Causes of Breast Pain and Treatment Options

Everything you need to know about breast pain

Breast pain is common, but it can be worrisome when you have it, especially if you are concerned that it could be a symptom of breast cancer. Although breast cancer may cause breast pain at times, this type of pain usually results from other causes—which can include breast-related issues as well as non-breast-related issues.

Breast pain may feel sharp or dull, it can be intermittent or constant, and it can range from mild to severe. To find out the underlying cause and determine the right treatment plan for you, your healthcare provider will ask you about your medical history, do a physical examination, and possibly order imaging tests.

This article will explore the many possible causes of breast pain and how they are treated.

Breast-Related Causes

Breast pain is common. In fact, it is estimated that 70%–80% of women will experience it at some point during their life. Breast pain can arise for a variety of reasons, which is why it's important to get it checked out by your primary care provider or obstetrician-gynecologist (ob-gyn).

The possible causes can be divided into two categories: those that relate to the breast and those caused by other medical issues.

Breast-Related Causes

breast-related causes of breast pain
 Illustration by Emily Roberts, Verywell

Problems with the breast that cause breast pain include normal hormonal changes, localized infections, and more.

Cyclic Mastalgia

If your healthcare provider determines your breast pain is just that—breast pain and nothing else—this is called mastalgia. One type of mastalgia is called cyclical mastalgia.

Cyclic breast pain varies with the menstrual cycle, so it worsens and improves in response to monthly hormonal shifts.  This pain is usually diffuse, meaning that it's located throughout the breast and into the armpit areas. The pain of cyclic mastalgia often feels like a dull, heavy aching in both breasts,

Since this type of pain is linked to menstruation, it only affects premenopausal women.

Noncyclic Mastalgia

Noncyclic breast pain may hurt inside, beneath, or near the breast, all over the breast, or in one specific area. It can feel dull, sharp, or burning. Noncyclic breast pain can be a side effect of medication-related hormonal changes, including those induced by oral contraceptive pills, infertility treatments, and hormone therapy.

It can also affect women who have large breasts or obesity. For women with large breasts (either from obesity or genetics), pain may worsen if a supportive bra is not worn. This is due to the stretching of Cooper's ligaments, which are bands of connective tissue that support and shape female breast tissue. These ligaments are not part of male breasts.

There is mixed evidence that certain lifestyle factors may contribute to or cause noncyclic mastalgia, such as caffeine consumption, smoking, and eating a high-fat diet.

Fibrocystic Breast Changes

Fibrocystic breast changes—previously called fibrocystic breast disease—is a noncancerous condition that is characterized by breast fibrosis and cysts, which cause tender lumps and bumps in one or both breasts.

  • Breast fibrosis is thickened tissue within the breast, often described as feeling ropelike, rubbery, and/or hard.
  • Breast cysts, which are most common in women in their 40s (and can occur in men of any age), are fluid-filled sacs. They feel like soft, round lumps beneath the skin and can be tender to the touch. For women, breast cysts often become painful just before their menstrual period.

Breast Injury

The breasts are covered with sensitive, elastic skin that protects nerves, blood vessels, and connective tissues. After a breast injury, such as from a seat belt during a car accident, bruising and an aching pain will persist until the skin and underlying tissues have healed.

Sometimes an injury to the breast heals with scar tissue, which can cause persistent pain. This, known as fat necrosis, may appear as a hard lump, which can sometimes make it difficult to distinguish it from breast cancer.

Breast Surgery

After any type of breast surgery, whether it is an augmentation, reduction, or reconstruction, the breast hurts as incisions heal and scar tissue develops. As with any scar tissue, pain may come and go, even long after the surgery.

Milk Duct Disorders

A few benign but painful conditions can develop inside the milk ducts. For example, milk ducts (which are also present in males) can become clogged and infected, causing mastitis (a breast infection).

Mastitis may cause a tingling sensation that develops into significant pain, and a red, swollen breast, fever, and malaise. If untreated, an abscess (a collection of pus) may develop.

