Breast pain

Overview

Breast pain (mastalgia) can be described as tenderness, throbbing, sharp, stabbing, burning pain or tightness in the breast tissue. The pain may be constant or it may occur only occasionally, and it can occur in men, women and transgender people.

Breast pain can range from mild to severe. It may occur:

• Just a few days a month, in the two to three days leading up to a menstrual period. This normal, mild-to-moderate pain affects both breasts.
• A week or longer each month, starting before a period and sometimes continuing through the menstrual cycle. The pain may be moderate or severe, and affects both breasts.
• Throughout the month, not related to a menstrual cycle.

In men, breast pain is most commonly caused by a condition called "gynecomastia" (guy-nuh-koh-MAS-tee-uh). This refers to an increase in the amount of breast gland tissue that's caused by an imbalance of the hormones estrogen and testosterone. Gynecomastia can affect one or both breasts, sometimes unevenly.

In transgender women, hormone therapy may cause breast pain. In transgender men, breast pain may be caused by the minimal amount of breast tissue that may remain after a mastectomy.

Most times, breast pain signals a noncancerous (benign) breast condition and rarely indicates breast cancer. Unexplained breast pain that doesn't go away after one or two menstrual cycles, or that persists after menopause, or breast pain that doesn't seem to be related to hormone changes needs to be evaluated.

Symptoms

Breast pain can be cyclic or noncyclic. Cyclic means that the pain occurs on a regular pattern. Noncyclic means that the pain is constant, or that there's not a regular pattern. Each type of breast pain has distinct characteristics.

Breast pain characteristics

Cyclic breast pain

Noncyclic breast pain

Clearly related to the menstrual cycle and changing hormone levels Described as dull, heavy or aching Often accompanied by breast swelling, fullness or lumpiness Usually affects both breasts, particularly the upper, outer portions, and can radiate to the underarm Intensifies during the two weeks leading up to the start of the menstrual period, then eases up afterward More likely to affect people in their 20s and 30s, as well as people in their 40s who are transitioning to menopause

Unrelated to the menstrual cycle Described as tight, burning, stabbing or aching sensation Constant or intermittent Usually affects one breast, in a localized area, but may spread more diffusely across the breast In women, most likely to occur after menopause

Extramammary breast pain

The term "extramammary" means "outside the breast." Extramammary breast pain feels like it starts in the breast tissue, but its source is actually outside the breast area. Pulling a muscle in the chest, for example, can cause pain in the chest wall or rib cage that spreads (radiates) to the breast. Arthritis that involves the cartilage in the chest, also known as costochondritis, can also cause pain.

When to see a doctor

Make an appointment with your doctor if breast pain:

• Continues daily for more than a couple of weeks
• Occurs in one specific area of your breast
• Seems to be getting worse over time
• Interferes with daily activities
• Awakens you from sleep

Breast cancer risk is very low in people whose main symptom is breast pain, but if your doctor recommends an evaluation, it's important to follow through.

Causes

Changing hormone levels can cause changes in the milk ducts or milk glands. These changes in the ducts and glands can cause breast cysts, which can be painful and are a common cause of cyclic breast pain. Noncyclic breast pain may be caused by trauma, prior breast surgery or other factors.

Sometimes, it's not possible to identify the exact cause of breast pain, but some factors may increase the risk.

Risk factors

Breast pain is more common among people who haven't completed menopause, although it may occur after menopause. Breast pain can also occur in men who have gynecomastia, and in transgender people who are undergoing gender reassignment.

Other factors that may increase the risk of breast pain include:

• Breast size. People who have large breasts may experience noncyclic breast pain related to the size of their breasts. Neck, shoulder and back pain may accompany breast pain that's caused by large breasts.
• Breast surgery. Breast pain associated with breast surgery and scar formation can sometimes linger after incisions have healed.
• Fatty acid imbalance. An imbalance of fatty acids within the cells may affect the sensitivity of breast tissue to circulating hormones.
• Medication use. Certain hormonal medications, including some infertility treatments and oral birth control pills, may be associated with breast pain. Breast tenderness is a possible side effect of estrogen and progesterone hormone therapies that are used after menopause. Breast pain may be associated with certain antidepressants, including selective serotonin reuptake inhibitor (SSRI) antidepressants. Other medicines that can cause breast pain include those used to treat high blood pressure and some antibiotics.
• Excessive caffeine use. Although more research is needed, some people notice an improvement in breast pain when they reduce or eliminate caffeine.

Prevention

The following steps may help prevent the causes of breast pain, although more research is needed to determine their effectiveness.

• Avoid hormone therapy if possible.
• Avoid medications that are known to cause breast pain or make it worse.
• Wear a properly fitted bra, and wear a sports bra during exercise.
• Try relaxation therapy, which can help control the high levels of anxiety associated with severe breast pain.
• Limit or eliminate caffeine, a dietary change some people find helpful, although studies of caffeine's effect on breast pain and other premenstrual symptoms have been inconclusive.
• Avoid excessive or prolonged lifting activities.
• Follow a low-fat diet and eat more complex carbohydrates.
• Consider using an over-the-counter pain reliever, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others) — but ask your doctor how much to take, as long-term use may increase your risk of liver problems and other side effects.