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Pain of the Breast “mammary glands” (Mastodynia, mastalgia)

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Chronic, frequent, cyclic or sporadic pain in the mammary glands is a very common and familiar phenomenon, apparently, to every woman.

 

Obviously, “just pain” in any organ cannot be considered a disease. Pain is always an alarm signal, it is a message that comes to the brain that there are problems or dangers in this part of the body. Any pain, even the so-called. phantom (occurring, for example, “in the palm” after amputation of the entire arm), has its own psychophysiological causes, and in most cases these causes are pathological.

Chronic, frequent, cyclic or sporadic pain in the mammary glands is a very common and familiar phenomenon, apparently, to every woman. In some cases (for example, with gynecomastia) men also face it. Pain in the mammary gland is called mastodynia or mastalgia (these terms are equivalent, but the first of them is used in the International Classification of Diseases). Mastodynia, therefore, is not a disease, but a syndrome, i.e. a holistic and diagnostically recognizable set of symptoms, which can be due to a variety of reasons, but in any case requires consultation with a mammologist-gynecologist. Often, mastodynia not only reduces the quality of life, affecting the psychological state of a woman and disrupting her social functioning, but also indicates the presence of very serious health problems.

The reasons

Factors that cause the occurrence of mastalgic syndrome can be divided into two large groups. The first covers physiological, transient, conditionally normal pain in the mammary glands. The most common of these causes are fluctuations in hormonal balance during certain periods of a woman’s life (puberty, menopause, pregnancy or its artificial termination, premenstrual syndrome). In particular, pain in the mammary glands during PMS is noted by up to half of menstruating women.

Sometimes mastodynia is one of the manifestations of a neurotic disorder (in particular, hysterical or hypochondriacal) or a consequence of the irradiation of pain along the conduction nerves from an extramammary pathological focus (for example, in cardiovascular, vertebrological, neurological, pulmonological diseases), i.e. in this case, the pain is not associated with any pathology in the gland itself. In addition, transient and non-pathological mastodynia may be due to wearing too tight underwear or clothing that does not match the size of the chest.

Other common causes of mastodynia include injuries and bruises of the mammary glands, taking hormone-containing or diuretic drugs, kidney and liver diseases, metabolic disorders (especially if lipid metabolism is disturbed), plastic and other surgical operations on the glands, and nipple piercing.

Finally, the cause of mastodynia may be a pathological process or a pathological condition of the mammary gland: inflammation of various etiologies ( mastitis ), hyperplastic growths of certain tissues in mastopathy ), benign tumors (eg, fibroadenoma) or breast cancer . By itself, such a possibility creates the need to at least consult a doctor, especially if the pain becomes more frequent or progresses in severity.

Symptoms

There are cyclic (periodic, repetitive) and non-cyclic mastodynia.

Cyclic pains are more inherent in aching, pulling, choking nature, described by many patients not even as pain, but as uncomfortable, interfering sensations. Swelling of the breast and hyperesthesia of the nipples (increased tactile sensitivity) are quite typical in this case.

Non-cyclic pains vary widely both in intensity – from slight to very strong, in which even touching the gland is unbearable – and in character (from dull to shooting, throbbing, sharp, etc.). Such mastodynia occurs, as a rule, in one of the glands and is often accompanied by additional symptoms, such as local hyperemia (reddening of the skin), discharge from the nipple, the presence of painful seals when palpated, etc. As the name implies, non-cyclic pain is not associated with the menstrual cycle.

 

Diagnostics

First of all, a detailed collection of complaints and anamnesis is performed, as well as an external examination and palpation of the glands (required both). Such anamnestic data as age, the number of onset and end-of-term pregnancies, successful births, spontaneous and induced abortions are of diagnostic value; regularity of the cycle and sexual life; the presence of acute or chronic diseases in the reproductive and other systems of the body.

Routine general clinical tests are prescribed, with a high probability it may be necessary to study the hormonal blood picture.

Of the instrumental diagnostic methods, X-ray contrast mammography, ultrasound of the mammary glands, and in some cases MRI or CT are the most informative.

At the slightest suspicion of a malignant neoplastic process, a biopsy is performed – these days, as a rule, it is a fine-angle aspiration biopsy (TAB) under ultrasound guidance – followed by a histological analysis of the biopsy specimen.

Treatment

It is easy to see that the paragraph “Treatment” in this material is, by and large, nonsense. Of course, the therapeutic strategy and tactics in each particular case are determined by the diagnostic results and many individual factors: someone needs long-term combined treatment, including expensive high-tech methods and powerful drugs, and someone may not need treatment at all.

However, it should be emphasized once again: pain in the mammary gland, of any nature, intensity, frequency, cannot be ignored. If your chest hurts, go to see a doctor.

 

 

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