcinolone acetonide needs to grasp the indications, generally used for estrogen level is too high, other drugs have poor therapeutic effect, for the onset of patients over 40 years of age, with a family history of breast cancer and other high-risk factors, biopsy confirmed that there is atypical hyperplasia of the mammary epithelium should be preferred to triamcinolone acetonide treatment. Surgical treatment For those who have bad effect of drug treatment, high risk factors of breast cancer and those who cannot exclude cancerous lesions, surgery can be considered for examination and treatment. (1) Hollow needle biopsy: For those who have limited thickening of breast hyperplasia, irregular pain, bad effect of medication, symptoms of breast hyperplasia over 40 years old, family history of breast cancer or suspected lesions detected by auxiliary examination, hollow needle aspiration biopsy should be performed actively, and if necessary, puncture should be performed under the positioning of ultrasound or X-ray to improve the diagnostic accuracy of small lesions. This method has the advantages of minimally invasive and no (or minimal) scarring compared with other surgeries. (2) lumpectomy: for breast hyperplasia after general drug treatment is ineffective, or after treatment of other hyperplastic lesions improve but the isolated breast lump does not disappear, combined with a single ductal overflow, ultrasound or X-ray suggests that there is a tumor-like foci of the person should be actively performed lumpectomy, preoperative preparation for radical mastectomy. (3) Mastectomy: Mastectomy should be performed for those who have multifocal atypical hyperplasia of grade II or above confirmed by biopsy, those who are accompanied by intraductal papilloma, or those who have mutation of breast cancer susceptibility gene (BRCA1/2) confirmed at the same time. Such patients can choose lumpectomy with one-stage implantation, which can restore the perfect shape of female breasts while resecting the lesions. Follow-up observation For patients with high risk factors of breast hyperplasia, a reasonable follow-up observation program should be formulated while actively treating them, and they should be rechecked at least once every half a year, and quarterly for those with very high risk, in order to be alert to the occurrence of breast cancer. Patients should be taught to do self-examination during the initial consultation. With the improvement of people’s living standard and the accelerated pace of life, the incidence of breast hyperplasia is gradually increasing, so it is very important to take active preventive and curative measures. Combined with the pathogenesis of mammary hyperplasia, we believe that prevention should be carried out in the following aspects: 1, choose the appropriate age to get married and have children; 2, try to breastfeeding after giving birth; 3, pay attention to the adoption of effective contraceptive measures; 4, pay attention to maintaining a regular and quality of sex life; 5, good at adjusting their own emotions, maintain a cheerful and calm state of mind; 6, multi-directional to take a scientific lifestyle, regularity, less late at night, quit smoking, and take care of your health and safety. Regular, less late at night, quit smoking and drinking, low-fat diet, drink less caffeine, theophylline, theobromine and other ingredients of the drink, careful use of breast products, choose the right type of supportive bra, etc.; 7, active prevention and treatment of various gynecological diseases; 8, a yearly examination of the breast specialties.