Definition
Mastalgia is any pain felt in the breast. Cyclical mastalgia is pain in the breast that varies in association with the menstrual cycle. Non-cyclical mastalgia is pain in the breast that follows no pattern or is intermittent.
Key Points
- Mastalgia is commonly due to disorders of the breast or nipple tissue but may also be due to problems in the underlying chest wall or overlying skin.
- Pain is an uncommon presenting feature of tumours but any underlying lump should be investigated as for a lump (see Chapter 4).
- Always look for an associated infection in the breast.
- Mammography should be routine in women presenting over the age of 45 years to help exclude occult carcinoma.
Important Diagnostic Features
Non-Breast Conditions
- Tietze’s disease (costochondritis): tenderness over medial ends of ribs (typically 2nd/3rd/4th), not limited to the breast area of the chest wall, typically unilateral, relieved by NSAIDs.
- Bornholm’s disease (epidemic pleurodynia caused by coxsackie A virus): marked pain with no physical signs in the breast, worse with inspiration, no underlying respiratory disease, relieved with NSAIDs.
- Pleurisy: associated respiratory infection, pleural rub, may be bilateral.
- Angina: usually atypical angina, may be hard to diagnose, previous history of associated vascular disease.
Mastalgia Due to Breast Pathology
Mastitis/Breast Abscess
- During lactation: red hot tender lump, systemic upset.
Treatment: aspirate abscess (may need to be repeated), do not stop breastfeeding, oral antibiotics.
- Non-lactational abscesses: recurrent, associated with smoking, associated with underlying ductal ectasia:
treatment: outpatient aspiration, give oral antibiotics, stop smoking, prophylactic metronidazole for recurrent sepsis, repeat aspiration if necessary.
Infected Sebaceous Cyst
- Single lump superficially in the skin of the periareolar region, previous history of painless cystic lump:
treatment: excise infected cyst ± antibiotics.
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