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Pain - breast; Mastalgia; Mastodynia; Breast tenderness

There are many possible causes for breast pain. For example, hormone level changes related to menstruation or pregnancy are often responsible for breast tenderness. Some degree of swelling and tenderness just before your period is normal.

Although many women with pain in one or both breasts may fear breast cancer, breast pain is NOT a common symptom of cancer.

Boys and men have breast tissue. If a male has breast tissue that can be seen, the condition is called gynecomastia. Adolescent boys can have some breast swelling and tenderness as a part of normal development. This is due to hormone changes, and is similiar to breast tenderness in women.

Some degree of breast tenderness is normal. The discomfort may be caused by hormonal changes due to:

• Menopause (unless a woman is taking hormone replacement therapy)
• Menstruation and premenstrual syndrome(PMS)
• Pregnancy -- breast tenderness tends to be more common during the first trimester and in women who are pregnant at a young age
• Puberty in both girls and boys

Soon after childbirth, your breasts may become swollen with milk. This can be very painful and is usually accompanied by swelling. If you also have an area of redness, call your health care provider. Breastfeeding itself may also cause breast pain.

Other common causes of breast pain include:

• Alcoholism with liver damage
• Injury
• Infection of the breast tissue (mastitis)

Fibrocystic breast changes are also a common cause of breast pain. Fibrocystic breast tissue contains lumps and bumps that tend to be more tender just before your menstrual period.

Certain medications may also cause breast pain, including digitalis preparations, methyldopa (Aldomet), spironolactone (Aldactone), certain diuretics, Anadrol, and chlorpromazine.

Shingles can lead to pain felt in the breast if the painful blistering rash appears on the skin over one of your breasts.

Call your doctor if you have:

• Discharge from your nipples, especially blood or pus
• Given birth within the last week and your breasts are swollen or hard
• Signs of a breast infection, including localized redness, pus, or fever
• Noticed a new lump associated with the pain that does not go away after your menstrual period
• Persistent, unexplained breast pain

Your health care provider will perform a breast examination and ask questions about your breast pain, such as:

• How long have you had the symptoms?
• Are one or both of your breasts affected?
• Do you have any nipple discharge?
• Do you perform breast self-examination?
• Have you noticed any lumps or anything unusual when you examine your breasts?
• When was your last mammogram?
• What other symptoms do you have? Do you have fever?
• What medicines do you take?

Tests that may be done include:

• Breast biopsy
• Culture of nipple discharge to test for infection
• Cytology (microscopic evaluation) of nipple discharge
• Fine needle aspiration -- a small needle is inserted into the breast to remove fluid that may have collected in a cyst (usually not cancerous)
• Magnetic resonance imaging (MRI)
• Mammography

Treatment may include the following:

• Diet changes
• Medication changes
• Pain relievers

Your health care provider should schedule a follow-up visit in case the symptoms have not gone away in a given period of time. Your doctor may recommend that you see a specialist if the symptoms do not go away or if you have a complicated condition.

Wear a well-fitting bra for support, especially if your breasts are large.

Perform a monthly breast self-exam 3-5 days after your period (when the breast tissue is the least tender). This is important to feel for any changes in your breast tissue. If you detect any change from the previous month, notify your doctor.

Valea FA, Katz VL. Breast diseases: diagnosis and treatment of benign and malignant disease. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 15.