Breast Pain (Mastalgia) - Causes, Diagnosis & Treatment

Introduction

Breast pain, also called mastalgia, affects nearly 70% of women at some point in life. While most cases are harmless, some could signal underlying pathology. Here's everything you need to know about identifying, understanding, and treating breast pain.

 

What Is Breast Pain?

• Definition of mastalgia
• Differentiation between cyclical and non-cyclical pain
• Localized vs diffuse pain
• Pain related to breast pathology vs unrelated systemic causes

Types of Breast Pain

1. Cyclical Mastalgia

• Linked to menstrual cycle
• Common in younger women
• Pain in outer upper quadrant
• Dull, heavy, bilateral

2. Non-Cyclical Mastalgia

• Unrelated to periods
• Sharp, burning, or localized pain
• Seen in older women
• May be unilateral

3. Extramammary (Non-Breast) Pain

• Tietze’s syndrome – costochondritis, tenderness over ribs
• Pleurisy – pleuritic chest pain, respiratory infection
• Bornholm’s disease – coxsackie virus, painful inspiration
• Angina – cardiac-related pain, often confused

Breast Pain Due to Underlying Breast Pathology

1. Fibrocystic Disease

• Common in reproductive age
• Breast feels nodular, cobblestone texture
• Upper outer quadrant
• Management: supportive bra, diet changes

2. Breast Abscess and Mastitis

• Painful, red, hot tender lump
• Lactating women: common post-infection
• Non-lactational: smoking, duct ectasia
• Treatment: aspiration, antibiotics

3. Periductal Mastitis

• Inflammatory condition around milk ducts
• Often linked to smoking
• Recurrent pain, discharge, periareolar swelling

4. Infected Sebaceous Cyst

• Localized lump, often superficial
• Treatment: excision ± antibiotics

5. Rare but Possible: Carcinoma

• Breast pain is rare in cancer
• Always evaluate associated lump
• Occult carcinoma must be excluded especially >45 years

Explore more: Breast Lump Detection

Mastalgia Without Overt Breast Pathology

• Pain present, but no lump or imaging finding
• Often hormonal or musculoskeletal
• Common around menopause or hormonal fluctuations

Differentiating Breast from Non-Breast Causes

Feature	Breast Pathology	Non-Breast Pathology
Pain with inspiration	❌	✅ (e.g., pleurisy)
Rib tenderness	❌	✅ (Tietze's syndrome)
Cardiac risk factors	❌	✅ (Angina)
Associated breast lump	✅	❌
Local inflammation	✅	❌

Red Flags in Breast Pain

• Persistent, localized pain without menstrual association
• Associated lump, skin changes, nipple discharge
• Age >45 with new-onset pain
• No relief with conservative treatment

Diagnostic Workup for Breast Pain

Non-Breast Origin

• Chest X-ray (pleurisy, rib abnormalities)
• ECG, stress test (angina)

Breast Pathology

• Clinical Exam
• Ultrasound – best for dense breasts (young women)
• Mammography – preferred >40 years
• FNAC or Biopsy – if lump is present

Mastalgia Without Pathology

• Routine mammography (especially >45)
• Hormonal evaluation in select cases

Learn more: Haemoptysis Explained

Treatment Strategies

Lifestyle & Supportive

• Well-fitting bra
• Reduce caffeine & dietary fat
• Vitamin E, evening primrose oil

Medications

Cyclical Mastalgia:

• Paracetamol, danazol, tamoxifen, bromocriptine

Non-Cyclical:

• NSAIDs, local analgesics

Infection or Cyst

• Antibiotics, aspiration, surgical drainage if needed

Surgery

• Rarely required
• For abscess recurrence or cosmetic relief

FAQs About Breast Pain

Is breast pain a sign of cancer?

Rarely. But any persistent pain with a lump should be checked.

How long does cyclical breast pain last?

Usually 3–5 days before menstruation; resolves afterward.

Can menopause cause breast pain?

Yes. Hormonal changes around perimenopause may cause pain.

What home remedies help with mastalgia?

Supportive bra, dietary changes, evening primrose oil, vitamin E.

Is breast pain normal in teenage girls?

Yes. It's common during puberty due to hormonal changes.

Conclusion

While breast pain is usually benign and treatable, it deserves attention. Distinguishing between cyclical, non-cyclical, and extramammary causes is key. Early evaluation, proper support, and targeted management ensure peace of mind and long-term comfort.