Chapter 5 – The Breast

Mastalgia and chest wall pain

Mastalgia or breast pain is a common normal finding which may cause significant discomfort and anxiety. Up to 70 per cent of women experience this symptom in their lifetime.(14, 15) 

Breast pain is not a common presenting symptom of breast cancer. It is important to differentiate between true breast pain and pain that is referred to the breast, such as from the chest wall or intra-thoracic structures, as management of these conditions is different. It is less important to differentiate cyclical mastalgia (pain that occurs only in the luteal phase of the menstrual cycle) from non-cyclical mastalgia, as management of these conditions is similar.(15)

The most common type of mastalgia is pain referred from the chest wall. The nerve supply to the breast is derived from branches of the intercostal nerves from T3 to T5 which if irritated, can lead to pain that is felt in the breast or nipple. In particular, irritation of a branch of T4 can result in the shooting pain up to the nipple that some women describe. Referred pain to the breast can also be caused by costochondritis, or tender costochondral junctions sometimes associated with swelling (Tietze’s syndrome).(16)

Features suggesting that breast pain is referred ... Buy now