Tight, sore and grainy breasts – these are the signs of mastosis, a benign breast disease that affects many women. In addition to the discomfort it causes, mastosis is also often a source of concern.

Mastosis (or sclerocystic mastosis or cystic fibrosis of the breast) is a benign disease of the breast, manifested by tension and pain in the breasts (mastodynia), as well as an irregular, dense and granular consistency of the breasts, with compact areas there where the mammary gland is largest (on the sides and top of the breasts). We speak of “fibrous breasts” or “granular”.

On palpation, we also note the presence of small round and mobile masses. These may be cysts (a benign mass filled with fluid) or a fibroadenoma (a small benign mass of fibrous tissue and glandular tissue). These are benign conditions affecting 50 to 80% of women, most often between 30 and 50 years old.

Breasts affected by mastosis have the particularity of having a high density of glandular tissue. It’s genetic: some women are born with this type of breast, which they will keep all their lives. This anatomical feature makes the breasts very sensitive to hormonal variations. In addition, there is usually a hormonal imbalance between estrogen and progesterone, with lutheal insufficiency (the ovaries do not produce enough progesterone during the post-ovulatory phase) and hyperestrogenism (excess estrogen).

Thus, when the estrogen level is higher than that of progesterone, pain may appear, as well as this granular consistency. Some women will have pain in the breast at the time of ovulation (estrogen surge) or at the start of menstruation; others ovulate at the end of the cycle.

These hormonal variations can become more pronounced after your forties, when progesterone is scarce.

A clinical examination, possibly supplemented by an ultrasound and / a mammogram, will confirm the diagnosis of mastosis and its benign character. The examinations will confirm the presence or not of cysts or adenofibromas. If in doubt, a biopsy can be performed.

Monitoring a mastosis

Then, monitoring will be done on a case-by-case basis, depending on the patient, her age and her family history of breast cancer in particular. Mastosis usually complicates monitoring of the breasts. The clinical examination is painful for the patient, and the density and heterogeneity of the breasts make palpation difficult for the healthcare professional.

As a precaution, examinations may therefore be more frequent. But here too, they turn out to be more complex. On reading, mammography is more difficult because the breast is denser, hence the importance of being followed in a center specializing in senology. Mammography and ultrasound are usually systematically combined to complement each other. If necessary, tomosynthesis (3D mammography) can be performed. 

Self-palpation for screening

Also for women, who are advised to carry out regular self-palpation of the breasts in search of an abnormal mass, the presence of a mastosis can complicate the procedure and be a source of great concern because the breasts are, by nature, very granular. It is still important to perform this self-examination once a month. If the mass is mobile, if its size varies during the cycle, if it appears or disappears, these are rather reassuring signs, but it is always important to talk to your doctor.

There are two main treatments to relieve mastosis: 

The progestin-only contraceptive pill

A progestin-only contraceptive pill may be prescribed to limit breast pain, correcting lutheal insufficiency. It relieves symptoms, but is not effective in all women. Hormonal sensitivity is indeed very different from one woman to another. 

The progestin-based gel

A progestin-based or anti-inflammatory gel, to be applied to the breasts when they are painful, may be prescribed.

In homeopathy, the prescription of Folliculinum in high dilutions (15 to 30 CH) would limit hyperostrogeny. Other remedies can be prescribed as a basic treatment, depending on the woman’s background: Lachesis, Iodum, Calcarea Carbonica. Homeopathy being a field medicine, it is important to consult a specialist for a personalized protocol.

In the pre-menopausal period, the symptoms of mastosis may worsen, because the level of progesterone decreases before that of estrogen. But once this transition period has passed, mastosis will tend to disappear, and its symptoms with: pain, tension, cysts. Unless, of course, the woman is taking hormone replacement therapy with a high dose of estrogen. 

During pregnancy, and more particularly the first trimester during which the hormonal impregnation is very strong, the mother-to-be may suffer from mastosis.