Mastalgia causes
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2] Hilda Mahmoudi M.D., M.P.H.[3]
Overview
Two thirds of breast pains are cyclical and one third have non cyclical cause.
Cyclical breast pain is very often associated with fibrocystic breast changes or duct ectasia and believed to be caused by aberrations in dynamic hormonal changes mainly involving prolactin response to thyrotropin. Some degree of cyclical breast tenderness is normal in the menstrual cycle, and is usually associated with menstruation and/or premenstrual syndrome (PMS).
Noncyclical breast pain has various causes and is harder to diagnose.It is more likely to be unilateral and variable in its location in the breast.Some degree of non-cyclical breast tenderness can normally be present due to hormonal changes in puberty (both in girls and boys), in menopause and during pregnancy and breastfeeding. Other causes of non-cyclical breast pain include alcoholism with liver damage (likely due to abnormal steroid metabolism), mastitis and some medications. Also, shingles can cause a painful blistering rash on the skin of the breasts.
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Causes
Causes Related to the Breast
- Fibrocystic changes
- Increased number of cysts or fibrous tissue in otherwise normal breasts
- Can be associated with pain or nipple discharge - fibrocystic disease
- If fibrocystic changes are cause of pain- found in 50-90% asymptomatic women
- Hormonal etiology - pain often cyclic; most severe during luteal phase
- Tissue edema/water retention with dilated/blocked ducts - not proven
- Mastitis or breast abscess
- Acute onset, usually due to Staphylococcus aureus (S. aureus) or streptococci
- Erythema, local tenderness induration
- Most common in lactating women
- Pendulous breasts
- Pain due to stretching of Cooper’s ligaments
- Can involve the breast
- Presents with painful breast nodules
- Trauma to chest wall
- Fat necrosis
- Usually induced by trauma
- Tender, firm mass, +/- calcification on mammogram
- Usually due to a respiratory infection
- Pleuritic pain from underlying pulmonary/pleural disease
- Thoracic spine arthritis
- Referred chest pain
Flowchart
| Breast Pain | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Cyclic Pain | Localized Tenderness | Generalized Tenderness | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Premenstural Syndrome | Trauma Mastitis Abscess Herpes Zoster Breast Fibroadenoma | Fibrocystic Diseases Pregnancy Alcoholism Caffeine | Digitalis Methyl-Dopa Spironolactone Chlorpromazine Estrogens Oral Contraceptives | ||||||||||||||||||||||||||||||||||||||||||||||||||||||