Causes of Breast Pain and Treatment Options

Breast pain—also known as mastalgia—is common and often related to normal fluctuations in your hormones or other benign causes. In some instances, the pain may be due to something more serious. Take time to observe the type of pain and location: Do you have dull or sharp pain? Is it in one breast? Does it come and go, or is it constant? Is it mild or severe?

Then talk to your healthcare provider, who will review your medical history, do a physical examination, and possibly order imaging tests to find what is causing your pain.

This article will explore the many possible causes of different types of breast pain and how they are treated.

Pain from Hormone Fluctuations

Breast pain can arise for a variety of reasons, but one of the most common causes involves hormonal fluctuations that naturally occur during your menstrual cycle. Fluctuations can also occur when you are pregnant, undergoing menopause, or taking medications that directly or indirectly affect levels of the hormone estrogen.

It is estimated that 70% to 80% of females will experience breast pain at some point in their lives. 

Cyclic Mastalgia

Cyclical mastalgia is breast pain that occurs with phases of your menstrual cycle. The pain will come and go on a regular cycle, mainly occurring at the time of ovulation when estrogen levels are high.

Cyclic mastalgia pain is usually diffuse, meaning that it is felt throughout the breast and may even extend into the arm. The condition is typically bilateral, meaning it affects both breasts. The pain is often described as a dull, heavy ache.

Pregnancy

Breast pain during pregnancy is a common occurrence when high levels of estrogen, progesterone, and prolactin (the hormone associated with lactation) increase blood flow to the breasts and nipples. This causes them to become swollen, achy, and tender to the touch.

For many, mastalgia is most common in the first trimester, though it can occur at any stage of pregnancy and breastfeeding.

Menopause

Cyclic mastalgia can worsen during perimenopause when hormones can surge and drop erratically. Perimenopause is the time before menopause when your ovaries gradually stop working. The pain can sometimes persist well into menopause when ovulation stops, particularly if you are on estrogen-replacement therapy.

If you are in or around your 40s and experience new or worsening cyclical breast pain, it may be a sign that you are entering perimenopause.

Hormonal Medications

There are many medications that can affect hormones in people with breasts and trigger chronic breast pain. Some of the more common causes of drug-induced mastalgia include:

• Oral contraceptives (birth control pills)
• Estrogen replacement therapy
• Antidepressants called selective serotonin reuptake inhibitors (SSRIs)
• Anabolic steroids like oxymetholone
• Antipsychotic drugs like Thorazine (chlorpromazine)
• Digoxin (digitalis)
• Aldomet (methyldopa)
• Spironolactone diuretics ("water pills")
  

Fibrocystic Breast Changes

Fibrocystic breast changes—previously called fibrocystic breast disease—is a noncancerous condition characterized by breast fibrosis (scarring) and cysts (round, fluid-filled capsules in tissues). Symptoms include tender lumps and bumps in the breast along with breast swelling and diffuse pain. Breast tissue may also feel ropey and hard.

As your period approaches, the soft, round cysts can gradually become more and more painful.

Breast Fibroadenoma

Breast fibroadenoma is the most common type of benign (non-cancerous) breast tumor typically seen in premenopausal females. The only symptom is a round, rubbery, moveable lump in your breast that may feel tender and painful, especially before your period.

Some breast fibroadenomas can be as small as a lentil or as big as a plum. They may also change in size during your menstrual cycle due to fluctuating hormones.

A simple fibroadenoma does not raise your risk of breast cancer but may still be removed if it is causing pain or is excessively large.

Pain Not Related to Hormonal Changes

Noncyclic mastalgia is breast pain that does not involve hormonal fluctuations due to your menstrual cycle. Noncyclic breast pain may sometimes be chronic (long-lasting) or acute (developing suddenly and often severely).

Noncyclic breast pain may hurt inside, beneath, all over the breast, or in one specific part of the breast. It can feel dull, sharp, or burning depending on the underlying cause. Many cases are unilateral (affecting one breast) but some are bilateral.

