Mastalgia is one of the most common breast-related complaints encountered in surgical practice. Although breast pain often raises concern regarding malignancy, the association between isolated mastalgia and breast cancer remains low. Mammary duct ectasia represents an important benign cause of non‑cyclical mastalgia characterized by dilatation of the major lactiferous ducts and periductal inflammation. Because its clinical manifestations may mimic periductal mastitis or it may mimic early carcinoma associated with duct papilloma,patients frequently undergo repeated imaging and unnecessary treatment. This review summarizes current evidence regarding epidemiology, pathophysiology, clinical presentation, diagnostic evaluation, and management of duct ectasia–related mastalgia and proposes a structured clinical management algorithm suitable for routine surgical practice.