Even though breast pain is common, experiencing it can be alarming, especially if your mind immediately jumps to the fact that it’s a symptom of breast cancer. While that’s sometimes true, there are many other potential (and more likely) causes, both that stem from issues inside your breast (e.g., a breast cyst or hormone-related breast tenderness) as well as outside your breast (e.g., chest wall injury or muscle spasm).
Breast pain is common. In fact, up to 70 percent of women experience it at some point in their lifetime. There are, however, several potential causes of breast pain, which is why it’s important to get it checked out by your primary care doctor or obstetrician-gynecologist (OB/GYN).
In exploring the possibilities, it’s perhaps best to divide them into two categories—those that relate to the breast itself and those that refer pain to the breast area.
Some breast pain results from an issue with the breast itself, be it how tissue is influenced by normal changes in hormones, a localized infection, or other concerns.
HER2-Positive Breast Cancer
HER2 genes cause breast cancer to grow, but multiple new treatments are evolving that can help fight the disease regardless of stage.
Cyclic Mastalgia (Females Only)
If your doctor determines your breast pain is just that—breast pain and nothing else—this is called mastalgia. One type of mastalgia is called cyclical mastalgia
Cyclic breast pain varies with a female’s menstrual cycle, so it increases and decreases in response to monthly hormone swings. The pain of cyclic mastalgia often feels like a dull, heavy aching in both breasts and is diffuse, located throughout the breast and into the armpit areas.
Since this type of pain is linked to menstruation, premenopausal women are most likely to experience it. In post-menopausal women, most breast pain is non-cyclical mastalgia.
Noncyclic breast pain may be felt inside, beneath, or near the breast. When it occurs, this sharp or burning breast pain may be felt all over or in one specific area or trigger zone.
Noncyclic breast pain commonly results from medication-related hormone changes, including those induced by oral contraceptive pills, infertility treatments, and hormone replacement therapy.
Enlarged breasts as a result of obesity may also cause noncyclic mastalgia. For women, large breasts (either from obesity or genetics) may be especially painful if a supportive bra is not worn. This is due to stretching of Cooper’s ligaments, which are bands of connective tissue that support and shape breast tissue. These ligaments are absent in the male breast.
Lastly, there is mixed evidence that certain lifestyle factors may contribute to or cause noncyclic mastalgia, such as caffeine consumption, smoking, and eating a high-fat diet.
Fibrocystic Breast Changes
Fibrocystic breast changes—previously called fibrocystic breast disease—is a non-cancerous condition that is characterized by breast fibrosis and cysts, which cause tender “lumps and bumps” in one or both breasts.
Breast fibrosis refers to the thickening of the tissue within the breast, often described as feeling rope-like, rubbery, and/or hard to the touch.
Breast cysts, which are most common in women in their 40s (but can occur in men and at any age), are fluid-filled sacs that feel like soft, round lumps beneath the skin. They may be tender to the touch and for women, breast cysts often become painful just before their menstrual period.
Your breasts are covered with sensitive, elastic skin that protects nerves, blood vessels, and connective tissues. If you’ve had a breast injury (e.g., from a seat belt during a car accident), you can expect bruising and an aching pain that will persist until the skin and underlying tissues have healed.
Sometimes an injury to the breast heals with scar tissue, which can cause pain. This, known as fat necrosis, may appear as a hard lump, making it difficult to distinguish it from breast cancer.
After any type of breast surgery, whether it is an augmentation, reduction, or reconstruction, your breast will hurt as incisions heal and scar tissue develops. And, as with scar tissue related to an injury, pain may come and go even long after your surgery.
Milk Duct Conditions and Infections
A few benign but painful conditions can develop inside the milk duct system. For example, milk ducts (which are also present in men) can become clogged and infected, causing mastitis (a breast infection). In addition to a tingling sensation that develops into significant pain, those with mastitis develop a red, swollen breast. Fever and malaise also commonly occur. If untreated, an abscess (a collection of pus) may develop.
While mastitis is most common in women who are breastfeeding, it may also occur in non-lactating women and men.
Another potentially painful milk duct problem is ductal ectasia, also called mammary duct ectasia. This condition, which is rare in men, is characterized by widening and wall thickening of a milk duct below the nipple, which leads to blockage and fluid build-up within the duct.
Besides a tender and red area near the nipple, a person may develop a thick green or black nipple discharge, and the nipple may be pulled inward. If scar tissue develops from the inflamed duct, a lump may form.
Breast cancer is often painless, but breast pain can be a symptom of the disease. Research has found that around one in five or one in six women experience breast pain in the 90-day period leading up to their diagnosis. Remember, though, that breast cancer can affect both women and men.
