How common is mastodynia?

• Predominant age - Generally adolescence through menopause • Predominant sex - Most common in women, rarely men - May occur in adolescent males during puberty

What are the risk factors for mastodynia?

• Diet high in saturated fats • Cigarette smoking • Recent weight gain • Pregnancy • Large pendulous breasts (caused by stretching of Cooper's ligament) • Caffeine has not been shown to be a risk factor

What causes mastodynia?

• Hormonal influences (i.e., hormone replacement therapy, OCPs, pregnancy, menses, puberty, menopause) • Benign breast disorders (i.e., fibrocystic changes) • Lactation problems (engorgement, mastitis, breast abscess) • Extramammary tissue • Hidradenitis suppurativa • Breast masses, including breast cancer • Postthoracotomy syndrome • Spinal and paraspinal disorders • Potential side effects of medications • Postradiation effects • Costochondritis (Tietze syndrome) • Trauma (including sexual abuse/assault)

How is mastodynia diagnosed?

• Possibly thyroid-stimulating hormone test • Prolactin test if galactorrhea is found • Papanicolaou test of discharge, if any present

How is mastodynia treated?

Complementary and Alternative Medicine Vitamin E and evening primrose oil has not been found to be of benefit for chronic mastalgia

What is the outlook for mastodynia?

• Premenstrual mastalgia increases with age, then generally stops at menopause unless patient is receiving hormone replacement therapy. • Most patients can control symptoms without receiving hormone treatment. • Several months of hormone treatment may provide several more months of relief, but mastalgia may recur. • Cyclic mastalgia responds better than noncyclic mastalgia to treatment. • Effects of long-term hormonal treatment are unknown. • If other treatment fails, a final possibility is subcutaneous mastectomy (used rarely). • Oophorectomy is drastic, but may also provide relief for some patients.

Guide

Mastodynia

Gerald Hurowitz, M.D.Published 12 January 20084 min read

Key points

Patient may need reduction mammoplasty if cause is macromastia.
Cyclical mastalgia: Prevalence and impact in an outpatient breast clinic sample.
Nonassociation of caffeine and fibrocystic breast disease.
Efficacy of topical nonsteroidal antiinflammatory drugs in mastalgia treatment.

• Painful breast tissue that can be cyclic and usually associated with hormonal changes related to menses, hormones, pregnancy, or menopause.
• Noncyclical pain can be constant or intermittent.
• Pain is often bilateral.
• System(s) Affected: Skin/Exocrine
• Synonym(s): Mastalgia, Breast pain

EPIDEMIOLOGY

Predominant age - Generally adolescence through menopause
Predominant sex - Most common in women, rarely men - May occur in adolescent males during puberty

Incidence

Most mild, but 11% report mild to severe pain

RISK FACTORS

Diet high in saturated fats
Cigarette smoking
Recent weight gain
Pregnancy
Large pendulous breasts (caused by stretching of Cooper's ligament)
Caffeine has not been shown to be a risk factor

Genetics

Familial tendency

ETIOLOGY

Hormonal influences (i.e., hormone replacement therapy, OCPs, pregnancy, menses, puberty, menopause)
Benign breast disorders (i.e., fibrocystic changes)
Lactation problems (engorgement, mastitis, breast abscess)
Extramammary tissue
Hidradenitis suppurativa
Breast masses, including breast cancer
Postthoracotomy syndrome
Spinal and paraspinal disorders
Potential side effects of medications
Postradiation effects
Costochondritis (Tietze syndrome)
Trauma (including sexual abuse/assault)

ASSOCIATED CONDITIONS

Premenstrual syndrome
Pregnancy

SIGNS AND SYMPTOMS

Breasts aching, heavy, or tender
Breasts enlarged

History

Duration, frequency, associated symptoms, related activities
Past medical history with focus on Gyn/OB history
Diet/smoking
Family history (especially of breast cancer)

Written and revised by

Gerald Hurowitz, M.D.

Our doctors write and review articles for accuracy and keep them up to date.

health.am provides general information, not medical advice. Always consult a qualified health professional about your own health.

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Mastodynia

Gerald Hurowitz, M.D.Published 12 January 20084 min read