Development of Benign Diseases

Breast tissue is under the control of hormones in our body. A woman's hormonal balance is greatly affected by factors such as excessive stress, ongoing diseases, fatigue, and irregular nutrition. In this case, hormones are produced more or less than necessary and their ratios with each other are disrupted. This causes some benign diseases to occur in the breast.

Fibroadenoma: This is the condition popularly called milk gland. It is a mobile structure that develops due to the increase in cells in the breast ducts and can be felt as hard as an eraser. It cannot be considered a cancerous structure, but it has been observed that it can change by 3-4%. Many options are taken into consideration in follow-up and treatment, depending on the structure of the fibroadenoma detected. Although it is more common in the breasts between the ages of 18-29, it can be observed that they grow and change due to the hormonal changes experienced in the premenopausal period. Fibroadenomas that grow, degenerate and begin to bleed are considered high risk and are taken into surgery. However, the growth of fibroadenomas can be largely controlled by good stress-sleep control, monitoring and control of hormones that affect breast tissue, and reducing inflammatory problems in the body. Depending on the person's stress level, psychological counseling is required, control and treatment is planned by a gynecologist for irregularities in female hormones, and by an endocrinologist for conditions that increase cell growth and edema in the body, such as hypothyroidism and diabetes.

Cyst

Cysts in the Breast: The ducts may become blocked due to changes in the support and duct tissues of the breast tissue. The fluid in the breast ducts cannot maintain its normal flow and accumulates in the duct. In rare cases, the size of the cysts formed in this way can reach from a few mm to a few cm.  The cysts, which are generally detected as painless masses within the breast tissue during examination, are mobile structures that are not very hard. It is usually seen between the ages of 30-35. Although rare, it can become infected. It is characterized by sudden swelling, hardness and redness in the breast. This situation is called complicated cyst.When infection develops, the cyst wall integrity is disrupted, irregular and edematous on ultrasound. In painful cases, the treatment is to first drain the cyst with a fine needle under USG guidance and remove the infected fluid. Antibiotics may also be added to the treatment. The probability of cysts becoming cancerous is very low. Therefore, they do not need surgery.

However, if they become complicated and their general irregularities are disrupted and changes in blood-blooded polyps (which are structures formed as a result of cell reproduction in response to inflammation in the tissues) are detected, they may be considered for removal because they have the potential to change in the future. Simple cysts can only be treated by draining them. However, cysts containing polyps tend to refill even if the cyst is completely emptied. It is recommended to remove this type of refilling cysts.

Fibrocystic Structure and Breast Edema: Fibrocystic changes in the breast and hardness that can be felt due to edema usually occur before menstruation and may not be felt after menstruation. It can usually be identified with swelling and tenderness. Small cystic structures are usually noted in breast ultrasound. Treatment is planned according to the cause of the disease. Although breast edema is in the benign disease group, if it lasts for a long time, it exceeds the body's destruction and production capacity and can be a stepping stone to the development of precancerous lesions. Fibrocystic structure and edema, just like cellulite, occur as a result of the inflammatory reaction between the tissues of the body, which gradually hardens the tissue. Medical protocols to reduce inflammation, an antioxidant nutrition plan with reduced caffeine, and herbal supplements reduce edema in the breast tissue, increasing patient comfort and preventing the progression of benign problems and changes in the tissues. Complaints may decrease when high levels of estrogen or pregesterone, stress, cortisol and prolactin, thyroid hormones and conditions that cause inflammation in the body (such as insulin resistance and obesity) are taken under control in the emergence of fibrocystic structures.

Breast Pain (Mastodynia): Pain is also generally a symptom of benign diseases of the breast. Pain in breast cancer is more often detected as an advanced symptom. Since breast cancer can disrupt the comfort of life, its cause must be found and treated. Fibrocystic structures and breast infections are among the most common causes of breast pain. However, while the breast tissue develops under the skin, it is held tightly to the surrounding tissue with thin ligaments (Cooper's ligaments). Problems that cause pain in the surrounding tissue can also stimulate the breast and cause pain due to these ligaments. Before menstruation (4-5 days), when the edema of the breast tissue increases, the weight of the breast increases. This pain may become evident. The patient feels pain even during daily movements and is very uncomfortable even when lying down. The treatment strategy for painful breast conditions is primarily aimed at controlling hormones and stress, eliminating edema in the breast, and treating pain. In order to reduce the sensitivity of the surrounding tissue, anti-inflammatory nutrition, reducing excessive meat and carbohydrate consumption, reducing salt, increasing water, reducing caffeinated drinks, as well as chest muscle strengthening exercises such as pilates, using anti-inflammatory drugs, and antioxidant nutrition are recommended.

