Differential Diagnosis for Breast Pain
- Single most likely diagnosis
- Cyclical mastalgia: This is the most likely diagnosis given the patient's symptoms of intermittent bilateral breast pain that worsens premenstrually and improves with the onset of menses. The pain is typically described as dull and aching, often affecting the upper outer quadrants of the breasts, which matches the patient's presentation.
- Other Likely diagnoses
- Fatty necrosis: Although less common, fatty necrosis could be considered, especially given the patient's recent weight gain. However, it typically presents with more localized pain and possibly a palpable mass, which is not described in this case.
- Breast cysts: These are common in women of reproductive age and can cause breast pain, but they are usually associated with palpable masses, which this patient does not have.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Breast cancer: Although the patient's presentation is not highly suggestive of cancer (e.g., no masses, skin changes, or nipple discharge), breast cancer must always be considered in the differential diagnosis for breast pain, especially if there's a change in the pattern of pain or if other risk factors are present.
- Inflammatory breast cancer: This rare and aggressive form of breast cancer can present with pain, swelling, and skin changes, but it is much less common and the patient's symptoms do not strongly suggest this diagnosis.
- Rare diagnoses
- Sclerosing adenosis: A benign condition that can cause breast pain, but it is less common and typically associated with more localized symptoms and possibly a palpable mass.
- Mondor's disease: A rare condition characterized by thrombophlebitis of the superficial veins of the breast, presenting with a painful, cord-like structure. It does not fit well with the patient's bilateral and cyclical symptoms.