Mastalgia (breast pain) is common and can be localized or diffuse and unilateral or bilateral.
Etiology of Mastalgia
Localized breast pain is usually caused by a focal disorder that causes a mass Breast Masses (Breast Lumps) The term breast mass is preferred over lump for a palpably discrete area of any size. A breast mass may be discovered by patients incidentally or during breast self-examination or by the clinician... read more , such as a breast cyst, or an infection (eg, mastitis Mastitis Mastitis is painful inflammation of the breast, usually accompanied by infection. Fever later in the puerperium is frequently due to mastitis. Staphylococcal species are the most common causes... read more , abscess). Most breast cancers Breast Cancer Breast cancer most often involves glandular breast cells in the ducts or lobules. Most patients present with an asymptomatic mass discovered during examination or screening mammography. Diagnosis... read more do not cause pain.
Diffuse bilateral pain may be caused by fibrocystic changes Etiology The term breast mass is preferred over lump for a palpably discrete area of any size. A breast mass may be discovered by patients incidentally or during breast self-examination or by the clinician... read more or, uncommonly, diffuse bilateral mastitis. However, diffuse bilateral pain is very common in women without breast abnormalities. The most common causes in these women are
Hormonal changes that cause breast tissue proliferation (eg, during the luteal phase or early pregnancy, in women taking estrogens or progestins)
Large, pendulous breasts that stretch Cooper ligaments
Evaluation of Mastalgia
History of present illness should address the temporal pattern of pain and its nature (focal or diffuse, unilateral or bilateral). The relation between chronic or recurrent pain and menstrual cycle phase should be ascertained.
Review of systems should seek other symptoms suggesting pregnancy (eg, abdominal enlargement, amenorrhea, morning nausea) or fibrocystic changes (eg, presence of many masses).
Past medical history should cover disorders that could cause diffuse pain (eg, fibrocystic changes) and use of estrogens and progestins.
Examination focuses on the breast and adjacent tissue, looking for abnormalities such as skin changes including erythema, rash, exaggeration of normal skin markings, and trace edema sometimes termed peau d’orange (orange peel), and signs of infection, such as redness, warmth, and tenderness.
The following is of particular concern:
Signs of infection
Interpretation of findings
Absence of abnormal findings suggests that pain is due to hormonal changes or large, pendulous breasts. Abnormal findings may suggest other specific problems.
Pregnancy testing should be done if pain is unexplained and has lasted less than several months, particularly if other symptoms or signs are consistent with pregnancy.
Other testing is indicated infrequently—only if physical findings suggest another problem that requires testing.
Treatment of Mastalgia
For menstrual-related mastalgia, acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID) is usually effective. If pain is severe, a brief course of danazol or tamoxifen may be given. These drugs inhibit estrogen and progesterone. If estrogen or a progestin is being taken, stopping may be necessary.
For pregnancy-related breast pain, wearing a firm, supportive brassiere, taking acetaminophen, or both, can help.
Recent evidence suggests that evening primrose oil may reduce the severity of mastalgia.
Diffuse, bilateral breast pain is usually caused by hormonal changes or large, pendulous breasts and causes no abnormal physical findings.