Breast pain

Breast pain (mastalgia) is something most women experience over the course of their lives, and often, for different reasons and at different times. Many women during their reproductive years experience breast pain or tenderness right before their menstrual period. Known as “cyclic” breast pain, this type of pain or increased sensitivity is caused by hormonal changes associated with the menstrual cycle.

Other, noncyclic, breast pain can be caused by a number of factors, including injury, infection, pregnancy, medications and even large breast size. When this type of breast pain occurs in both breasts and in equal amounts, it is often caused by pregnancy or an outside factor that would affect both breasts equally, like medications. When it occurs in one breast or in one specific area, it is most commonly due to breast size, benign cysts or fibroadenomas (non-cancerous breast tumors) and, on more rare occasions, breast cancer.

Evaluation of breast pain will most likely begin with a physical breast exam by your provider. In some cases, you may need to have an imaging test of your breast. Breast imaging can be done with mammography, ultrasound and/or MRI. Most major medical organizations recommend mammograms every 1-2 years for all women, starting at age 40. Depending on breast density, family history and more, additional screenings may also be necessary.

Lifestyle tips

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Be sure to do a breast self-exam every month, in order to familiarize yourself with the look and feel of your breasts. By doing regular self-exams, you will be more likely to spot right away any changes that occur. The National Breast Cancer Foundation provides three strategies for effective breast self-exams:

  • In the shower: With the pads/flats of your three middle fingers, check the entire breast and armpit area, pressing down with differing levels of pressure. Your goal is to feel different depths of the breast: use light pressure to feel the tissue closest to the skin, medium pressure to feel a little deeper and firm pressure to feel the tissue closest to the chest and ribs. Feel for any lumps, thickening, hardened knots or other breast changes.
  • In front of a mirror: Look at your breasts with your arms at your sides, then raised above your head. Look for any changes in the shape and skin, any swelling, and any changes in your nipples. Then, rest your palms on your hips and press firmly to flex your chest muscles. Check for any changes, especially changes that seem to affect one breast and not the other.
  • Lying down: Place a pillow under your right shoulder, arm and head. Using your left hand, move your fingers around your right breast, gently covering the entire breast and armpit area. Switch the pillow to your left side, and do the same with your right hand on the left breast.

Make sure to wear well-fitted bras that provide adequate support and don’t dig in or restrict circulation. When purchasing a new bra, don’t assume that the same size bra you bought last is the right one for you now. Breast size and shape can change in response to age, weight, hormones, exercise and other factors. For a good fit, use a measuring tape to determine your band size and cup size, before heading to the store:

  • Band size: Wrap the measuring tape around your chest directedly beneath your breasts and measure in inches.
  • Cup size: Measure the fullest part of the bust (usually across the nipples) and round to the nearest inch. This is the bust measurement. Use an online calculator to convert these measurements to your cup size.
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  • Load your plate with fruits, vegetables, whole grains and lean proteins, rather than carbohydrates or processed foods high in sugar and saturated fat. Maintaining a healthy weight can help your breast tissue retain its shape and elasticity.
  • Limit your intake of red meat. Recent studies have shown a link between high intake of red meat like beef, lamb and pork and increased breast cancer risk.
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  • Stay physically active. Jogging or other forms of weight-bearing exercise may not be appropriate, depending on the type of breast pain you’re experiencing, but walking, swimming, water aerobics, yoga and tai chi are all beneficial forms of exercise that place less stress on your breasts.
  • Invest in well-fitting sports bras specifically designed for the type of exercise you’re engaging in. A sports bra that provides adequate support and range of motion for yoga may not be appropriate for running, or vice versa.
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  • If you’re a smoker, think about quitting. Smoking makes many different kinds of pain worse, and certain studies show that smoking may block the absorption of some medications, including analgesics (pain relievers). Smoking also appears to increase your chances of developing an inflammatory breast disorder like periductal mastitis.
  • Limit your alcohol intake. Moderate drinking—which for women consists of one alcoholic drink per day—is considered safe for most women, but more than that may interfere with circulation, give rise to more breast lumps and masses, and even increase your risk of breast cancer.
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A variety of medications can cause breast pain, including certain types of hormonal medications, antidepressants, high blood pressure and heart medications, and long-term steroids. If you are taking any medications which list breast pain as a possible side effect, explore alternatives with your health care provider.

