Breast pain
Breast pain (Mastalgia)
Breast pain (mastalgia) is a unilateral or bilateral painful sensation in the breast in women. The symptom is accompanied by heaviness and swelling of the breast, discharge from the nipple. Mastalgia is caused by hormonal changes, inflammatory and infectious diseases, benign and malignant neoplasms of the breast. Ultrasound, radiography, invasive methods, laboratory tests are used to verify the cause of pain. To eliminate the pain syndrome, analgesics, hormonal drugs, physiotherapy are used.
Causes of breast pain
Large breast size
Sports training
Menstrual cycle
Pregnancy and lactation
Mastopathy
Mastitis
Diseases of the nipples
Injuries
Benign formations
Malignant tumors
Thoracic osteochondrosis
Complications of pharmacotherapy
Rare reasons
Diagnostics
Treatment
Help before diagnosis
Conservative therapy
Surgical treatment
Prices for treatment
Causes of breast pain
Large breast size
Women with breasts of 4 or more sizes experience heaviness and tenderness of the mammary glands by the end of the day. Unpleasant sensations occur with insufficient support of the chest, which is why it sags and creates an additional load on the spine. The pain is dull, non-intense, significantly reduced in a horizontal position. The symptom is accompanied by painful aching sensations in the scapular area.
The appearance of pain in the mammary glands is provoked by an incorrectly selected bra, which either does not hold the breast at all, or squeezes it too much. Patients complain of bursting pain of moderate intensity in the mammary glands, which are aggravated by accidental careless touching. If such signs are observed daily or the pain increases sharply, you should contact a specialist.
Sports training
Women who exercise intensively and pump their pectoral muscles often complain of pain in the projection of the mammary glands. Muscle pain is caused by the accumulation of lactic acid in the tissues and swelling of myofibrils after overexertion. Symptoms disappear on their own after rest. Prolonged sharp pain after training can be caused by pathological causes, therefore, in this case, a specialist’s consultation is needed.
Menstrual cycle
Hormonal causes contribute to the development of mastalgia before menstruation. A sharp decrease in the amount of estrogens provokes swelling and swelling of the breast tissue, dull pains of moderate intensity occur. Patients note increased breast sensitivity and increased soreness during touching, wearing a bra. In most cases, the symptom disappears 2-3 days after the onset of menstrual bleeding.
In some women, cyclic pain is also observed in the middle of the monthly cycle, which corresponds to ovulation. During this period, the mammary glands are being prepared for possible fertilization, the volume of secretory cells increases. Such changes are manifested by discomfort and a feeling of bursting, an increase in the size of the mammary glands. The increased or paroxysmal nature of cyclical pain indicates pathological causes that require medical attention.
Pregnancy and lactation
Starting from the first trimester of pregnancy, structural changes necessary for milk production occur in both mammary glands. This is accompanied by constant heaviness and pain, the chest seems to “fill up” and swell. The pain in the mammary glands is moderate, does not cause severe discomfort. As the birth approaches, several drops of yellowish liquid may be released from the nipple.
Normally, there is no pain during breastfeeding. Discomfort is associated with a violation of the interval between feedings, when a large amount of milk accumulates in the ducts and alveolar tissue, causing swelling and heaviness. Sharp local pain in the areolar region is caused by cracks in the nipple and erosions of the delicate skin, which are formed when the feeding technique is violated and when the first teeth of the child are eruption.
Mastopathy
Fibrocystic changes in glandular tissue are the most common pathological causes of the presence of painful sensations. With nodular mastopathy, the pain is localized in one mammary gland. The symptom is noted in the second phase of the menstrual cycle, when unilateral edema increases, and the breast increases in size. Painful sensations are aching, stabbing, often radiate into the shoulder or shoulder blade.
Diffuse mastopathy is characterized by excruciating bursting or stabbing pains that spread throughout the chest. Before menstruation, the breast swells, its tissue becomes dense, at the slightest touch, the pain syndrome increases. With the onset of bleeding, the soreness gradually subsides. Regular severe pain disrupts sleep and appetite, some patients have a fear of oncological pathology.
Mastitis
Infectious causes cause severe pain in the mammary gland in women, due to the purulent process and the accumulation of pathological inflammatory mediators that irritate the nerve endings. Pain in purulent mastitis is sharp, twitching, unbearable. They worsen in an upright position and subside slightly with an elevated position of the breast. A fetid yellow-green liquid is released from the nipples.
Due to severe pain, patients stop sleeping, the condition worsens due to high fever and intoxication. With non-purulent mastitis, soreness is less pronounced, constant dull pains are felt in the chest against the background of an increase in body temperature to 38.5 ° C. Discomfort increases when squeezing the areola area, touching the affected part of the breast. Such symptoms are an indication for emergency medical care.
