Non-cyclical mastalgia

Specialty: Gynecology and breast.

• Constant breast pain
• breast pain not related to the cycle
• persistent idiopathic mastalgia
• continuous unilateral breast pain

Why it occurs

• Ductal ectasia
• Simple tension breast cyst or inflamed cyst
• Previous trauma, hematoma or lobular fat necrosis
• Subacute or chronic non-infectious mastitis
• Referred chest wall pain (Tietze syndrome, costochondritis, cervical radiculopathy or previous intercostal shingles)
• Infiltrating ductal or lobular adenocarcinoma (rare cause but must be ruled out)

Initial workup

Bilateral diagnostic mammography as an initial examination in patients over 35 years of age, systematically associated with a high-resolution breast ultrasound focused on the painful point. Breast MRI with gadolinium in case of clinical-radiological discordance. Core needle biopsy (CNB) if any nodules, architectural distortion, or suspicious microcalcifications are detected (BI-RADS classification 4 or 5).

Standard management

• Ibuprofen 400-600 mg orally every 8 hours for a maximum of 5-7 consecutive days during pain crises
• Naproxen 250-500 mg orally every 12 hours with gastric protector if the regimen is prolonged
• Paracetamol 500-1000 mg orally every 8 hours if anti-inflammatories are contraindicated
• Local infiltration of the chest wall with 1% lidocaine associated with triamcinolone 40 mg if costochondral or chest wall origin is confirmed (note: performed by qualified personnel to avoid pneumothorax).