Treatment options

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  • Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen (Tylenol) are effective ways to relieve cyclic breast pain, and often reduce the severity of menstrual cramps, as well.
  • For severe cyclic breast pain, taking hormonal birth control continuously (in consultation with a health care provider) may improve symptoms.
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  • Breast reduction: In certain cases, large breast size contributes to chronic back, neck and shoulder pain that cannot be resolved with well-fitting bras, physical or occupational therapy, or pain relievers. Such problems are most common in women whose band and bust measurements result in a large cup size.
  • Lumpectomy: Also known as “breast-conserving surgery,” a lumpectomy involves the surgeon removing the part of the breast where a tumor is located.
  • Mastectomy: In a mastectomy, the surgeon removes the entire breast. A “double mastectomy” refers to the removal of both breasts. This is typically done when a woman has more advanced breast cancer, has small breasts but a big tumor in one of the breasts, or has a genetic mutation for inherited breast cancer.
Alternative therapies
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  • Cold and heat therapy (ice packs and heating pads) can help to relieve breast pain due to injury or infection.
  • Topical treatments, which deliver pain-relieving medication directly through the skin, can also be useful. These products typically include capsaicin, lidocaine or diclofenac.
  • Physical therapy can help relieve pain due to poor posture, a weak core, repetitive stress and other types of injuries.
  • Acupuncture and acupressure (which uses finger pressure rather than fine needles) may stimulate the release of endorphins, which are the body’s natural pain relievers.

Frequently asked questions

What causes breast pain?
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Breast pain can be caused by a number of factors, including hormonal changes, injury, infection (mastitis), breast size and other underlying conditions, including non-proliferative masses such as cysts and fibroadenoma, and proliferative masses with or without atypia. In rare cases, proliferative masses with atypia (atypical hyperplasia) may indicate the presence of breast cancer, but breast pain typically is not the first symptom associated with such masses.

My provider mentioned I have fibrocystic breasts. What does this mean? Am I at greater risk for breast cancer?
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Up to half of American women ages 20-50 have fibrocystic breasts, a common noncancerous condition that can cause breast pain, cysts and lumps that suddenly appear and go away. Believed to be caused by rising and falling levels of hormones, especially estrogen, fibrocystic breasts don’t appear to increase a woman’s chances of developing breast cancer, but can make breast cancer more difficult to identify. Some women with fibrocystic breasts find their symptoms are improved by limiting or eliminating their caffeine intake.

I think I found a lump during my breast self-exam. What should I do?
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Contact your health provider for a conversation and follow-up. While most breast lumps are noncancerous, the presence of a lump may indicate a need for further testing, including a mammogram, ultrasound, magnetic resonance imaging (MRI) or fine needle biopsy.

If I find a breast lump, what are my chances I have breast cancer?
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Most breast lumps are noncancerous—and, in fact, most women have them. According to the American Cancer Society, 80-85% of breast lumps are harmless, especially in women under 40. Most are related to the menstrual cycle, but some can also be related to a plugged milk duct or a breast injury. If you feel a lump, of any size or consistency, be sure to mention it to your health provider.

My breast pain is in my nipples, but nowhere else. Should I be concerned?
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Tingling or soreness in the nipples can be a symptom of cyclic breast pain, early pregnancy, latch problems during breastfeeding and occasionally, other conditions, such as periareolar infection (also called periductal mastitis) and mammary duct ectasia. These conditions often have no obvious cause but may be related to trauma or conditions that impair immunity, such as diabetes or rheumatoid arthritis. Very rarely, nipple pain is due to Paget disease, a rare cancer of the nipple and areola (darker-pigmented area around the nipple).

What is mastitis?
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Mastitis refers to inflammation of the breast and is most commonly associated with lactation-related infections; however, it can also occur in women whose breasts aren’t producing milk. Regardless of cause, most cases of mastitis can be successfully treated with antibiotics.

Does it hurt to have a mammogram?
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For most women, mammograms are not painful. There are two plates that are used to compress the breast tissue. This pressure can feel like an ache and usually lasts only seconds. If you are still having your periods, you might consider timing your mammogram to be done in the week right after your period, as the breasts are often less tender during this time.

What is a 3D mammogram?
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Digital breast tomosynthesis, also known as 3D mammography, is a test that takes X-rays of the breast and puts them together in a 3D image. During the 3D part of the exam, an x-ray arm sweeps over the breast, taking multiple images in seconds. Tomosynthesis can be used to screen for early signs of breast cancer in women with no symptoms as well as a diagnostic tool for women that are having breast cancer symptoms. In addition, tomosynthesis can be much more accurate than traditional mammography in screening for breast cancer in women who have dense breasts. Overall, tomosynthesis can detect a higher portion of cancers than standard mammography and at a lower overall radiation dose.

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