While mastitis is most common in women who are breastfeeding, it may also occur in non-lactating women and men.

Another potentially painful milk duct problem is ductal ectasia, also called mammary duct ectasia. This condition, which is rare in men, is characterized by widening and wall thickening of a milk duct below the nipple. This leads to blockage and fluid buildup within the duct.

Besides a tender and red area near the nipple, a thick green or black nipple discharge can develop, and the nipple may be pulled inward. If scar tissue develops from the inflamed duct, a lump may form.

Breast Cancer

Breast cancer can affect both women and men. It is often painless, but breast pain can be a rare symptom. Research has found that breast pain affects approximately 6% of women leading up to the diagnosis of breast cancer.

One aggressive, uncommon type of breast cancer, inflammatory breast cancer, usually begins with breast pain, along with redness and swelling. With this type of cancer, most people are unable to feel a discrete lump.

Symptoms of breast cancer can include lumps, dimpling, nipple discharge, or bleeding. Usually, breast cancer doesn't cause symptoms at early stages, and it can often be identified at an early stage with a screening test, such as a mammogram.

Gynecomastia

Most cases of breast or nipple discomfort in men are due to a condition called gynecomastia, which is marked by enlargement of the glandular tissue in a man's breasts. Gynecomastia usually results from a hormonal imbalance, especially an increase in the production of estrogen (considered a female hormone) and/or a decrease in androgen (considered a male hormone).

Non-Breast-Related Causes

Sometimes pain occurs so close to the breast that it's hard to tell whether the pain is in the breast or beneath it. There are several non-breast-related causes of this type of pain.

non-breast related causes of breast pain
Illustration by Alexandra Gordon, Verywell

Costochondritis

Costochondritis is inflammation of the chest wall cartilage. If the cartilage near the sternum (breastbone) becomes inflamed, it may cause pain on the right side or left side of the chest or in the breast area.

Chest Wall Injury

Lifting, exercising, shoveling, or bending improperly can cause a pulled muscle in the chest wall, a rib fracture, a back injury, and more. These injuries can cause a sharp, knifelike, or burning pain near the breast.

Muscle Spasm

The chest wall muscles below the breast may spasm, causing pain that may last between a few seconds to several days. Pain from tense chest wall muscles can occur on either side.

Spine Disease

Degenerative changes of the spine, such as cervical or thoracic disc disease, can sometimes cause pain in the breast area.

Fibromyalgia 

Fibromyalgia may cause aching, sore pain anywhere in your body, including the chest. Fibromyalgia can affect muscles, joints, and connective tissues, creating generalized or focused pain. It also causes fatigue, sleep problems, numbness, tingling sensations, and thinking and memory problems.

Airway Problems

Some lung conditions may cause pain that involves the breast area.

Two examples include:

  • Pneumonia: Because the lungs are in the chest area underneath the breasts, this infection of one or both lungs can cause dull breast pain. This pain becomes sharp with coughing or taking a deep breath (called pleuritic pain).
  • Pulmonary emboli: Blood clots in the legs can break off and travel to the lungs, causing pain that feels like it is coming from the breast.

Heart Attack

What may be perceived as breast pain could be a sign of a heart attack.

Potential symptoms of a heart attack that warrant immediate medical attention include:

  • Chest pain or pressure
  • Pain in the neck, jaw, or left arm
  • Shortness of breath
  • Sweating
  • Nausea
  • Light-headedness or passing out
  • A feeling of impending doom

Heart Attack Symptoms in Women

Heart attack symptoms are often very different (and more vague) for women than for men. Rather than having crushing chest pain, women may simply not feel well or dismiss their chest discomfort as cyclic or noncyclic breast pain.

Esophageal Problems

Since the esophagus runs below the left breast, gastroesophageal reflux disease (GERD) can occasionally feel like breast pain. This pain may feel more like a burning pain and may be accompanied by an acidic taste in the mouth.

Other digestive system conditions also may cause pain that feels like it is coming from the breast or shoulder area (for example, gallbladder disease, which occurs on the right side).

