Breast Pain and Soreness (Mastalgia)

Cyclical vs non-cyclical breast pain

Causes of breast pain

Hormonal changes

Estrogen and progesterone cause breast tissue to swell and retain fluid before a period. Lumpy, tender breasts that change through the month are known as fibrocystic breast changes. See fibrocystic breast disease. Pain may also flare in early pregnancy, at puberty, during perimenopause and with hormone therapy or birth control.

Pregnancy and breastfeeding

Tender, swollen breasts are often an early pregnancy sign. During breastfeeding, pain may come from engorgement, a poor latch, a blocked duct, nipple thrush or mastitis, an infection that causes a red, hot area and flu-like symptoms.

Breast cysts and lumps

A breast cyst, a fluid-filled sac, can appear quickly and feel tender, especially before a period. Fibroadenomas are usually painless. Fat necrosis after an injury can form a firm, sometimes tender lump.

Chest wall pain

Pain can come from muscles, ribs or cartilage under the breast and feel as if it is in the breast. Costochondritis causes sharp pain where the ribs join the breastbone, worse with pressing or movement. Muscle strain from exercise, lifting or coughing is common.

Other causes

• a poorly fitting or unsupportive bra, especially with large breasts or high-impact exercise
• medicines: some antidepressants (SSRIs), hormone therapy, birth control pills, spironolactone and digoxin
• breast surgery or implants
• shingles on the chest wall, causing burning pain then a rash
• referred pain from the heart, lungs, gallbladder or esophagus

Breast pain and cancer

Breast pain is rarely the only symptom of breast cancer. Most breast cancers are painless lumps. However, inflammatory breast cancer can cause a painful, red, swollen breast that looks infected but does not get better with antibiotics. See your doctor about any pain that is persistent and in one spot, or that comes with a lump or skin change.

Pain in one breast

Pain in only one breast is usually still benign: cyst, mastitis, injury, chest wall strain or a localized area of fibrocystic tissue. Left-sided pain can occasionally be heart-related, so take it seriously if it comes with breathlessness, sweating or exertion. Pain that is focal, persistent and not cyclical should be examined.

How breast pain is evaluated

Your doctor will ask how long you have had the pain, whether it varies with your cycle, which medicines you take and whether you are pregnant or breastfeeding. A pain diary over 2 to 3 cycles helps show whether it is cyclical. They will examine both breasts and armpits. Imaging depends on your age and findings:

• Ultrasound for focal pain or a lump, especially under 30 to 40
• Mammogram with ultrasound for women over 30 to 40 with focal pain or other findings
• Aspiration of a painful cyst, which both diagnoses and relieves it

A normal exam and normal imaging are strongly reassuring.

Relief for sore breasts

• Wear a well-fitted, supportive bra, a sports bra for exercise, and a soft bra at night if pain wakes you.
• NSAIDs: ibuprofen tablets, or topical diclofenac gel rubbed onto the painful area, which has good evidence for mastalgia. Follow the label dose.
• Heat or cold: a warm pack or a cloth-wrapped ice pack.
• Review medicines and hormone therapy with your doctor.
• Reduce caffeine and add evening primrose oil if you find them helpful. Evidence is weak, but some people notice benefit.
• Prescription options for severe, persistent cyclical pain include tamoxifen or danazol, used rarely and short term because of side effects.

Frequently asked questions

Is breast pain a sign of breast cancer?

Rarely. Breast pain alone, especially in both breasts and linked to your cycle, is almost never cancer. Get checked if pain stays in one spot for more than a couple of weeks, or comes with a lump, skin dimpling, redness, nipple changes or discharge.

Why does only one of my breasts hurt?

Common reasons are a cyst, mastitis, an injury, a strained chest muscle or costochondritis, and hormonal tenderness that is uneven. Persistent, focal pain in one breast should be examined, and imaging may be arranged.

Why are my breasts sore before my period?

Rising progesterone and estrogen in the second half of the cycle cause breast tissue and milk ducts to swell and hold fluid, making breasts heavy and tender. It usually eases within a few days of your period starting.

Can breast pain be from the heart?

Sometimes. Heart pain can be felt in the left chest or breast area. Call 911 or your local emergency number if breast or chest pain comes with breathlessness, sweating, nausea, or pain spreading to the arm, neck or jaw.

What can I take for breast pain?

A supportive bra and an anti-inflammatory such as ibuprofen tablets or diclofenac gel work for most people. Heat or cold packs can also help. If pain is severe and persistent, your doctor can review hormones or medicines and discuss prescription options.