Last updated: July 4, 2023

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Summarytoggle arrow icon

Mastalgia is defined as breast pain or discomfort. It is often caused by physiological changes (e.g., hormonal effects, lactation), but can also result from underlying disease (e.g., benign inflammatory breast conditions). Mastalgia is classified as cyclical (associated with menstrual cycles), noncyclical (not associated with menstrual cycles), or extramammary (originating outside of the breast, such as the chest wall). Imaging is required for all patients with an associated palpable breast mass. In patients without a palpable mass, cyclical mastalgia typically requires no further evaluation while breast imaging may be indicated in women with noncyclical mastalgia. Evaluation of extramammary pain depends on the suspected source of pain (e.g., musculoskeletal, pulmonary). Treatment commonly involves reassurance, analgesics, and management of the underlying etiology. In patients with severe or persistent pain, hormonal therapy (e.g., danazol, tamoxifen) may be considered under specialist guidance.

Epidemiologytoggle arrow icon

  • Peak age: 30–50 years of age [2]
  • Approx. 70% of women are affected during their lifetime. [2]

Epidemiological data refers to the US, unless otherwise specified.

Etiologytoggle arrow icon

Clinical featurestoggle arrow icon

Diagnosticstoggle arrow icon

Clinical assessment [3][4]

Examine the chest wall in all patients with mastalgia to evaluate for extramammary sources of pain. [3]

Imaging [4][5][6]

Palpable breast mass

No palpable breast mass

Imaging is indicated for all patients with mastalgia and a palpable breast mass. [3]

Treatmenttoggle arrow icon

Initial management [3][4]

  • Identify and treat the underlying etiology.
  • Nonpharmacological measures
    • Reassurance [3][4][7]
    • Use of a supportive, well-fitting bra
    • Adjust causative medications, if feasible. [3]
  • Analgesics

Management of moderate, severe, or refractory symptoms

Prognosistoggle arrow icon

Cyclical mastalgia [8]

  • Usually resolves spontaneously within 3 months of onset
  • Typically relapses and remits

Noncyclical mastalgia [8]

  • Resolves spontaneously in approx. 50% of patients
  • Usually responds poorly to treatment

Referencestoggle arrow icon

  1. Goyal A. Breast pain. BMJ clinical evidence. 2011; 2011.
  2. ACOG. Practice Bulletin No. 164 Diagnosis and management of benign breast disorders. Obstetrics & Gynecology. 2016; 127 (6): p.e141-e156.doi: 10.1097/aog.0000000000001482 . | Open in Read by QxMD
  3. Salzman B, Collins E, Hersh L. Common Breast Problems. Am Fam Physician. 2019; 99 (8): p.505-514.
  4. Holbrook AI, Moy L, Akin EA, et al. ACR Appropriateness Criteria Breast Pain. Journal of the American College of Radiology. 2018; 15 (11): p.S276-S282.doi: 10.1016/j.jacr.2018.09.014 . | Open in Read by QxMD
  5. Holbrook AI. Breast Pain, A Common Grievance: Guidance to Radiologists. AJR Am J Roentgenol. 2020; 214 (2): p.259-264.doi: 10.2214/ajr.19.21923 . | Open in Read by QxMD
  6. Lyman GH, Carrier M, Ay C, et al. American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer. Blood Adv. 2021; 5 (4): p.927-974.doi: 10.1182/bloodadvances.2020003442 . | Open in Read by QxMD
  7. Rosolowich V, Saettler E, Szuck B, BREAST DISEASE COMMITTEE.. Mastalgia.. Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC. 2006; 28 (1): p.49-57.doi: 10.1016/S1701-2163(16)32027-8 . | Open in Read by QxMD
  8. $Contributor Disclosures - Mastalgia. None of the individuals in control of the content for this article reported relevant financial relationships with ineligible companies. For details, please review our full conflict of interest (COI) policy:.

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