Obesity and Large Breasts

Obesity is defined as a body mass index (BMI) of 30 or greater. At this weight, the accumulation of fat in the breasts can increase their density and weight. The extra weight puts stress on connective tissues called Cooper's ligaments that support female breasts, causing them to stretch and become painful. (The ligaments are not found in male breasts.)

Similar breast pain may be felt in females of normal weight who have very large breasts. The pain may worsen if a supportive bra is not worn.

Breast Injury

After a breast injury, such as following a car accident, bruising and deep aching pain are common when underlying tissues, connective tissues, nerves, and blood vessels are damaged.

Even after the injury heals, pain can persist in some people due to fat necrosis. Fat necrosis describes the death of fat cells due to disrupted blood flow. The death of these cells can cause a hardened lump that pulls on surrounding tissues, causing sharp, deeply felt pain.

In some cases, the pain may not involve the breast but be the result of a pulled muscle in the chest wall. These injuries can cause a sharp stabbing or burning pain that can worsen with arm and shoulder movement.

Breast Surgery

After any type of breast surgery—whether breast augmentation, breast reduction, or breast reconstruction—pain can occur as the incisions heal and scar tissue develops. This is normal, and symptoms usually resolve over time.

However, if you don't follow your postoperative rehabilitation plan, including gentle stretching exercises, adhesions can form. Adhesions are tissues that stick together and become fused. When this happens in the breast, you may feel pain when reaching or stretching.

With mastectomy, damage to the pectoral, thoracodorsal, long thoracic, and intercostal nerves can sometimes occur as breast tissues and lymph nodes are removed. Damage to these nerves can cause numbness, tingling, or shooting pain in your armpit, upper arm, shoulder, or chest wall.

Breast Infections

There are different infections that can affect the breast, most of which are bacterial. These include common bacteria like Staphylococcus aureus, Streptococcus species, and Klebsiella pneumoniae.

Depending on the type or severity of infection, you might experience breast swelling (usually unilateral), pain, fever, fatigue, redness, itching, nipple discharge, skin changes, and swollen lymph nodes in the armpits.

Fungal infections are far less common and typically affect people who are immunocompromised.

Examples of breast infections include:

• Lactational mastitis (caused by bacteria that enter cracked nipples in breastfeeding people)
• Subareolar abscess (caused by bacteria that form a pocket of pus under the nipple area)
• Breast aspergillosis (caused by a fungus that enters cracked nipples in breastfeeding people)
  

Inflammatory Breast Cancer

In rare instances, breast pain can be a sign of breast cancer. Although most breast cancers do not cause pain in either the breast or nipple, one type called inflammatory breast cancer can cause chronic, non-cyclical breast pain.

Inflammatory breast cancer is rare, accounting for just 1% of 5% of all breast cancers in the United States. It can cause the breast to become swollen and discolored, and the skin to appear dimpled like an orange peel.

In addition to causing heaviness, pain, and inversion (retraction) of the nipple, inflammatory breast cancer is distinctive in that there may not be a palpable lump in the breast.

Even with certain non-inflammatory breast cancers, people may report increased breast pain in tandem with hormonal changes during their menstrual cycle.

Milk Duct Disorders

In addition to mastitis, there are other non-infectious conditions that may affect the lactiferous ducts, otherwise known as the milk ducts. These include:

• Ductal ectasia: This is a condition in which the thickening of the walls of the milk duct causes blockage, tenderness, and redness. Ductal ectasia can also cause nipple inversion along with a thick green or blackish discharge. Ductal ectasia tends to occur closer to menopause.
• Intraductal papilloma: This is a benign growth in the milk ducts that typically develops closer to the surface of the nipple. The growths are generally too small to be felt but can cause pain and a bloody discharge. As with ductal ectasia, intraductal papilloma occurs closer to menopause.

Neither ductal ectasia nor a solitary intraductal papilloma increases the risk of breast cancer. However, if you have multiple papillomas, your risk is increased slightly.

