Breast Pain

Symptoms

Breast pain (mastalgia) can be described as throbbing, tenderness, sharp, stabbing, burning pain or tightness in the breast tissue. The pain may be constant or it may occur only occasionally. It can occur in men, women and transgender people. Breast pain can range from mild to severe and it may be cyclic; occurring just a few days a month, usually in the two to three days leading up to a menstrual period. A week or longer each month, starting before a period and continuing through the menstrual cycle. Or pain may be noncyclic; occurring throughout the month, not related to a menstrual cycle.

Each type of breast pain has distinct characteristics:

In men, breast pain is most commonly caused by a condition called "gynecomastia" (guy-nuh­koh-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.

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 your doctor

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. 

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
• Is accompanied by a mass

Tests to evaluate breast pain may include

• Clinical breast exam. Your doctor checks for changes in your breasts, examining your breasts and the lymph nodes in your lower neck and underarm. If your medical history and the breast and physical exam reveal nothing unusual, you may not need additional tests.
• Mammogram. If your doctor feels a breast lump or unusual thickening, or detects a focused area of pain in your breast tissue, you'll need an X-ray exam of your breast that evaluates the area of concern found during the breast exam (diagnostic mammogram).
• Ultrasound. An ultrasound exam uses sound waves to produce images of your breasts, and it's often done along with a mammogram. You might need an ultrasound to evaluate a focused area of pain even if the mammogram appears normal.
• Breast biopsy. Suspicious breast lumps, areas of thickening or unusual areas seen during imaging exams may require a biopsy before your doctor can make a diagnosis. During a biopsy, your doctor obtains a small sample of breast tissue from the area in question and sends it for lab analysis.

Treatment for breast pain

For most people, breast pain resolves on its own over time. Most often no treatment is needed. 

If you do need help managing your pain or if you need treatment, your doctor might recommend that you:

• Eliminate an underlying cause or aggravating factor. This may involve a simple adjustment, such as wearing a bra with extra support or eliminating underwires.
• Use a nonsteroidal anti-inflammatory (NSAID) medication. You may need to take NSAIDs when your pain is intense. Your doctor may recommend that you apply an NSAID cream directly to the area where you feel pain.
• Adjust birth control pills. If you take birth control pills, skipping the pill-free week or switching birth control methods may help breast pain symptoms, but don't try this without your doctor's advice.
• Reduce the dose of menopausal hormone therapy. You might consider lowering the dose of menopausal hormone therapy or stopping it entirely.
• Take a prescription medication. Danazol is the only prescription medication approved by the Food and Drug Administration for treating fibrocystic breasts. However, danazol carries the risk of potentially severe side effects, such as heart and liver problems, as well as weight gain and voice changes. Tamoxifen, a prescription medication for breast cancer treatment and prevention, may help, but this drug also carries the potential for side effects that may be more bothersome than the breast pain itself.