MASTALGIA

1. MASTALGIA DON PAUL MATHEW 2002 BATCH

2. BREASTPAIN MASTODYNIA SYNONYMS

3. INCIDENCE • Western societies mastalgia,is a common complaint affect up to 70% of women • Less common in asian cultures, affecting as few as 5%. • It is not unusual for women to have 2–3 days of mild breast pain premenstrually • Breast pain may be bilateral, may be in only one breast or part of one breast, • Pain radiate to the axilla and down the medial aspect of the upper arm. .

4. The affected breast is often extremely tender to touch and pain may be accompanied by swelling. • Although breast nodularity is sometimes associated with breast pain, it is a separate entity and should be assessed independently.

5. CLASSIFICATION • 3 components: cyclical noncyclical chest-wall pain

6. Classification and description of mastalgia Cyclical Pronounced pattern; Pain experienced around luteal phase of menstrual cycle; associated with ovulatory cycles; More common in pre-menopausal women; Often bilateral; in upper outer quadrant

7. often described as sharp, shooting, stabbing; heaviness, aching, deep tenderness, throbbing • Breast engorgement and tenderness • The intensity of pain can vary from mild to severe enough to limit clothing selections, sleep, positions, or hugging.

8. Non cyclical No pattern; no association with menstrual events; may be bilateral pain tends to be well-localized; often sub-areolar or medial; often described as heavy, aching, tender, fearful, burning, pulling, stabbing, pinching.

9. Chest wall pain • No pattern; • any age; • almost always unilateral; • consider costochondritis (Tietze’s syndrome),

10. ETIOLOGY • The etiology of mastalgia is not well understood. • hyperresponsiveness of prolactin to stimulation by thyrotropin-releasing hormone, • elevated levels or abnormalities of lipid metabolism.

11. It has been proposed that breast pain during the luteal phase of the menstrual cycle may be due to higher serum estrogen-to-progesterone ratio Which is due to • Decrease in progesterone

12. CAUSES • Breast injury • Normal female menstrual cycles • Premenstrual syndrome

13. Pregnancy- causes breast tenderness or breast aching • Start of menstruation - causes breast tenderness in adolescent girls.

14. Fibrocystic breast disease Estrogen therapy ANDI

15. BREAST CANCER SCLEROSING ADENOSIS DUCTAL ECTASIA

16. BREAST PAPILLOMA

17. Breast engorgement - from the start of lactation after childbirth • Breast abscess • Shingles (pain is only in 1 breast, usually accompanied by a rash)

18. Breast lipoma Chronic cystic mastitis Sporadic puerperal mastitis

19. Breast fat necrosis • Galactocoele

20. Neck injury Neck arthritis Cirrhosis of liver Chest wall pain Rib pain Pectoral muscle sprain Costochondral separation

21. . • DRUGS • digoxin • methyldopa • spironolactone • oxymetholone • chlorpromazine

22. Mondor's disease. Thrombophlebitis of the thoracoepigastric veiN • ANGINA

23. INVESTIGATION Pain chart Rule out malignancy and other causes by MAMMOGRAM ASPIRATION BIOPSY USG MAMMOTOME

24. Indication for taking treatment Breast pain is severe enough to interfere with your lifestyle when it occurs for more than a few days each month Before treatment is begun, document the frequency and severity of your pain for at least one to two menstrual cycles with the help of a PAIN DIARY TREATMENT

25. Noncyclicbreast pain is managed by treating the underlying cause. If a mass or lump is found, it is checked and treated. Chest wall tenderness is treated with anti-inflammatory medication or rarely by steroid injections. Cyclical breast pain Education and reassurance is an integral part of treatment

26. General management . Well-Fitting Support Bra individually fitted bra or a sports bra, 75–85% improvement in mastalgia was reported Avoidance of methylxantines ( caffeine , tea , coladrinks) Decrease fat intake Decrease salt intake Apply warm compresses to your breasts for pain relief .

27. Specific management • Topical non-steroidal anti-inflammatory drugs • potential for effective treatment of cyclical and noncyclical mastalgia - • diclofenac and piroxicam • Topical, non-steroidal anti-inflammatory gel, such as diclofenac 2% in pluronic lethicin organogel (PLO)

28. Evening Primrose Oil Long chain fatty acid g-linolenic acid (GLA) 3000 mg OD(oral) Side effects Soft stool, headaches ++

29. DANAZOL Decreases both oestrogen &prolactin secretion 200-400 mg bid in luteal phase of the cycle for 6 months Used only in severe conditions SE: Amenorrhea, menstrual irregularity, Weight gain, hirsutism, deepening voice, hot flashes, acne

30. antioestrogen 20 mg daily alleviate pain SE : Hot flashes, menstrual irregularity, nausea, bloating, vaginal dryness, rarely DVT, pulmonary embolus

31. Bromocriptine- Supresses prolactin secretion 2.5 mg bid for 3-6 months Se:nausea, dizziness, headache, postural hypotension, (rarely seizures, stroke ,hypertension)

32. GOSERELIN GnRH analogue 3.75 mg/month depot inj. I.M • DIURETICS

33. STOP Hormone Replacement Therapy (HRT) • Mild and temporary to severe and persistent breast tenderness can result from taking estrogen replacement • At Least a change in dose, formulation, or scheduling should be considered for women on HRT. • Progesterone agents as birthcontrol

34. FOLLOW UP • Follow-up care will vary depending on the cause of your breast pain, severity of symptoms, and treatment strategy. • Regular and routine mammograms are an excellent investment in your future well-being

35. BREAST SELF-EXAMINATION • Once you reach age 20, you should begin do it 7days after menustration • If passed menopause, do it the same time each month .

36. Premenstrual breast pain usually increases with age and then generally stops at menopause. Most women are able to control their symptoms without hormonal treatment. OUT LOOK..

37. THANKYOU