While breast cancer is not the cause of most people’s breast pain, this symptom is fairly common in those with this diagnosis.
One aggressive, albeit much less common type of breast cancer—inflammatory breast cancer—usually begins with breast pain, along with redness and swelling. With this type of cancer, most people are unable to feel a discreet lump.
Gynecomastia (Males Only)
Most cases of breast or nipple discomfort in men are due to a condition called gynecomastia, which is characterized by enlargement of the glandular tissue in a man’s breasts. Gynecomastia usually results from a hormone imbalance (more specifically, an increase in estrogen and/or a decrease in androgen production).
Sometimes a pain occurs so close to your breast that it’s hard to tell if the pain is actually in your breast or beneath it. There could be several non-breast related reasons behind your pain that must be considered.
Costochondritis is a potentially painful inflammation of the chest wall cartilage. If the cartilage near your sternum (breastbone) becomes inflamed, pain may be felt on the right or left side of the chest within the breast area.
Chest Wall Injury or Trauma
If you’ve been lifting, exercising, shoveling, or bending improperly, you may have developed a pulled muscle in your chest wall, caused a rib fracture, or brought on back pain—all of which may feel the same as a sharp, knife-like or burning pain in your breast.
There are chest wall muscles below your breast that may spasm, causing pain that may last just a few seconds or several days. Pain from tense chest wall muscles can occur on either side.
Degenerative changes of the spine, such as cervical or thoracic disc disease, can sometimes cause breast pain—often reported as a burning sensation.
Fibromyalgia may also cause an aching, sore pain anywhere in your body, and chest pain is not uncommon. Fibromyalgia can affect muscles, joints, and connective tissues, creating generalized or focused pain. Along with this, fatigue, sleep problems, numbness and tingling sensations, and thinking and memory problems may occur.
A few lung conditions may give rise to pain that is felt in the breasts. Two examples include:
- Pneumonia: Because the lungs are located in the chest area underneath your breasts, this infection of one or both lungs can cause dull breast pain. This pain becomes sharp with coughing or taking a deep breath (called pleuritic pain).
- Pulmonary emboli: Blood clots in your legs that break off and travel to your lungs may cause pain that feels like it is coming from your breast.
What may be perceived as breast pain could be a sign of a heart attack. Potential symptoms of a heart attack that warrant immediate medical attention include:
- Chest pain or pressure
- Pain in your neck, jaw, or left arm
- Shortness of breath (This is particularly common in women who are having a heart attack.)
- Lightheadedness or passing out
- A feeling that something just isn’t right or a sense of impending doom
Heart Attack Symptom in Women
Please note that symptoms of a heart attack in women are often very different (and vaguer) than those experienced by men. Rather than having crushing chest pain, women may simply not feel well or dismiss their chest discomfort as cyclic or noncyclic breast pain.
Since your esophagus runs below your left breast, gastroesophageal reflux disease can occasionally feel like breast pain. Pain related to the esophagus may feel more like a burning pain, and you may have an acidic taste in your mouth, but that’s not always the case.
Other digestive system conditions may also cause pain that feels like it is coming from your breast or shoulder area (for example, gallbladder disease, which occurs on the right side).
Some people develop a burning or tingling pain felt on the skin or outer surface of the breast. This may be shingles—a skin condition that tends to affect people over the age of 60, but can occur in anyone. With shingles, the pain may precede the onset of the rash by several days.
When to See a Doctor
It’s important to see your doctor, either your primary care physician or your gynecologist, for any new breast or nipple pain. While most cases of breast pain are mild and easily managed, you do not want to delay a diagnosis of breast cancer or a serious non-breast related cause like a heart condition.
Besides pain, other breast-related symptoms that warrant a doctor’s evaluation include:
- Breast swelling, even if no discrete lump is felt
- Skin changes on your breast or nipple like redness, scaling, thickening, or dimpling
- Nipple discharge (other than breast milk)
- Swollen lymph nodes, especially around the collarbone or armpit
The first step if you have breast pain is to make an appointment to see your doctor. While most cases of breast pain are mild, self-limited, and benign, only your doctor can rule out a more worrisome and serious diagnosis.
When you see your doctor for breast pain, she will first ask you questions prior to performing a physical examination to determine the origin of your pain. While not an exhaustive list, here are some questions your doctor may ask you:
- Is your pain located on one breast or both?
- What does the pain feel like?
- Is your pain mild or severe?
- Are you taking birth control pills or hormone replacement therapy?
