creation date: 2026-10-19 21:35
tags: Workups
Breast Tenderness
Background
Breast tenderness, or mastalgia, can be due to a number of conditions, but is most commonly associated with pregnancy/lactation and the menstrual cycle.
Pathophysiology
Differential Diagnosis
Cyclical (Menstrual Cycle Pattern)
Non-Cyclical
Pregnant / Postpartum
- Lactational Mastitis
- Erythema, tenderness, warmth, induration, systemic symptoms
- Treat: remove milk, NSAID/cold pack; Abx if not improved after 24 hrs
- Engorgement
- Bilateral (usually), firmness, swelling, improves with feeding
- Blocked duct
- Palpable lump, localized tenderness, mild erythema, no systemic, doesn’t drain with feeding
- Galactocele
- Masses near retroareolar that varies through day, not painful, decreases with milk expression
- Breast abscess
- Pus in tissue, mostly caused by S. aureus, breast pain, erythema, edema, purulent discharge from nipple, possible systemic, nausea
Initial Evaluation
History
Physical Exam
Investigations
If a mastitis presentation is not resolved with antibiotics, a breast cancer workup (imaging) is indicated.