Breast: Pain (Mastodynia, Mastalgia)

Published on 31/05/2015 by admin

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Last modified 31/05/2015

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Chapter 155 Breast: Pain (Mastodynia, Mastalgia)

INTRODUCTION

Description: Mastalgia is the nonspecific term used for breast pain of any etiology.
Prevalence: Most women experience breast pain at some point in their lives (may be transient).
Predominant Age: Reproductive.
Genetics: No genetic pattern.

ETIOLOGY AND PATHOGENESIS

Causes: Fibrocystic change. Rapid hormonal change (especially a change that involves an increase in estrogen levels, such as starting birth control pills or hormone replacement or during early pregnancy). In the absence of obvious pathologic changes, mastalgia has been attributed to caffeine consumption and high-fat diets, but hard data are lacking. Nongynecologic causes—dorsal radiculitis or inflammatory changes in the costochondral junction (Tietze’s syndrome), sclerosing adenosis, chest wall muscle spasms, costochondritis, neuritis, fibromyalgia, and referred pain.
Risk Factors: Pregnancy, hormone therapy. Caffeine consumption and high-fat diets have been suggested but remain unconfirmed causes.

CLINICAL CHARACTERISTICS

Signs and Symptoms

• Diffuse breast pain, often with radiation to the shoulders or upper arms, which may or may not be related to the menstrual cycle. Unilateral or localized pain suggests a pathologic process.

DIAGNOSTIC APPROACH

Differential Diagnosis

• Fibrocystic change (most commonly presents as cyclic, diffuse, bilateral pain and engorgement, with the worst symptoms occurring just before menses)
• Mastitis or breast abscess
• Trauma
• Chest wall abnormalities (herpes zoster, costochondritis, radicular pain)
• Breast cancer (breast pain is a presenting complaint in less than 10% of patients with breast cancer)
• Mondor’s disease

Associated Conditions: Fibrocystic change, fibroadenoma, and mastitis.

Workup and Evaluation

Laboratory: No evaluation indicated.
Imaging: Mammography may be indicated for other reasons but seldom directly assists in the evaluation of mastalgia.
Special Tests: None indicated.
Diagnostic Procedures: History and physical examination. The presence of scattered bilateral nodularity suggests fibrocystic change.

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