In advanced situations, purulent inflammation turns into an abscess of the breast, as evidenced by increased and clearer localization of pain in one area. The skin above this place turns red or purple, touching causes sharp soreness. There is usually no discharge from the nipple. Against the background of the pain syndrome, a high fever occurs, sometimes of the hectic type.
Diseases of the nipples
With eczema of the nipples, itching and discomfort initially appear in the areolar region (darker skin surrounding the nipple), and after a few days polymorphic rashes form, combined with sharp pain. Then the bubbles turn into erosions and small ulcers, while there is an increase in pain syndrome. As he recovers, the soreness gradually subsides and is replaced by intense itching, mainly at night.
Pain in the mammary gland on the side of the lesion is characteristic of inflammation of the nipple of bacterial and viral causes. The symptoms are localized in the area of the areola, sometimes the pathological process spreads to the surrounding breast tissue. When pressing on the nipple, a purulent or bloody secret is released. The disease requires examination by a specialist, because without treatment there is a risk of massive purulent inflammation or sepsis.
Injuries
When hitting the chest area, a sharp severe pain initially occurs, which lasts from hours to several days, depending on the degree of bruising of the breast. In uncomplicated cases, a bruise forms on the skin, and the glandular parenchyma remains intact. With strong blows, the pain syndrome lasts for a week or more, bloody fluid is released from the nipple.
Pain in the mammary glands occurs not only with direct mechanical influences, but also when wearing a tight bra. Prolonged traumatic compression of the chest leads to microcirculation disorders, which is manifested by bursting painful sensations and heaviness. Symptoms worsen in the evening, when there is pronounced swelling and hypersensitivity of the gland skin.
Benign formations
In the initial stages of adenoma and breast cysts, pain does not always bother. The discomfort and heaviness that are observed before menstruation are characteristic. As the formation increases in size and hormonal disorders, a constant pain syndrome develops, the breast thickens and swells. Sometimes the patient independently finds a dense node in the mammary gland, with palpation of which the pain becomes stronger.
Unpleasant sensations remain the only symptom of the disease for a long time, then the pain is joined by the periodic release of a transparent or whitish secretion from the nipple. With intra-flow papilloma, soreness is accompanied by the expiration of a thick greenish secretion that occurs when the contents stagnate in the milky tubules. With lipoma, there is a slight soreness in the area of volumetric education.
Malignant tumors
In the advanced stages of breast cancer, tumor causes cause severe excruciating pain, leading to neurasthenia, insomnia. But at the beginning, nonspecific symptoms prevail in the form of discomfort and soreness, heaviness in the chest in the late afternoon. These manifestations are similar for many diseases, so it is important to observe oncological alertness.
With an independent examination of the breast, the patient discovers the formation of an irregular shape and dense consistency, which does not shift in relation to the skin, it hurts very much. In this area, typical changes of the skin are formed: “lemon peel”, retraction of the skin area. Sometimes the pain spreads to the area of the armpits, which indicates the involvement of lymph nodes in the process.
Thoracic osteochondrosis
Degenerative changes in the connective tissue of vertebral cartilage lead to damage to nerve fibers. The pain that occurs with thoracic osteochondrosis is localized not only in the back, but also on the front surface of the chest in the breast area. The pain is strong, paroxysmal, usually aggravated by sharp turns and tilts of the trunk.
This disease is sometimes a provoking factor in the development of intercostal neuralgia, which is characterized by stabbing or burning pains in the ribs and mammary glands. The soreness is localized on the anterolateral side of the chest, it increases with careless touching and squeezing with tight clothes. Pain often radiates in the area of the shoulder blades and collarbones.
Complications of pharmacotherapy
Mastalgia is mainly associated with the use of female sex hormone preparations. Symptoms occur at the stage of selection of oral contraceptives, when prescribing estrogen derivatives during menopause. The pains in the mammary glands are mild, in nature they resemble soreness in the premenstrual period. The symptom is provoked by other medicinal causes: taking neuroleptics, antidepressants, tranquilizers.
Rare reasons
Iatrogenic conditions: the first days after abortion, operations in the anterior chest wall.
Placement of breast implants.
Intercostal myalgia.
Endocrine diseases: pathology of the pituitary gland, thyroid gland, adrenal glands.
Tuberculosis of the breast.
Diagnostics
The mammologist is engaged in establishing the cause of the development of pain in the mammary glands, if necessary, the doctor attracts other specialists for consultation. A comprehensive laboratory and instrumental approach allows you to examine in detail not only the breast, but also the endocrine system, musculoskeletal system. The most informative are such studies as:
Ultrasound examination. Ultrasound of the breast is shown to young women, because the glandular parenchyma of the breast is denser and is better visualized using sonography. Limited rounded formations or diffuse changes are detected, which are associated with the appearance of pain in the mammary gland. The detection of a cavity with thick walls and hypoechoic contents indicates the presence of an abscess.