- If premenopausal, does your pain occur at regular intervals, like mid-cycle or just prior to menstruating?
- Have you experienced any trauma recently to the chest?
- Have you recently engaged in a vigorous exercise program that involved the chest muscles?
- Do you have a family history of breast cancer and/or a history of a benign breast condition (some of which can increase your risk of breast cancer)?
During your physical exam, your doctor will first inspect your breasts to look for any abnormalities like skin changes, rashes, or swelling. Next, your doctor will press on your breast tissue to determine whether any lump(s) or masses are present or whether there is any nipple discharge.
If she suspects your pain could be from a non-related breast source, she may also press on and examine your back, shoulder, and chest wall, in addition to listening to your heart and lung sounds.
If your pain is truly breast-related and focal (localized to one spot), your doctor will proceed with imaging tests to better evaluate your breast tissue. If breast pain is diffuse or “all over,” your doctor may skip imaging tests and proceed with a treatment and follow-up plan.
If a breast mass or lump is felt, depending on your age, a diagnostic mammogram, and/or ultrasound will be ordered. In some cases, a breast magnetic resonance imaging (MRI) scan will be needed.
A breast biopsy, which entails removing cells from a suspicious area, is the only definitive way to diagnose (or rule out) breast cancer. Once the cells are removed, a doctor (called a pathologist) will examine the cells under a microscope.
Blood and Other Tests
If your doctor suspects a non-breast related source for your pain, you may need further tests. For example, if a possible lung or chest wall source (e.g., a rib fracture) is suspected, your doctor may order an X-ray of your chest.
Likewise, if your doctor is worried about angina or a heart attack, she will proceed with an electrocardiogram, cardiac enzyme blood tests, and/or refer you to the emergency department.
The treatment plan for your breast pain will depend on your diagnosis. While some conditions may require simple self-care strategies, other diagnoses require more intensive therapy, such as surgery.
If your breast pain is due to cyclical or non-cyclical mastalgia, your doctor may suggest one or more of the following strategies:
- Wearing a well-fitted bra with steel underwire during the day and a soft but supportive bra at night
- Wearing a sports bra during exercise
- Applying a warm compress to the tender breast or chest wall area
- Stopping or changing the dose of your birth control pill or hormone replacement therapy, if applicable
- Smoking cessation*
- Sticking with a low-fat, caffeine-free diet*
*Keep in mind that these strategies lack robust scientific evidence.
When an issue with a chest wall muscle is the source of your pain, your doctor may recommend Tylenol (acetaminophen) or a nonsteroidal anti-inflammatory (NSAID) to soothe your pain. Less commonly, if the pain is severe and/or persistent, your doctor may recommend a trigger point injection.
Tylenol and NSAIDs are also used to ease the pain of cyclic or noncyclic mastalgia and breast cysts. However, if a woman’s breast pain persists for more than six months, her doctor may prescribe a short-term course of tamoxifen (one to three months).
That said, prescribing tamoxifen for breast pain is not an overall ideal practice, as the drug carries potential, somewhat burdensome side effects like:
- Hot flashes
- Vaginal dryness
- Joint pain
- Leg cramps
In addition, tamoxifen increases your risk of blood clots, stroke, uterine cancer, and cataracts.
Lastly, antibiotics are the mainstay treatment for mastitis and for cases of ductal ecstasia that do not resolve on their own.
Surgery is required to treat certain breast pain diagnoses. For example, if an abscess is found on the breast, surgical drainage is necessary. Likewise, for the majority of people with breast cancer, surgery is an essential part of the treatment plan.
There are some things you can to do help prevent certain breast pain diagnoses, especially the less common, albeit serious diagnosis of breast cancer:
- Maintain a healthy weight and exercise regularly
- Limit alcohol consumption
- Practice breast self-awareness and perform breast self-exams
It’s also very important to talk with your doctor about when you should begin screening for breast cancer, how often you should be re-screened, and what your personal risk factors for developing the disease are.
According to the American Cancer Society, a woman of average risk for developing breast cancer can start screening at the age of 40 with a mammogram every year. Women of higher risk—like those with a strong family history of breast cancer and/or a known BRCA1 or BRCA2 gene mutation—should get a breast MRI and a mammogram every year, usually starting at the age of 30.
Be sure to see your doctor if you develop breast changes, even if you had a recent “normal” mammogram.
A Word From Tips For Healthy Living
As you can see, breast pain is common, often easily managed, and most commonly due to a non-cancerous problem. That said, it’s important to have a “take charge” attitude when it comes to figuring out why it’s occurring. In the rare instance your pain is due to cancer, prompt and early treatment is key to being cured.