History

Cyclical mastalgia causes soreness, frequently in the upper and outer quadrants of the breast in the week preceding a period. The pain usually disappears after the period and there is freedom from soreness or pain for two weeks, when it recommences. Symptoms are common in the 20–45-year age group. Non-cyclical mastalgia may occur and is more common in the fourth and fifth decades. Duct ectasia occurs in the fifth decade. The pain is usually behind the nipple and associated with subareolar erythema and a thick, creamy nipple discharge. Fat necrosis will be suggested by a history of trauma, which occasionally the patient will be embarrassed to admit (often the partner’s teeth!). Breast abscess or mastitis will be obvious. It usually occurs during pregnancy or lactation but it may occur in a retroareolar position in a patient with duct ectasia. Breast fullness and soreness is a symptom of early pregnancy. Patients may indicate breast pain where the condition is not actively in the breast but behind it. Tietze’s disease (costochondritis of the costal cartilages) will present with pain related to the breast. Mondor’s disease (superficial thrombophlebitis of the subcutaneous veins of the chest wall) also presents with pain in the breast. It may be associated with an underlying carcinoma. Rib secondaries may also present with pain behind the breast. Herpes zoster may present with pain radiating round into the breast and precedes the development of a vesicular eruption by 2–3 days.