Q: Is breast pain a symptom of decompression sickness (DCS)?
A: Yes, breast pain can be a clinical manifestation of type 1 DCS, particularly in its cutaneous and lymphatic forms. It is essential to distinguish whether the discomfort is localized to the soft tissues of the breast or indicative of cardiac or musculoskeletal issues. Joint pain, skin changes, and lymphatic involvement typically indicate mild type 1 DCS. Cutaneous (skin) DCS tends to present in areas overlying adipose tissue, a specialized form of connective tissue that primarily provides energy storage and insulation. The abdomen, back, thighs, and breasts are the commonly affected regions.
The Role of the Lymphatic System in Diving Injuries
Lymphatic DCS arises in anatomical regions containing lymphatic tissue, which primarily influences immune function and fluid regulation. The breast contains an extensive network of lymphatic vessels and lymph nodes, making it susceptible to obstruction and inflammation from DCS. Lymphatic DCS can lead to swelling and discomfort involving the lymph nodes in the axillae (under the shoulder joint), groin, or behind the ears. Breast pain may be misinterpreted or overlooked, particularly if it is the diver’s sole complaint. Reports of breast pain describe symptoms ranging from localized tenderness and itching to sensations of engorgement resembling lactation. People may attribute these presentations to inflammatory changes and impaired lymphatic drainage.
Immediate Response and Treatment for Breast DCS
Responders should conduct a complete neurological exam and administer high-flow oxygen.
When breast pain is suspected to be a symptom of Type 1 DCS, DAN experts emphasize the necessity of a “complete neurological exam.” For many divers, this sounds like a complex hospital procedure, but in the field, it is a systematic check to ensure that bubbles aren’t affecting the central nervous system, which would upgrade the diagnosis to a more serious Type 2 DCS.
A proper field neuro exam assesses several key areas:
- Mental Status: Checking for disorientation, confusion, or memory loss.
- Cranial Nerves: Ensuring eye movements are smooth, facial sensations are symmetrical, and hearing is intact.
- Motor Strength: Testing the resistance and power of all muscle groups in the arms and legs to find subtle weaknesses.
- Sensory Perception: Testing for “numbness,” “tingling,” or a loss of sensation, particularly in the areas surrounding the breast tissue or torso.
- Coordination and Balance: Performing “finger-to-nose” tests or checking the diver’s gait (walking) to ensure the cerebellum is unaffected.
Because breast pain can be the “sole complaint” but still coexist with hidden neurological deficits, this exam is critical. Even if the symptoms seem localized to the skin or lymphatics, a hidden neurological issue changes the treatment priority.
For a more detailed breakdown of how these symptoms manifest, you can read more about neurological decompression sickness and why early detection is vital for recovery.
Anyone experiencing symptoms should seek medical attention and may require hyperbaric oxygen treatment. They should avoid diving for at least one to two weeks and only resume after their symptoms have completely resolved and they have received clearance from their physician.
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FAQs
Can breast pain be a symptom of decompression sickness (DCS)?
es, breast pain is a recognized clinical manifestation of Type 1 DCS, specifically within its cutaneous (skin) and lymphatic forms. It often affects areas with higher adipose (fatty) tissue.
What does breast pain from DCS feel like?
Divers have reported symptoms ranging from localised tenderness and itching to a sensation of engorgement or swelling, similar to the feeling of lactation.
Why does DCS affect the breasts?
The breasts contain significant adipose tissue and an extensive network of lymphatic vessels. Both tissues are susceptible to nitrogen bubble accumulation and lymphatic obstruction during decompression.
How is lymphatic DCS in the breast treated?
Initial treatment involves high-flow oxygen and a neurological exam. Definitive treatment often requires hyperbaric oxygen therapy (HBOT) administered by medical professionals.
When can I dive again after experiencing breast pain from DCS?
You should avoid diving for at least one to two weeks. Return to diving only after symptoms have completely resolved and you have received formal clearance from a diving physician.
This article was originally published in Scuba Diver Magazine
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