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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.
- Peak age: 30–50 years of age 
- Approx. 70% of women are affected during their lifetime. 
Epidemiological data refers to the US, unless otherwise specified.
- Cyclical mastalgia: primary breast pain associated with the menstrual cycle
- Noncyclical mastalgia: primary breast pain not associated with the menstrual cycle
- Extramammary pain: secondary breast pain referred from extramammary locations
- Cyclical mastalgia 
- Noncyclical mastalgia 
- Extramammary pain: depends on the underlying condition
Clinical assessment 
- Patient history
- Focused physical examination
- Imaging is indicated for all patients.
- See “Palpable breast mass” for details.
- Cyclical mastalgia: no imaging necessary (regardless of age)
- Focal noncyclical mastalgia
- Nonfocal or diffuse noncyclical mastalgia
Imaging is indicated for all patients with mastalgia and a palpable breast mass. 
Initial management 
- Identify and treat the underlying etiology.
- Reassurance 
- Use of a supportive, well-fitting bra
- Adjust causative medications, if feasible.