Shingles

Burning or tingling pain on the skin or outer surface of the breast may be shingles, a skin condition that tends to affect people over the age of 70 but can occur in anyone. With shingles, the pain may precede the onset of the rash by several days.

When to See a Healthcare Provider

It's important to see a healthcare provider—either your primary care physician or your gynecologist—for any new breast or nipple pain. While most cases of breast pain are mild and easily managed, you do not want to delay a diagnosis of breast cancer or a serious non-breast related cause, like a heart condition.

Breast Cancer Healthcare Provider Discussion Guide

Get our printable guide for your next healthcare provider's appointment to help you ask the right questions.

Doctor Discussion Guide Woman

Besides pain, other breast-related symptoms that warrant a healthcare provider's evaluation include:

  • Breast swelling, even if no discrete lump is felt
  • Skin changes on your breast or nipple, including redness, scaling, thickening, or dimpling
  • Nipple discharge (other than breast milk)
  • Swollen lymph nodes, especially around the collarbone or armpit

Diagnosis

If you have breast pain, it's important to make an appointment to see your healthcare provider. The good news is that most cases of breast pain are mild, self-limiting (will resolve without treatment), and benign (noncancerous). It's still important to get a diagnosis and treatment in case there is a serious cause or if your pain won't resolve quickly on its own.

Medical History

When you see your healthcare provider for breast pain, they will ask you questions prior to performing a physical examination.

While not an exhaustive list, here are some questions your healthcare provider may ask you:

  • Is your pain located in one breast or both?
  • What does the pain feel like?
  • Is your pain mild or severe?
  • Are you taking birth control pills or hormone therapy?
  • If you're premenopausal, does your pain occur at regular intervals, like mid-cycle or just prior to menstruating?
  • Have you recently experienced any trauma to the chest?
  • Have you recently engaged in a vigorous exercise program that involved the chest muscles?
  • Do you have a family history of breast cancer and/or a history of a benign breast condition?

Physical Examination

During your physical exam, your healthcare provider will visually inspect your breasts to look for any abnormalities like skin changes, rashes, or swelling. Next, they will press on your breast tissue to determine whether any lump(s) or masses are present or whether there is any nipple discharge.

They may also press on and examine your back, shoulder, and chest wall, in addition to listening to your heart and lung sounds.

Imaging

If you have breast mass or lump, you might have a diagnostic mammogram, and/or ultrasound. In some cases, a breast magnetic resonance imaging (MRI) scan will be needed.

According to the American College of Radiology, ultrasound is typically used to evaluate women under age 30 with noncyclic breast pain. For women 30 and older, ultrasound, mammography, digital breast tomosynthesis (also known as 3D mammography) can all be considered.

Biopsy

A breast biopsy is a procedure during which cells are removed from an area of concern, This is the only definitive way to diagnose or rule out breast cancer.

Once the cells are collected, a medical specialist called a pathologist will examine the cells with a microscope.

Blood and Other Tests

If your healthcare provider suspects a non-breast-related source for your pain, you may need further tests. For example, your healthcare provider may order an X-ray of your chest if you have signs of a rib fracture.

If you have signs of angina (severe heart-related chest pain) or a heart attack, you may have an electrocardiogram (ECG), cardiac enzyme blood tests, and appropriate intervention.

Treatment

The treatment plan for your breast pain will depend on your diagnosis. While some conditions may require simple self-care strategies, other conditions require medical or surgical interventions.

Self-Care Strategies

If your breast pain is due to cyclic or noncyclic mastalgia, your healthcare provider may suggest one or more of the following strategies:

  • Wearing a well-fitted bra with steel underwire during the day and a soft, supportive bra at night
  • Wearing a sports bra during exercise
  • Applying a warm compress to the tender breast or chest wall area
  • Stopping or changing the dose of your birth control pill or hormone replacement therapy, if applicable
  • Quitting smoking
  • Eating a low-fat, caffeine-free diet

Medications

If a pulled chest wall muscle is the source of your pain, your healthcare provider may recommend Tylenol (acetaminophen) or a nonsteroidal anti-inflammatory drug (NSAID) to soothe your pain. Less commonly, if the pain is severe and/or persistent, your healthcare provider may recommend a trigger point injection.

