Breast pain [Mastalgia]
An unreliable indicator of cancer, breast pain commonly results from benign breast disease. It may occur during rest or movement and may be aggravated by manipulation or palpation. (Breast tenderness refers to pain elicitedby physical contact.) Breast pain may be unilateral or bilateral; cyclic, intermittent, or constant; and dull or sharp. It may result from surface cuts, furuncles, contusions, or similar lesions (superficial pain); nipple fissures or inflammation in the papillary ducts or areolae (severe localized pain); stromal distention in the breast parenchyma; a tumor that affects nerve endings (severe, constant pain); or inflammatory lesions that distend the stroma and irritate sensory nerve endings (severe, constant pain). Breast pain may radiate to the back, the arms and, sometimes, the neck.
Breast tenderness in women may occur before menstruation and during pregnancy. Before menstruation, breast pain or tenderness stems from increased mammary blood flow due to hormonal changes. During pregnancy, breast tenderness and throbbing, tingling, or pricking sensations may occur, also from hormonal changes. In men, breast pain may stem from gynecomastia (especially during puberty and senescence), reproductive tract anomalies, or organic disease of the liver or pituitary, adrenal cortex, or thyroid glands.
History and physical examination
Begin by asking the patient if breast pain is constant or intermittent. For either type, ask about onset and character. If it's intermittent, determine the relationship of pain to the phase of the menstrual cycle. Is the patient a nursing mother? If not, ask about any nipple discharge and have her describe it. Is she pregnant? Has she reached menopause? Has she recently experienced flulike symptoms or sustained injury to the breast? Has she noticed a change in breast shape or contour?
Ask the patient to describe the pain. She may describe it as sticking, stinging, shooting, stabbing, throbbing, or burning. Determine if the pain affects one breast or both, and ask the patient to point to the painful area.
Instruct the patient to place her arms at her sides, and inspect the breasts. Note their size, symmetry, and contour and the appearance of the skin. Remember that breast shape and size vary and that breasts normally change during menses, pregnancy, and lactation and with aging. Are the breasts red or edematous? Are the veins prominent?
Note the size, shape, and symmetry of the nipples and areolae. Do you detect ecchymosis, a rash, ulceration, or a discharge? Do the nipples point in the same direction? Do you see signs of retraction, such as skin dimpling or nipple inversion or flattening? Repeat your inspection, first with the patient's arms raised above her head and then with her hands pressed against her hips.
Palpate the breasts, first with the patient seated and then with her lying down and a pillow placed under her shoulder on the side being examined. Use the pads of your fingers to compress breast tissue against the chest wall. Proceed systematically from the sternum to the midline and from the axilla to the midline, noting any warmth, tenderness, nodules, masses, or irregularities. Palpate the nipple, noting tenderness and nodules, and check for discharge. Palpate axillary lymph nodes, noting any enlargement. (See Breast pain: Common causes and associated findings.)
Medical causes
❑ Areolar gland abscess. Areolar gland abscess is a tender, palpable mass on the periphery of the areola following an inflammation of the sebaceous glands of Montgomery. Fever may also occur.
❑ Breast abscess (acute). In the affected breast, local pain, tenderness, erythema, peau d'orange, and warmth are associated with a nodule. Malaise, fever, and chills may also occur.
❑ Breast cyst. A breast cyst that enlarges rapidly may cause acute, localized, and usually unilateral pain. A palpable breast nodule may be present.
❑ Fat necrosis. Local pain and tenderness may develop in fat necrosis, a benign disorder. A history of trauma usually is present. Associated findings include ecchymosis; erythema of the overriding skin; a firm, irregular, fixed mass; and skin retraction signs, such as skin dimpling and nipple retraction. Fat necrosis may be hard to differentiate from cancer.
❑ Fibrocystic breast disease. Fibrocystic breast disease is a common cause of breast pain that's associated with the development of cysts that may cause pain before menstruation and are asymptomatic afterward. Later in the course of the disorder, pain and tenderness may persist throughout the cycle. The cysts feel firm, mobile, and well defined. Many are bilateral and found in the upper outer quadrant of the breast, but others are unilateral and generalized. Signs and symptoms of premenstrual syndrome — including headache, irritability, bloating, nausea, vomiting, and abdominal cramping — may also be present.
❑ Mammary duct ectasia. Burning pain and itching around the areola may occur, although ectasia is commonly asymptomatic at first. The history may include one or more episodes of inflammation with pain, tenderness, erythema, and acute fever, or with pain and tenderness alone, which develop and then subside spontaneously within 7 to 10 days. Other findings include a rubbery, subareolar breast nodule; swelling and erythema around the nipple; nipple retraction; a bluish green discoloration or peau d'orange of the skin overlying the nodule; a thick, sticky, multicolored nipple discharge from multiple ducts; and axillary lymphadenopathy. A breast ulcer may occur in late stages.
❑ Mastitis. Unilateral pain may be severe, particularly when the inflammation occurs near the skin surface. Breast skin is typically red and warm at the inflammation site; peau d'orange may be present. Palpation reveals a firm area of induration. Skin retraction signs — such as breast dimpling and nipple deviation, inversion, or flattening — may be pres-ent. Systemic signs and symptoms — such as high fever, chills, malaise, and fatigue — may also occur.
❑ Sebaceous cyst (infected). Breast pain may be reported with sebaceous cyst, a cutaneous cyst. Associated symptoms include a small, well-delineated nodule, localized erythema, and induration.
Special considerations
Provide emotional support for the patient, and emphasize the importance of monthly breast self-examination.
Prepare the patient for diagnostic tests, such as mammography, ultrasonography, thermography, cytology of nipple discharge, biopsy, or culture of any aspirate.
Pediatric pointers
Transient gynecomastia can cause breast pain in males during puberty.
Geriatric pointers
Breast pain secondary to benign breast disease is rare in postmenopausal women. Breast pain can also be due to trauma from falls or physical abuse. Because of decreased pain perception and decreased cognitive function, elderly patients may not report breast pain.
Pictures
![Breast pain [Mastalgia] - 4418.1.jpg](/bookimages/5/4418.1.jpg)
Book Source Details
- Book Title: Handbook of Signs & Symptoms (Third Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2006 Lippincott Williams & Wilkins.
Other Book Chapters Related to Breast pain
Read excerpts from these other book chapters related to Breast pain:
Medical Books Excerpts
- Nipple Discharge
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Breast pain
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2008 Williams & Wilkins.
More About Causes of Breast pain
» Next page: Galactorrhea/Nipple Discharge (A Pocket Manual of Differential Diagnosis)
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