When to See a Healthcare Provider

It's important to see a healthcare provider—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 healthcare provider's evaluation include:

• Breast swelling, even if no discrete lump is felt
• Skin changes on your breast or nipple, including redness, scaling, thickening, or dimpling
• Nipple discharge (other than breast milk)
• Swollen lymph nodes, especially around the collarbone or armpits

Breast Cancer Healthcare Provider Discussion Guide

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How Breast Pain Is Diagnosed

If you have breast pain, it's important to make an appointment to see your healthcare provider. The good news is that most cases of breast pain are mild, self-limiting (will resolve without treatment), and benign (noncancerous). It's still important to get a diagnosis and treatment in case there is a serious cause or if your pain won't resolve quickly on its own.

Medical History

When you see your healthcare provider for breast pain, they will ask you questions prior to performing a physical examination.

While not an exhaustive list, here are some questions your healthcare provider may ask you:

• Is your pain located in one breast or both?
• What does the pain feel like?
• Is your pain mild or severe?
• Are you taking birth control pills or hormone therapy?
• If you're premenopausal, does your pain occur at regular intervals, like mid-cycle or just prior to menstruating?
• Have you recently experienced any trauma 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?

Physical Examination

During your physical exam, your healthcare provider will visually inspect your breasts to look for any abnormalities like skin changes, rashes, or swelling. Next, they will press on your breast tissue to determine whether any lump(s) or masses are present or whether there is any nipple discharge.

They may also press on and examine your back, shoulder, and chest wall, in addition to listening to your heart and lung sounds.

Imaging

If you have a breast mass or lump, you might have a diagnostic mammogram, and/or ultrasound. In some cases, a breast magnetic resonance imaging (MRI) scan will be needed.

According to the American College of Radiology, ultrasound is typically used to evaluate women under age 30 with noncyclic breast pain. For women 30 and older, ultrasound, mammography, digital breast tomosynthesis (also known as 3D mammography) can all be considered.

Biopsy

A breast biopsy is a procedure during which cells are removed from an area of concern, This is the only definitive way to diagnose or rule out breast cancer.

Once the cells are collected, a medical specialist called a pathologist will examine the cells with a microscope.

Blood and Other Tests

If your healthcare provider suspects a non-breast-related source for your pain, you may need further tests. For example, your healthcare provider may order an X-ray of your chest if you have signs of a rib fracture.

If you have signs of angina (severe heart-related chest pain) or a heart attack, you may have an electrocardiogram (ECG), cardiac enzyme blood tests, and appropriate intervention.

How Is Breast Pain Treated?

The treatment plan for your breast pain will depend on your diagnosis. While some conditions may require simple self-care strategies, other conditions require medical or surgical interventions.

Self-Care Strategies

If your breast pain is due to cyclic or noncyclic mastalgia, your healthcare provider may suggest one or more of the following strategies:

• Wearing a well-fitted bra with steel underwire during the day and a soft, 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
• Quitting smoking
• Eating a low-fat, caffeine-free diet

Medications

If a pulled chest wall muscle is the source of your pain, your healthcare provider may recommend Tylenol (acetaminophen) or a nonsteroidal anti-inflammatory drug (NSAID) to soothe your pain. Less commonly, if the pain is severe and/or persistent, your healthcare provider may recommend a trigger point injection.

Tylenol and NSAIDs like Advil or Motrin (ibuprofen) are also used to ease the pain of cyclic or noncyclic mastalgia and breast cysts. If cyclic breast pain persists for more than six months, a short-term course of tamoxifen (one to three months) may be prescribed.

That said, the drug carries potential side effects like hot flashes, vaginal dryness, joint pain, and leg cramps. In addition, tamoxifen also has potentially serious side effects, like an increased risk of blood clots, stroke, uterine cancer, and cataracts.

Antibiotics are the first-line treatment for mastitis and for non-resolving ductal ectasia.

Surgery

Surgery may be needed for the treatment of certain types of breast pain. For example, if an abscess is found on the breast, surgical drainage could be necessary. Likewise, for most people with breast cancer, surgery is an essential part of the treatment plan.

Summary

Although breast pain can be alarming and stressful to experience, more often than not the underlying cause of the pain is not breast cancer. Getting the pain professionally evaluated is important since treatment is diagnosis-specific. Once an appropriate diagnosis is made, you can get started on treatment to help ease your pain.