Breast Discharge: It is generally seen due to benign diseases. Green-blue discharges accompany the fibrocystic structure. Complaints can regress and decrease when female hormones such as estrogen and progesterone, which cause an increase in fibrocystic tissue, and stress-related cortisol levels, are taken under control and with anti-edema treatments. Milky discharge is called galactorrhea. It usually refers to hormonal disorders such as prolactin elevation, which occurs due to excessive emotionality and love of children. Treatment is determined according to the disease. While support is sought from a gynecologist for high estrogen and progesterone values, when high cortisol is detected, good sleep control, psychological counseling, as well as medical and supportive treatments to resolve edema in the tissues, antioxidants to reduce inflammation in the body, and a diet appropriate to the person's biological structure are recommended. In conditions where prolactin is high, it is recommended that the person receive psychological counseling for stress control, and prolactin hormone secretion is reduced with special medications. And if necessary, a pituitary MRI is taken to understand whether there is a focus in the brain that secretes this hormone in the pituitary gland.

Lipoma: These are masses of fatty tissue under the skin and are felt as softer areas. As long as they don't grow they won't cause any problems. Sometimes the patient may complain of pain as well as the feeling of a mass in the lipoma. This is usually not due to the Lipoma itself, but possibly due to pressure on a nerve right next to it. If it bothers the patient, the sebaceous gland must be removed. Although it is among the benign masses, it can turn into a rapidly spreading mass called 'Liposarcoma'. Therefore, it is recommended to take it when rapid growth or hardening is detected. Rarely, they can cause pain when pressed on any nearby nerve nerves, as well as some tumoral changes due to fatty tissue. That's why they are included in the annual impressions. 

Infections: Although it is more common during breastfeeding, it can also occur during periods when body resistance is weakened. If treated early, it can heal without leaving any problems. If delayed, stiffness and deformity may be permanent. It occurs due to milk retention during breastfeeding and can be resolved primarily by cold application, gentle heating during full breastfeeding and good breastfeeding. If the infection exceeds 2-3 days, skin rash and breast pain begin to occur, and in this case, there is firmness on examination but nothing is seen on USG, again, cold application, supportive treatments that relax the circulation in this area, as well as appropriate antibiotics can be given to the child. Breastfeeding continues. If a cyst or a small abscess that is likely to be infected is detected on USG, the infected fluid is drained by using needles thick enough to allow the flow of condensed fluid. Cold compress, antiedema treatment, antibiotics are given and she is asked to continue breastfeeding. If the infection in the breast is very severe and a large abscess has developed, despite to the treatments used, the abscess is need to be surgically opened, washed and cleaned. In cases where the infection is advanced, the patient should be seen frequently and should not be interrupted until the infection is fully healed. Some rare infections, especially in the breast, can cause abscesses and severe stiffness in the body. This condition is called Granulomatous mastitis. Treatment is difficult and long-lasting.

Granumatous Mastitis: In the treatment, edema-inhibiting supports, antibiotics and drainage of abscesses are important, and in this disease, cortisone can be added to the treatment to prevent excessive hardening due to the development of fibrous tissue in the breast. Surgical removal of infected structures is not recommended until the infection is completely dealt with. In Granomatous Mastitis, the structure may heal or disappear completely, or even if it heals, a large hard structure may remain in the breast. In this case, surgical removal may be considered. When mastitis is first encountered, if there is discharge or an infected cyst or abscess, culture is performed and when microbes are detected, treatment is continued with targeted antibiotic ion. However, in every case, material for culture cannot be found, and even if culture is performed, there may be no growth. In cases where no microbes are detected, medical treatment continues depending on whether the disease responds to antibiotics.

Gynecomastia: Since it occurs due to a hormonal problem in men, it responds to medical treatment if medical treatment is considered and if it does not exceed a certain size, the breast is not excessively hardened and does not cause excessive pain. In order to plan medical treatment, liver function tests, TSH, FSH, LH values, sugar and insulin levels, CRP, Sedim and total cortisol, DHEA and total testosterone should be checked in men. If these values are normal and there is gynecomastia, it is evaluated as primary gynecomastia (gynecomastia that develops without a secondary cause) and surgery is planned. Conditions in which these values are distorted are evaluated together with the patient's condition and complaints, and the treatment is planned accordingly. If the patient responds to medical treatment within 2 months and his/her complaints decrease, the patient is taken into medical follow-up. Meanwhile, in the development of gynecomastia, chemical pollutants taken from the environment in which the patient lives (for example, direct contact with pesticides and food additives produced for animals) and the medications used (some heart medications, antihypertensives and prostate medications) can cause gynecomastia. Food habits and one-sided nutrition (consuming chicken every day with the concern of staying healthy - chicken is a female animal) keep the person under constant pressure from female hormones and these reasons can cause gynecomastia. Staying away from pollutants and taking the necessary precautions, regulating medications and nutrition are important in terms of regressing the development and complaints of gynecomastia due to secondary causes. Medical treatment is based on regressing edema in the breast tissue and preventing the breast from turning into more dangerous cancerous diseases in the future. During surgery, it is recommended to remove the tissue located just below the breast tissue. Since it is not usually a very large tissue, it is entered through an incision at the end line of the dark colored area just around the nipple, called the areola. Breast tissue, including the nipple, is removed. The patient's comfort is ensured by lipoconturing (correction of edge swelling) the excess fat around it.