Breast pain, or mastalgia, is a common complaint and often results from benign breast conditions rather than cancer. It can be cyclic or non-cyclic, unilateral or bilateral, and may present as dull, sharp, burning, or throbbing pain. Radiation to the back, arms, or neck may occur, and the pain may worsen with movement or physical contact.

Common Causes

• Hormonal fluctuations before menstruation or during pregnancy

• Superficial lesions (cuts, boils, contusions)

• Inflammatory lesions that irritate nerve endings

• Benign growths such as cysts or fat necrosis

• Tumors affecting nerve endings

• Gynecomastia in males, particularly during puberty or aging

History and Physical Examination

A detailed assessment should include:

Patient History

• Onset, duration, and pattern of pain (cyclic or constant)

• Menstrual and reproductive history

• Presence of nipple discharge, trauma, or infection

• Associated symptoms such as fever or flu-like illness

Physical Examination

• Inspect breasts for symmetry, redness, swelling, or skin changes

• Check for nipple retraction, inversion, or discharge

• Palpate for nodules, tenderness, or masses

• Assess axillary lymph nodes for enlargement

Medical Causes of Breast Pain

Areolar Gland Abscess

A tender mass on the areola’s edge, usually with fever.

Acute Breast Abscess

Characterized by localized pain, redness, warmth, and a nodule. Systemic signs include fever and chills.

Breast Cyst

A rapidly enlarging cyst may cause sudden, sharp pain with a palpable mass.

Fat Necrosis

Usually follows trauma; associated with pain, skin changes, and a hard mass that may mimic cancer.

Fibrocystic Breast Disease

Pain worsens before menstruation and may persist through the cycle. Often bilateral, especially in the upper outer breast quadrants.

Mammary Duct Ectasia

Burning pain, itching, and nipple discharge. May include retraction and peau d’orange.

Mastitis

Severe unilateral pain with redness and warmth, often with fever and systemic symptoms.

Infected Sebaceous Cyst

Presents with localized pain, redness, and a well-defined nodule.

Special Considerations

Emotional Support

Reassure the patient and explain benign nature in most cases.

Diagnostic Tests

Prepare for tests like mammography, ultrasound, nipple discharge cytology, or biopsy.

Patient Counseling

• Teach proper brassiere selection

• Demonstrate breast self-exam techniques

• Recommend warm or cold compresses for relief

• Emphasize monthly self-examination

Age-Specific Notes

Pediatric Pointers

Transient gynecomastia in adolescent boys can cause temporary breast pain.

Geriatric Pointers

Breast pain in older women is uncommon and may signal trauma or abuse. Sensory decline may reduce symptom reporting.

References

Gärtner R, Jensen MB, Nielsen J, et al. Prevalence of and factors associated with persistent pain following breast cancer surgery. JAMA. 2009;302:1985.Loftus LS, Laronga C. Evaluating patients with chronic pain after breast cancer surgery: The search for relief. JAMA. 2009;302:2034.