1, congenital malformation of breast development
Since the development of the mammary gland is the development of breast buds at the embryonic breast line site, under normal circumstances the excess breast buds gradually disappear and only a pair of breast buds develop into mammary glands. If for some reason during embryonic development, the nipple cannot be generated – nipple agenesis. If the excess nipple continues to develop without disappearing and forms an abnormality of multiple nipples or parametrium. In adults, redundant small nipples, as few as 1-2 and as many as 10 or more, can be found under the armpits and on both sides of the trunk during pregnancy or lactation. There is usually no effect on the body. If the parametrium secretes milk and the milk ducts are poorly developed to form milk retention, it may have cancerous changes and can be surgically removed.
2.Inflammatory breast disease
Acute suppurative mastitis is clinically common, and 90% of the cases are in the postpartum period, especially in first-time mothers. The main reason is that the body’s resistance decreases after childbirth, pathogenic bacteria invade through the nipple, resulting in blockage of the milk ducts, poor milk discharge, retention and combined with bacterial infection. The main manifestations are red, swollen, hot and painful breasts, which can also form abscesses, and the patient can have a high fever that does not go away. Active anti-inflammatory treatment is required. Drainage of breast milk before abscess formation is the main concern, and pus must be drained after abscess formation. All women in labor should prevent the occurrence of acute purulent inflammation of the breast. The main chronic inflammatory disease of the breast is breast tuberculosis. The main manifestation is a breast mass, often with chest wall tuberculosis involvement. The incidence is not high, but it needs to be differentiated from breast cancer.
3. Simple hyperplasia and cystic hyperplasia of the breast
Mammary gland hyperplasia is mainly due to ovarian endocrine dysfunction with different degrees of glandular hyperplasia, forming a lump with poorly defined borders and no envelope to touch. The main clinical manifestations of mastocytosis are breast swelling and pain, and nodules of varying sizes in the breast. It mostly occurs in women aged 30-40 years. It can be painful on one side or both sides and can radiate to the shoulder and back armpit, and can change due to emotional changes and menstrual cycle. It is heavy before menstruation, but decreases or disappears after menstruation, and is caused by ovarian secretion disorder.
The pathological changes are mainly glandular epithelial cell hyperplasia, congestion, edema, ductal expansion, and severe expansion to form cysts of different sizes called cystic hyperplasia. Mammary gland hyperplasia, especially cystic hyperplasia, can occur as heterogeneous hyperplasia and carcinoma, which are called precancerous lesions.
4.Neoplastic diseases of the breast
(1) Benign breast tumors
Breast fibroids, fibroadenomas, lipomas, and intraductal papillomas are all benign breast tumors. Generally, there are no obvious symptoms, and most of them are found in single or multiple round lumps in the breast when bathing, with good activity, no adhesion with skin and bottom tissue, and no skin changes. Fibroids mostly occur in young women, 20-40 years old. The diagnosis can be confirmed by auxiliary examination and treated by surgical excision.
(2) Breast cancer
Breast cancer is a malignant tumor that endangers women’s health and has become the number one killer of women in recent years. The incidence of breast cancer is gradually increasing, and the increase has reached 10 times, and the age of incidence is getting younger, mostly occurring between 35-55 years old, with a lower incidence above 70 years old. There are some differences in the incidence rate among regions at home and abroad. The incidence is higher in developed countries and large modern cities.
The main clinical manifestations are.
① Intramammary mass: a single (rarely multiple) painless lump in the breast, mostly in the upper outer quadrant of the breast, varying in size, hard texture, indistinct borders, and poor mobility. The ligament may be infiltrated and the skin may be sunken like a dimple – dimple sign. If the breast cancer cells infiltrate the skin, the follicular pore and surrounding lymphatic blockage will be edematous, resulting in dotted depressions resembling orange peel – the orange peel sign. This sign is not early stage anymore.
Nipple changes: Nipple may appear as flaking, erosion, itching, retraction, fixation, etc. Also, due to the rapid growth of the mass, the nipple may be elevated or shifted to one side because of the contraction of the milk ducts.
③ Nipple overflow: the milk ducts may be dipped and there may be bloody nipple discharge, and the overflow is mostly unilateral, single breast, and bloody.
Symptoms of lymphatic metastasis: Due to the rapid growth of breast cancer tissues and lymphatic tissues and metastasis to regional lymph nodes, single or multiple enlarged lymph nodes fused into lumps can be touched in the supraclavicular, infraclavicular and axillary areas.
(5) Symptoms of hematogenous metastasis: Cancer cells may enter the bloodstream to the lung, liver and bone, and often to the vertebrae, femur and pelvis, followed by the corresponding symptoms.
3.Population with high incidence of breast cancer
3.1 Those who have early menarche (<12 years old), late menopause (>55 years old), or menstruation for >35 years;
3.2 Those who have a family history of breast cancer in the immediate family;
3.3 Those who have already had breast cancer on one side;
3.4 Those who have received repeated radiation to the breast for various reasons;
3.5 Those who are unmarried, unpregnant or have had their first full-term child over 35 years of age;
3.6 Married with no children or those who have had children and are not breastfeeding;
3.7, suffering from uterine fibroids, hypothyroidism;
3.8 Those with a history of benign breast lesions, especially those with pathologically confirmed active papillomas in the milk ducts;
3.9. Those who are immunocompromised or have defects;
3.10 Obesity, high fat diet and high standard of living;
3.11 Women with trauma, emotional depression, depressive personality, bad temper and sulking;
3.12 Women who have repeated abortions;
3.13.People with poor quality of sexual life;
3.14, menopausal sex hormone replacement therapy patients.