title: Mastodynia refractory to medical therapy: is there a role for mastectomy and breast reconstruction?
abstract: BACKGROUND
  Mastodynia is among the most frequently reported symptoms in women with breast complaints; it is usually classified as cyclic, noncyclic, or nonbreast in origin. A useful response with medical or conservative therapy is obtained in the majority of these patients. There is a subset of patients, however, who have exhausted every medical effort and psychiatric counseling and will desire mastectomy with breast reconstruction in the hope of alleviating their chronic pain.
  
  
  METHODS
  Three patients with noncyclical, bilateral mastodynia referred for breast reconstruction options from December of 2000 to March of 2004 are presented in this article. Daily breast pain charts with a visual analogue scale for pain assessment were analyzed and recorded for all patients throughout the study period.
  
  
  RESULTS
  Two patients underwent delayed reconstruction and had complete resolution of pain 6 to 8 weeks after bilateral mastectomy, with no recurrence of mastalgia after reconstruction. One patient underwent bilateral mastectomy with immediate reconstruction and achieved complete resolution of her pain 3 months postoperatively. Histopathologic findings of all breast specimens revealed benign breast tissue with proliferative breast disease consistent with mastodynia.
  
  
  CONCLUSIONS
  This modality, which includes mastectomy with or without reconstruction, is a viable alternative after exhaustion of all other nonsurgical options and when quality of life is significantly affected. Although mastectomy for the treatment of mastodynia refractory to medical therapy does not guarantee alleviation of chronic breast pain, it should be considered in these often desperate patients.
authors.affiliation: Department of Surgery, William Beaumont Army Medical Center, El Paso, Texas, USA. salgado_plastics@hotmail.com
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Salgado
authors.forename: Samir
authors.initials: S
authors.lastname: Mardini
authors.forename: Hung-Chi
authors.initials: HC
authors.lastname: Chen
mesh_terms: D000328:Adult; D001941:Breast Diseases / Q000601:surgery*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D016462:Mammaplasty; D008408:Mastectomy; D008875:Middle Aged; D010146:Pain / Q000601:surgery*; D011788:Quality of Life; D012189:Retrospective Studies