I Have Breast Pain – What Should I Do?

Breast pain (especially dull, aching, itching, or sharp), soreness, discomfort, and tenderness are common complaints, however, not likely related to a serious concern. Doctors call it mastalgia. Most women have breast pain at one time or another, often more in one breast than the other. Sometimes the pain is only in one breast or in only one area of one breast. It is important to talk to your doctor about your concerns.

Your healthcare professional can help you determine the cause of your breast pain and whether you require treatment.

Here are some frequent questions from our patients at Elizabeth Wende Breast Care about breast pain:

Why do I often feel discomfort around my menstrual cycle, and will it eventually go away?

Most women feel some breast discomfort during their menstrual cycle. Hormonal fluctuations are making your breasts painful and are the number 1 reason for breast pain. It is normal to have breast tenderness that comes and goes around the time of your period. This is because the hormones (estrogen and progesterone) stimulate the glandular breast tissue. This may cause a small fluid accumulation in the tissue and can cause the breast tissue to be lumpier and more uncomfortable or even painful. Irregular periods are commonly associated with breast pain and swelling.

Breast pain can happen at various times in your life including puberty, around your monthly cycle, pregnancy, perimenopause, and menopause. Even some hormone medications can cause breast pain.

What questions will my doctor ask me about the pain?

  • What does the pain feel like?
  • How long have you had this pain?
  • How bad is the pain and what does it feel like (is it sharp, fullness of breasts, tenderness, etc.)?
  • Does it come and go?
  • Do you notice the pain as a pattern related to your period or menopause?
  • How much caffeine do you drink daily?
  • Are you under stress?
  • Could it be related to trauma (chest or muscle injury, seat belt injury)?
  • Do you have any redness, swelling, or visible changes to your breast or nipple?

I’m pregnant and my breasts hurt, why is that?

If you become pregnant, your breasts may remain painful usually during the first trimester as hormone production ramps up. Breast tenderness is one of the earliest signs of pregnancy for many women.

I am breastfeeding and it is causing breast tenderness. Why?

Breastfeeding can sometimes be the source of breast pain. Some of the things you can experience while nursing include:

  • Painful nipples from an improper latch (the way a baby latches on to suck)
  • Discomfort from a blocked milk duct
  • The tingling sensation during letdown (when the milk starts to flow to the baby)
  • Nipple soreness due to being bitten or having dry, cracked skin or an infection

If you have pain while breastfeeding, it is best to talk to your doctor or a lactation consultant. They can help you troubleshoot the problem while maintaining your milk supply.

Breastfeeding women are most likely to get breast infections (mastitis), but infections occasionally may occur in all women. If you have a breast infection, you may have a fever and symptoms in one breast, including redness and swelling. A breast infection will need to be evaluated by a doctor and treated right away (usually with antibiotics).

My breast pain does not have anything to do with my period—what could be causing it and how would I know if it is normal?

There are lots and lots of reasons for breast pain besides hormones (although it is the most common cause). Pain may come from the breast, or it could come from muscles or joints close to the breast and felt in the breast. It usually but not always involves just one breast. A poor-fitting bra, trauma to the chest wall (getting hit in the chest), arthritis, a side effect of certain medications, and psychiatric drugs sometimes cause breast pain.

What feels like breast pain may actually be coming from your chest wall. Muscle strain, a pulled muscle, inflammation around the ribs, or a bone fracture could be a reason for the pain. Women may suffer from arthritis or costochondritis (inflammation between the rib and breastbone), and this may appear to be breast-related pain.

When should I consult my primary care physician or OBGYN?

It is important to talk to your doctor about your concerns! A lump, breast pain that is new or different, or other breast changes should always be discussed with your doctor. Depending on your symptoms, your medical provider may suggest additional tests, such as a mammogram, breast biopsy, or other ways to determine the cause of the pain.

Talk to your doctor if you are worried if the pain does not improve or you notice any of these signs:

  • Your doctor will want to know more about the pain for further evaluation
  • You have a lump (painful or not)
  • You have redness, swelling, or drainage from the area (signs of infection)
  • You have nipple discharge
  • Your breast pan is not clearly associated with your menstrual cycle or lasts more than two weeks
  • Your breast pain is just in one spot and does not involve the whole breast
  • Your breast pain keeps getting worse
  • The pain is affecting your life and limiting what you can do
  • Any new breast symptoms
  • Pain that might be related to implants
  • Bruise that doesn’t go away

What will my doctor do?

Your doctor may order a mammogram. A breast radiologist will look at your imaging and determine if you need any additional pictures or breast ultrasound. If you are younger than 40, lactating, or pregnant, your doctor may order an ultrasound of your breast instead of a mammogram. The breast radiologist may decide to perform a mammogram as well to evaluate your area of pain.

What kinds of things might the breast radiologist see?

For most of the women who have imaging for breast pain, the mammogram and/or ultrasound are completely normal (75-88%). The radiologist will find a benign cause for the pain, in around 10% of women,

The most common benign cause of pain is a breast cyst. Breasts cysts are sacs of fluid in the breast and many women have them and never know it. They can become painful with changes in your body’s hormones or when they increase in size.

One-to-two percent of women may need further evaluation with a breast biopsy because the radiologist sees something on the images and cannot tell exactly what it is. A breast biopsy is an outpatient procedure where a small piece of tissue is removed from your breast to be evaluated under a microscope.

Very few women with breast pain have breast cancer and some studies show that your chance of having breast cancer is the same whether you have breast pain or not.

Could breast pain mean it is cancer?

Breast pain is rarely a sign of breast cancer. It’s unusual for breast cancer to cause pain, but possible. Inflammatory breast cancer often causes pain but it’s rare, accounting for 1% to 5% of breast cancer cases in the United States. Symptoms of this aggressive disease often come on suddenly and progress rapidly. Inflammatory breast cancer may cause the breast to become red or discolored, swollen or feel heavy, painful, skin on the breast may also thicken or dimple. If you are concerned about inflammatory breast cancer, see your doctor immediately.

Summary

Breast pain (especially dull, aching, itching, or sharp) is common in women and often not a serious concern.

Most women feel some breast discomfort with their menstrual cycle because hormones (estrogen and progesterone) stimulate the glandular breast tissue. This may cause a small fluid accumulation in the tissue and cause the breast tissue to be lumpier, uncomfortable, or even painful. Stress and caffeine can worsen the pain.

Sometimes the pain seems to be within the breast when it’s really coming from a nearby location (shoulder, neck, chest wall). Women may suffer from arthritis or costochondritis (inflammation between the rib and breastbone) and this may appear to be breast-related pain. For these reasons, the mammogram is often normal when breast pain is present.

Sometimes the pain is only in one breast and frequently only one area of the breast.

While breast pain is typically not an early sign of breast cancer, it may be helpful to undergo a thorough evaluation of this symptom. Women who have breast pain may be advised to get a mammogram, ultrasound, or both. In these cases, a doctor may recommend diagnostic mammography, which may involve more images than a routine mammogram. The mammography center may also recommend an ultrasound with your mammogram.

 

 

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