Breast Pain (mastodynia)

Breast pain is one of the most common symptoms and most frequent reason for breast-related consultations. Breast pain is not a typical symptom of breast cancer, but it does not exclude the diagnosis; therefore, testing and clinical exam are the initial management for breast pain.

The patterns of breast pain are cyclical or non-cyclical. Cyclical pain is related to the menstrual cycle. Premenstrual tenderness or heaviness lasting 2-3 days is considered normal.

Pronounced pain is when the duration lasts more than one week. Characteristics of severe pain are loss of sleep or alteration of a normal lifestyle. Non-cyclical breast pain has no relationship with the menstrual cycle.

Possible contributing factors to breast pain include hormone changes, water retention, caffeine intake, abnormal prostaglandin synthesis, and an emotional component. The emotional component associated with breast pain is the condition called fibrocystic disease. It can simply be described as palpable lumps in the breast, usually associated with pain and tenderness that fluctuates with the menstrual cycle.

The treatment of breast pain should be based on the severity of the symptoms. The management will not alter the breast tissue but may minimize the level of pain. It is recommended that you keep a diary for evaluation of the severity and successful treatment of your breast pain.

The management of breast pain begins with a complete history and exam. A normal exam can be very reassuring and can by itself relieve some of the breast discomfort. Wearing a sport bra at night and avoiding an under-wire bra may improve your symptoms.

Evening Primrose Oil is a natural agent. It is potentially useful in mild to moderate cases and has virtually no side effects. The initial dose is one tablet daily, but may be increased to one tablet twice a day.

Over the counter non-steroidal/anti-inflammatory agents such as Motrin and Advil have been successful in the treatment of breast pain. There has been some evidence that a low fat, high fiber diet, along with supplements of Vitamins A, C and E, in addition to decreasing caffeine, have had encouraging results. As a last resort to refractory breast pain, prescription medication or surgical excision may be considered.

In summary, breast pain is a very common complaint that needs clinical evaluation to exclude a serious pathology. Once the breast pain is determined benign, there are many treatment options to minimize the symptoms. Keeping a diary will help determine the pattern and successful management of the pain. It will be beneficial to provide us with this information at the time of your follow-up.

Twice voted a Top Doc in the Detroit Metro area, the author is a breast cancer surgeon at Comprehensive Breast Care, as well as Director Oncology Services, Troy, MI and Director, Center For Breast Health, Troy Beaumont Hospitals.