Tylenol and NSAIDs like Advil or Motrin (ibuprofen) are also used to ease the pain of cyclic or noncyclic mastalgia and breast cysts. If cyclic breast pain persists for more than six months, a short-term course of tamoxifen (one to three months) may be prescribed.

That said, the drug carries potential side effects like hot flashes, vaginal dryness, joint pain, and leg cramps. In addition, tamoxifen also has potentially serious side effects, like an increased risk of blood clots, stroke, uterine cancer, and cataracts.

Antibiotics are the first-line treatment for mastitis and for non-resolving ductal ectasia.

Surgery

Surgery may be needed for the treatment of certain types of breast pain. For example, if an abscess is found on the breast, surgical drainage could be necessary. Likewise, for most people with breast cancer, surgery is an essential part of the treatment plan.

Prevention

You can lower the risk of some causes of breast pain, such as shingles or a pulled muscle. For example, you can have a shingles vaccine, and you can be careful with exercise and lifting. But these problems can occur even with preventative methods.

Breast cancer rarely causes pain as the initial symptom, but infections or scars from surgery may cause pain at later stages of the disease. Breast cancer prevention and early detection is important.

There are some things you can do to help prevent breast cancer:

  • Maintain a healthy weight and exercise regularly.
  • Limit alcohol consumption.
  • Practice breast self-awareness and perform breast self-exams.

It's important to talk with your healthcare provider about when you should begin screening for breast cancer, how often you should be rescreened, and what your personal risk factors for developing the disease are.

According to the American Cancer Society, a woman of average risk for developing breast cancer can start screening at the age of 40, getting a mammogram every year. Women of higher risk—like those with a strong family history of breast cancer and/or a known BRCA1 or BRCA2 gene mutation—should get a breast MRI and a mammogram every year, usually starting at the age of 30.

Be sure to see your healthcare provider if you develop breast changes, even if you had a recent normal mammogram.

Summary

Although breast pain can be alarming and stressful to experience, more often than not the underlying cause of the pain is not breast cancer. Getting the pain professionally evaluated is important, though, since treatment is diagnosis-specific. Once an appropriate diagnosis is made, you can get started on treatment to help to ease your pain.

A Word From Verywell

As you can see, breast pain is common, often easily managed, and most commonly due to a noncancerous problem. That said, it's important to have a take-charge attitude when it comes to determining why it's occurring. In the rare instance that your pain is due to cancer, prompt, and early treatment is key.

Frequently Asked Questions

  • What causes a sharp pain in the breast?

    A sharp pain in the breast can be caused by an injury in the chest wall, pneumonia, and noncyclic mastalgia. Noncyclic mastalgia can also cause soreness and burning in one or more areas within, underneath, and around the breast. If you feel any type of pain in your breast, it can help to share your symptoms with a healthcare provider so they can offer treatment.

  • Can menopause cause your breasts to hurt?

    Breast pain and tenderness before and after menopause are common. Cyclic breast pain caused by fluctuations in hormones is common for menstruating women, and it can worsen during perimenopause (the years leading up to menopause) and even continue after menopause, especially if you're on hormone therapy.

  • Is breast pain a sign of breast cancer?

    In rare instances, breast pain can be a sign of breast cancer, but pain in the breast is usually related to other factors such as hormonal changes. Of those who are later diagnosed with breast cancer, about 6 percent had breast pain as one of their first symptoms. If you’re worried about pain, talk to your healthcare provider about screening for breast cancer.

  • What kind of breast pain indicates pregnancy?

    Breast pain in pregnancy typically includes achy, swollen, sensitive breasts and nipples. This is due to hormonal fluctuations, similar to cyclical breast pain. These are often among the early symptoms of pregnancy.

Originally written by
Pam Stephan
Pam Stephan is a breast cancer survivor.
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