1. Solving the Mysteries of
Breast Pain
March 30, 2016

2. Mastalgia Definition: pain related to one or both breasts
-tenderness and fullness
-constant or sporadic
-burning or stabbing
-related to certain activities
-cyclic or non- cyclic

3. Breast Pain to Report to a Healthcare Provider
Pain persistent ( more than several weeks)
Pain that is sudden and severe
Pain in only one breast
Pain with a lump in the same breast
Pain associated with redness and warmth
Pain in a breast with change in skin texture
Pain with discharge from one breast
Pain associated with large amount of discharge not associated with pregnancy or nursing

4. Healthcare Provider’s Clinical Exam will Include:
Personal Hx of any previous illness or disease
Person hormonal Hx, age of onset of menses
Present hormonal status; pre or peri or post
Medication Hx BCP’s, HRT, OTC, supplements
Personal of Fam Hx of cancer: breast, ovarian
Clinical breast exam
MMG or US to evaluate, if problem refer

5. Cyclic Pain Pain occurs in both breast
Pain begins the week before onset of menses
Pain that increases until menses begin
Pain relieved by menstruation
Pain described as dull, aching with fullness
Pain may radiate to axilla and down arm
Pain in the pre menopausal women
Pain relieved at menopause unless using HRT

6. Keep a record! scale 0-10 CONTRIBUTING FACTORS; Caffeine; limit it!
High fat diet, encourage more fiber, lower fat
Increase exercise and healthy lifestyle
Proper fitting bra
Don’t sleep in it!
Hot and cold packs
Dietary Supplements: Vit E, Evening Primrose Oil
Natural progesterone or Beta carotene

7. Lymphatic Congestion
By far, a primary factor in almost any mastalgia pt
Encourage proper fitting bra
Instructional Video of lymphatic massage technique, easy to learn and do
Helps pt get to know breast tissue as well
Provides symptomatic relief consistently

8. Prescription Medications
BCP’s
Progesterone
Testosterone
Danazol (decreases hormonal fluctuation)
LHRH Agonist Injections (Lupron)
Thyroid Hormone Medication
Tamoxifen
Bromocriptine (Paroled) prolactin blocker

9. Remember: Cyclic pain is related to hormone fluctuation
Cyclic pain is not related to cancer
It’s a normal, most women experience it!
Monitoring it will identify it’s pattern
Diet and supplements can help
Wearing a well fitting bra can help
Severe cyclic pain can be addressed with Rx but non-aggressive interventions should be tried first

10. Non Cyclic Pain May be continuous, or only occur from time to time
Usually localized to a specific area or “trigger zone”
Described as sharp, stabbing, or burning sensation
Pain often replicated by movement or applying pressure to a specific area

11. Noncyclic Causes of Breast Pain
Benign Breast Disease/Conditions
Mastitis
Breast Abscess
Cellulitis
Mammary Duct Ectasia; inflammation or infection in and around milk ducts, frequently in smokers
Hematoma
Breast cysts
Fibroadenoma
Galactocele

12. Other causes of Noncyclic Pain
Chest Wall Conditions
Mondor’s; inflammation of a breast vein
Shingles
Musculoskeletal Conditions
Pinched Nerve
Degenerative conditions or injury
Chostochondritis or Tietze’s Syndrome

13. Clinical Factors Indicating Risk for Possible Cancer
Lump or increased thickness in one breast
Nipple discharge from the same breast
Nipple or breast retraction
Skin Thickening, Peau d’orange, color changes
Scaly appearance of the nipple, pruritis, (Paget’s dz)
Redness or inflammatory condition, may mimic abscess or mastitis
Chronic irritation of one nipple
Sensation of “pulling” in the breast

14. Remember:
Non cyclic pain has no pattern, not related to menses, can be chronic or sporadic
Variety of causes: must r/o infection, abscess, injury, chest wall conditions, lymphatic congestion (MOST COMMON)
Usually occurs has a “trigger point”
Physiologic conditions: hypothyroid, galactorrhea can cause pain
Pain with cancer is RARE, but all pain should be evaluated to r/o the possibility of cancer/