Breast: Mastalgia/Mastodynia

Mastalgia/Mastodynia

Definition

  • Definition: Breast Pain
  • Usually Mild & Self-Limited
  • About 15% will Require Treatment

Classification

  • Cyclical: Associated with Hormonal Fluctuations of the Menstrual Cycle
    • More Likely to Be Bilateral & Diffuse
    • Most Common Site of Cyclical Pain: Upper Outer Quadrant (UOQ)
  • Noncyclical: Not Associated with Hormonal Fluctuations of the Menstrual Cycle
    • More Likely to Be Unilateral with Variable Location
  • Extramammary: Referred Pain from Non-Breast Sources

Causes

  • Cyclical Causes:
    • Hormonal Changes
    • Fibrocystic Change – Most Common Cause
  • Noncyclical Causes:
    • Stretching of Cooper’s Ligaments – Seen in Obese or Pendulous Breasts
    • Hormonal Replacement
    • Breast Cysts
    • Ductal Ectasia
    • Mastitis/Abscess
    • Trauma
    • Thrombophlebitis (Mondor Disease)
    • Inflammatory Breast Cancer
    • *Diet/Lifestyle (Tobacco, High-Fat Diet & Caffeine) Show Anecdotal Association but No Randomized Control Trials Exist
  • Extramammary Causes:
    • Chest Wall Pain
    • Spinal/Paraspinal Pain
    • Post-Thoracotomy Syndrome
    • Trauma

Diagnosis

  • Initial: History & Physical Exam
  • Imaging (Diagnostic Mammogram & US) Indications:
    • Noncyclical Pain
    • Unilateral or Focal Pain
    • Suspicious Physical Exam Findings (Palpable Mass, Skin Changes or Bloody Nipple Discharge)

Treatment

  • Cyclical & Noncyclical Pain Are Treated Similarly
  • Initial Treatment: Conservative Therapy
    • Reassurance – Provides Adequate Relief for 78-85%
    • Warm Compress or Ice Packs
    • Weight Loss
    • Tylenol & NSAID’s
    • Other Therapies without Proven Benefit:
      • Evening Primrose Oil (EPO)
      • Caffeine/Nicotine Abstinence
  • If Conservative Therapy Fails: Medical Management
    • Tamoxifen (Selective Estrogen Receptor Modulators/SERM)
    • Danazol (Androgen) – More Side Effects than Tamoxifen
    • Oral Contraceptive Pills (OCP) if Cyclical