Mammography. X-ray is used as a screening method in women over 40 years old, and in young patients it is used to clarify the localization and size of the neoplasm. Mammography allows you to study the contours and internal structure of the tumor, common nonspecific structural changes prevail in inflammatory processes.
Radiography. An X-ray of the spine is carried out to assess the condition of the vertebrae, to identify pathological displacements or deformities. If osteochondrosis is suspected, the method is supplemented with tomography (CT or MRI), which well visualizes intercostal discs and cartilage tissue. Overview radiography of the OGC is required to search for tumor metastases.
Biopsy. Severe pain in the mammary gland and the detection of neoplasms by instrumental methods serves as the basis for a fine needle biopsy under ultrasound control. For greater informativeness, a thick-needle trepanobiopsy is performed. The resulting material is sent for histological and cytochemical examination.
Laboratory tests. General and biochemical blood tests can detect changes in the number of white blood cells and an increase in the ESR index. A specific diagnostic method is the determination of cancer markers and autoantibodies in the blood. To verify the bacterial cause of the disease, seeding of the discharge from the gland is done on selective nutrient media.
Additional methods. If pain in the mammary gland can be caused by intercostal neuralgia, electroneurography is recommended. The study helps to study the excitability of nerve fibers and the rate of transmission of impulses. Be sure to examine the female hormonal profile on different days of the menstrual cycle.
Breast examination by a mammologist
Breast examination by a mammologist
Treatment
Help before diagnosis
Minor soreness in the mammary glands, due to hormonal causes and the approach of the menstrual cycle, is not dangerous. To reduce discomfort, it is recommended to choose a larger bra with good breast support, which will not compress the gland tissue and aggravate the symptoms. With pronounced puffiness, 3-4 days before menstruation, it is necessary to limit the consumption of spicy and salty food.
To prevent pain in the breast area associated with the development of lactation mastitis, it is important to observe the rules of personal hygiene after each feeding, to prevent stagnation of milk. It is advisable to use special underwear for nursing from natural materials. Prolonged pain, accompanied by general malaise, indicate the presence of a pathological cause. It is necessary to consult a doctor and find out why the symptom occurred.
Conservative therapy
Medical tactics depend on the etiological factor of pain in the mammary gland. Etiotropic and pathogenetic drugs are mainly prescribed to eliminate the causes of pain syndrome and promote rapid recovery. Medications are combined with physiotherapeutic effects (electrophoresis, compresses), which are used only after the exclusion of tumor pathology. Most often , the pain treatment regimen includes:
Analgesics. The remedies are indicated for severe pain in the mammary glands, which disrupts sleep, appetite, causes asthenic symptoms. In typical cases, nonsteroidal anti-inflammatory drugs are used, effectively reducing the level of inflammatory mediators, reducing swelling.
Antibiotics. With bacterial infection, broad-spectrum drugs are needed that act on the typical infectious causes of mastitis. Medications are selected taking into account the results of back-sowing and a test for sensitivity to antibiotics, course therapy lasts at least 7 days.
Hormones. If severe pain in the mammary glands causes hormonal causes in the premenstrual period, estrogenic drugs are recommended. Funds are also needed in the treatment of benign breast formations, mastopathy.
Infusion solutions. Tumor and inflammatory causes are accompanied by severe intoxication, for the elimination of which intravenous infusions of colloidal and crystalloid solutions are carried out in combination with loop diuretics.
Cytostatics. Combinations of 2-3 chemotherapy drugs are prescribed for malignant neoplasms of the nipple and gland. Medicines are taken in courses, for the best effect they are supplemented with local radiation effects.
Restorative. With chronic pain in the mammary glands, the body is depleted, so ascorbic acid and vitamins of group B are used. With severe asthenia, anabolic steroid drugs are indicated.
Surgical treatment
Breast cancer is an absolute indication for surgical intervention. In rare cases, at the initial stage of the process, a sectoral breast resection is performed. In most situations, a radical mastectomy with the removal of regional lymph nodes is necessary. Sometimes, with an unstable hormonal background and a high risk of malignancy, a benign tumor is removed.
To reduce pain in the mammary gland with purulent inflammation, an autopsy and drainage of mastitis is indicated, providing for an incision of the skin at the site of fluctuation and rinsing the cavity with an antiseptic solution, followed by the installation of drainage. With a gangrenous form of mastitis, removal of the entire breast is required with further plastic surgery. Large hematomas formed after chest injuries are opened to prevent suppuration.
