Breast Pain (Mastalgia)

Types of breast pain

Cyclic breast pain

Cyclic mastalgia is linked to the menstrual cycle. Rising estrogen and progesterone in the second half of the cycle cause the milk glands and ducts to swell and retain fluid.

• dull, heavy, aching pain
• both breasts, often worse in the upper outer part toward the armpit
• starts 1 to 2 weeks before a period and improves when bleeding begins
• most common in your 20s to 40s, and usually stops after menopause
• often comes with lumpiness (fibrocystic breasts)

Non-cyclic breast pain

Non-cyclic pain does not follow the cycle. It is more common in women aged 40 to 50.

• burning, sharp, stabbing or tight pain
• often in one breast and one spot
• may be constant or come and go unpredictably

Extramammary (chest wall) pain

Pain that feels like it is in the breast may come from the muscles, ribs, cartilage or nerves underneath. It often worsens with movement, deep breaths, or pressing on a specific spot.

Cyclic vs non-cyclic breast pain

Causes of breast pain

Hormonal

• the menstrual cycle and premenstrual syndrome
• early pregnancy, often one of the first signs
• starting or changing hormonal contraception
• hormone therapy during or after menopause
• perimenopause, when hormone levels fluctuate unpredictably

Breast conditions

• Breast cysts: smooth, mobile, fluid-filled lumps that can be tender, especially before a period. Common at 35 to 50.
• Mastitis: inflammation or infection of the breast, most often while breastfeeding. A hot, red, painful wedge-shaped area with fever and flu-like aches.
• Breast abscess: a collection of pus that can follow mastitis.
• Duct ectasia: widened ducts behind the nipple causing pain, thick discharge and sometimes an inward nipple, usually near menopause.
• Fat necrosis: a firm, sometimes tender lump after injury, surgery or radiotherapy.
• Engorgement in the first days after birth, or blocked ducts while breastfeeding.

Chest wall and other causes

• Costochondritis: inflammation where the ribs meet the breastbone, tender to press.
• Muscle strain from exercise, heavy lifting or coughing.
• Shingles: burning pain on one side, followed by a band of blisters.
• Large breasts: stretched ligaments cause aching in the breasts, neck, shoulders and back.
• Poorly fitting bra, especially during exercise.
• Referred pain from the neck, spine, gallbladder or heart.

Medicines

Some antidepressants (SSRIs), spironolactone, digoxin, some blood pressure medicines and hormone treatments can cause breast pain or tenderness.

Pain in one breast

Pain confined to one breast is more often non-cyclic or from the chest wall. The usual causes are a cyst, mastitis, injury, muscle strain or costochondritis. One-sided pain that is in one spot, persists for weeks and does not vary with your cycle should be examined, and imaging is often arranged to be sure there is no underlying lump.

Is breast pain a sign of cancer?

Usually not. Studies of women referred for breast pain alone find cancer in a very small proportion, similar to women without pain. Breast cancer most often shows up as a painless lump. However, breast cancer can occasionally cause pain, and inflammatory breast cancer causes a red, swollen, warm breast with skin like orange peel, which can be mistaken for an infection.

See a doctor if pain comes with:

• a new lump or thickening
• skin dimpling, puckering, redness or orange-peel skin
• a nipple that has turned inward or has bloody discharge
• a persistent spot of pain that does not resolve

Breast pain in men

Men can get breast pain, usually from gynecomastia, a rubbery, tender swelling of breast tissue under the nipple. It is common during puberty and in older men, and can be caused by medicines (spironolactone, some prostate cancer treatments, anabolic steroids, cannabis), liver or kidney disease, and hormone imbalances. Male breast cancer is rare but usually appears as a firm, painless lump near the nipple, so any lump should be checked.

How doctors evaluate breast pain

A doctor will ask where the pain is, how long you have had it, whether it changes with your cycle, and about pregnancy, breastfeeding, medicines and family history. A pain diary over 2 to 3 cycles helps show whether it is cyclic.

The examination checks both breasts, the armpits and the chest wall. Depending on age and findings:

• Ultrasound: for a focal painful area, especially under age 30 to 40
• Mammogram: for women over 30 to 40 with a focal area of concern or due for screening
• Needle aspiration of a cyst, which also relieves its pain
• Pregnancy test when relevant

Treatment and relief for breast pain

Self-care

• A well-fitted, supportive bra: the most effective single measure. Wear a sports bra for exercise, and a soft supportive bra at night during painful weeks.
• Pain relievers: acetaminophen (paracetamol) or ibuprofen, following the label dose. A topical NSAID gel such as diclofenac rubbed on the painful area works well with fewer side effects.
• Warm or cold compresses.
• Review medicines and hormone therapy with your doctor.

Evidence for reducing caffeine, taking vitamin E or evening primrose oil is weak, though some women find them helpful and they are low risk.

Medical treatment

For severe pain lasting more than 6 months that affects daily life, a specialist may consider tamoxifen or danazol. Both have significant side effects, so they are used for short periods only. Antibiotics treat mastitis, and an abscess needs drainage.

Breastfeeding pain

Keep feeding or expressing from the affected breast during mastitis. Check latch with a lactation consultant, and see a doctor if fever lasts more than 24 hours.

Frequently asked questions

What causes breast pain?

Most breast pain is cyclic, caused by hormone changes before a period. Non-cyclic pain can come from cysts, mastitis, injury, large breasts, a poorly fitting bra or medicines. Pain that feels like it is in the breast can also come from the chest wall, such as costochondritis or a strained muscle.

When should I worry about breast pain?

See a doctor if pain is in one spot and lasts more than 2 to 3 weeks, does not change with your cycle, or comes with a lump, skin redness or dimpling, nipple changes or discharge. Get emergency care for chest pain with breathlessness, sweating or pain spreading to the arm or jaw.

Is pain in one breast a sign of cancer?

Rarely. One-sided breast pain is usually caused by a cyst, infection, injury or the chest wall. Breast cancer more often causes a painless lump. Persistent one-sided pain in a fixed spot should still be examined, and an ultrasound or mammogram may be offered.

Why are my breasts sore before my period?

Rising estrogen and progesterone after ovulation make breast ducts and glands swell and hold fluid. This causes heaviness, aching and tenderness in both breasts, worst in the days before your period, and it eases once bleeding starts. A supportive bra and pain relievers help.

Can men get breast pain?

Yes. The most common cause is gynecomastia, a tender swelling of breast tissue behind the nipple, which can occur in puberty, older age, or due to medicines, liver disease or hormone changes. Men with a firm lump in the breast should see a doctor promptly.