Differential Diagnosis for Unilateral Breast Pain Post-Breast Reduction
Post-Surgical Causes
- Postsurgical pain may result from nerve regeneration, focal nerve injury due to ischemia, or scar pain, particularly if the surgeon cut across Langer lines of tension or if there was postoperative infection or hematoma, according to the American College of Radiology 1
Noncyclical Mastalgia
- Noncyclical breast pain accounts for 25% of breast pain cases, is typically unilateral and focal, and is predominantly inflammatory rather than hormonal in origin, as stated by the American College of Radiology and supported by guidelines from other medical societies 1, 2
- Noncyclical mastalgia has spontaneous resolution in up to 50% of patients and does not respond well to hormonal manipulation, according to the American College of Radiology 1
Extramammary Causes
- Costochondritis (Tietze syndrome) can cause referred pain to the breast and is reproducible with chest wall palpation, as noted in guidelines from medical societies 2, 3
Less Likely but Important Considerations
- Cyclical pain represents 70% of all breast pain cases but is typically bilateral or diffuse, waxing and waning with the menstrual cycle, according to medical guidelines 4, 2
- The risk of cancer in women presenting with breast pain as the only symptom ranges from 1.2-6.7%, and is extremely low with cyclical pain alone in the absence of other signs, as stated in guidelines from medical societies 4, 3
Clinical Approach Algorithm
- For focal, noncyclical breast pain in a 37-year-old, diagnostic mammogram with ultrasound is recommended to exclude underlying benign or malignant lesions, according to medical guidelines 4
- Given the post-surgical history and focal nature, imaging is warranted in this case, as recommended by the American College of Radiology 1