From the Guidelines
Mastalgia, or breast pain, is a common symptom experienced by up to 80% of women at some point in their lives, and it is likely that women with macromastia are among those who experience this symptom due to the weight and size of their breast tissue. This discomfort typically occurs due to stretching of Cooper's ligaments (supportive breast tissue), pressure on nerves, or strain on surrounding muscles, particularly in the chest wall and shoulders 1. Women with larger breasts frequently experience this pain during physical activity, before menstruation, or after long periods of standing or sitting.
Some key points to consider in managing mastalgia in women with macromastia include:
- Wearing a properly fitted supportive bra is essential, particularly one with wide straps and full coverage, to help reduce strain on the chest wall and shoulders.
- Over-the-counter pain relievers like ibuprofen (400-600mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours) can help reduce inflammation and pain.
- Heat or cold therapy applied to the painful area for 15-20 minutes may also provide relief.
- For persistent or severe pain, consulting a healthcare provider is recommended as they might suggest physical therapy exercises to strengthen supporting muscles or discuss whether breast reduction surgery could be beneficial in some cases.
It's worth noting that while mastalgia is common, the association with malignancy is very low (0%-3.0%) in the absence of any accompanying suspicious clinical findings, such as a lump or nipple discharge 2. However, if the pain is focal and noncyclical, imaging with mammography, digital breast tomosynthesis (DBT), and ultrasound may be appropriate, depending on the patient’s age, as outlined in the American College of Radiology Appropriateness Criteria 3.
From the Research
Mastalgia in Women with Macromastia
- Mastalgia, or breast pain, is a common symptom experienced by women of all ages, and it can significantly impact quality of life 4, 5.
- Women with large and hypertrophic breast sizes report an increased prevalence and severity of musculoskeletal pain in the upper torso, including breast pain 6.
- The study found that women with hypertrophic breasts reported significantly higher total upper torso musculoskeletal pain scores compared to women with smaller breast sizes, and this was significant for the upper back, shoulders, neck, and breasts 6.
- Over two-thirds of women will experience breast pain in their lifetime, and it is suspected to be underreported and under-studied 5.
- Breast pain can be cyclical or non-cyclical, and its management depends on the type and severity of pain, as well as the presence of any underlying conditions 4, 5, 7.
Relationship Between Breast Size and Mastalgia
- Research has shown that breast size is a contributing factor to the development of musculoskeletal pain, including breast pain, in women 6.
- Women with larger breast sizes are more likely to experience breast pain due to the increased weight and strain on the breast tissue and surrounding muscles 6.
- The threshold at which breast size becomes problematic in terms of musculoskeletal pain is currently unknown, but it is believed that breast volumes greater than 1200 ml are associated with significant musculoskeletal pain 6.
Management of Mastalgia in Women with Macromastia
- Management of breast pain in women with macromastia depends on the severity and type of pain, as well as the presence of any underlying conditions 4, 5, 7.
- Conservative measures, such as non-pharmacologic strategies and topical nonsteroidal anti-inflammatory drugs, can be effective in reducing breast pain 4, 5, 7.
- In some cases, surgical treatment, such as breast reduction surgery, may be considered for women with severe and debilitating breast pain 7.