Why Do I Have a Pain in My Breast?

There are many potential culprits

Woman with chest pain
What are the causes of sharp breast pain?. Patrick Heagney/E+/Getty Images

It can be alarming to have a pain in your breast. What could this pain mean for you? How worried should you be? 

The first step if you have breast pain is to make an appointment to see your doctor. This does not mean that experiencing breast pain means something serious is going on. In fact, most breast pain is not a sign of something serious.

But it's impossible to separate out the common, non-serious causes from the less common, but serious causes without a good conversation and exam with your doctor.

When you see your doctor for breast pain, she will ask you questions and perform a thorough physical examination to determine the origin of the pain. First, your doctor will try to determine if your pain is truly breast-related, as there are other sources of pain in the chest that may simply feel like they are in your breast.

If a breast mass or lump is felt, a diagnostic mammogram, and/or ultrasound, and/or biopsy will be ordered. In some cases, a breast MRI will be needed, especially if you have a family history of breast cancer.

If your doctor suspects another cause for your breast pain, like heart disease, you will need further tests.

Let's explore the potential causes of pain in your breast (or breasts), including those that truly stem from the breast and others that are simply referred to the breast.

Breast-Related Causes of Breast Pain

If your doctor determines your breast pain is just that—breast pain and nothing else—this is called mastalgia.

There are two types of mastalgia: cyclic and non-cyclical breast pain. It's important to know that mastalgia does not increase your risk of developing breast cancer. 

Mastalgia (Cyclic Breast Pain)
Cyclic breast pain varies with your menstrual cycle, so it increases and decreases in response to your monthly hormone swings.

This pain often feels like a dull, heavy, aching in both breasts and is diffuse, located throughout the breast. Cyclic breast pain often extends into your armpit areas.

Since this type of pain is linked to a woman's menstrual cycle, premenopausal women are most likely to experience it.  

Mastalgia: Non-Cyclical Breast Pain
A sharp, burning or stabbing pain in one breast that is constant or intermittent is probably not related to your menstrual cycle and may be noncyclical breast pain. This type of breast pain may be inside, beneath, or near the breast. When it occurs, this sharp breast pain feels like it is in one specific area or trigger zone.

It's important to understand that this type of breast pain can show up regardless of your menopausal status. Finally, there are a number of causes of noncyclical breast pain, including oral contraceptive pills, hormone therapy, and other medications. In addition, large breasts may also be painful, especially if a woman is not wearing a proper, supportive bra.

Breast Injury
Your breasts are covered with sensitive, elastic skin that protects nerves, blood vessels, and connective tissues as well as ducts and lobes for producing breast milk. If you've had a breast injury, you can expect bruising and an ache that will persist until the skin and underlying tissues have healed.

Sometimes an injury to the breast heals with scar tissue, and this scar tissue can cause pain (called fat necrosis). Fat necrosis may appear as a hard lump as well, making it difficult to distinguish from breast cancer.

Breast Surgery
After any type of breast surgery whether it is an augmentation, reduction, or reconstruction, your breast will hurt as incisions heal and scar tissue develops. And as with scar tissue related to an injury, pain can come and go even long after your surgery.

Milk Duct Conditions and Infections
Several benign but painful conditions can develop inside your breast milk system.

An abscess may occur under your nipple or areola. Milk ducts can become clogged and infected, causing mastitis (a breast infection) or ductal ectasia.

In addition, breast cysts and fibroadenomas may grow and crowd your milk system or connective tissue, creating aches and pains.

Hormonal Causes
Hormone changes may also cause breast tenderness, especially when levels change during a woman's menstrual cycle or while on hormone pills, like oral contraceptive pills, infertility treatments, or hormone replacement therapy.

While hormonal changes often cause pain in both breasts, the pain may be felt in one breast more than the other. It's good to note, too, that medical conditions like hypothyroidism, characterized by a low level of thyroid hormones in the body, may also be linked to benign breast disorders that cause breast pain. 

Inflammation and Lumps
When you suspect breast infections or inflammation, visit your family doctor or gynecologist. You may need to take antibiotics or other prescription medications to clear up the problem.

Finally, whenever you find new breast lumps or bumps, consult with your doctor right away to get a clear diagnosis and proper treatment.

Breast Cancer
You may have heard that pain in your breast is a good sign, and that breast cancer is painless. This is true, at least to some degree. At times, however, breast pain can be a symptom of breast cancer.

For example, inflammatory breast cancer is an aggressive cancer form of breast cancer which usually begins with pain, redness, and more. With this type of cancer, most people are unable to feel a discreet lump. 

Non Breast-Related Causes of Breast Pain

Sometimes a pain occurs so close to your breast that it's hard to tell if the pain is in within your breast or beneath it. There could be several non-breast related culprits for your pain. 

Costochondritis
Costochondritis is a potentially painful inflammation of the chest wall cartilage and bones. If what feels like breast pain is actually in your cartilage than costochondritis in your sternum (breastbone) can cause pain on the right or left side of the chest. 

Chest Wall Injury
If you've been lifting, exercising, or bending improperly, you may have developed a pulled muscle in your chest wall, caused a rib fracture, or brought on back pain—all of which may feel the same as a sharp pain in your breast.

Muscle Spasm
Below your breast there are chest wall muscles that may spasm during times of anxiety and stress, causing pain that may last just a few seconds or several days. Pain from tense chest wall muscles can occur on either side. 

Fibromyalgia 
Fibromyalgia may also cause pain anywhere in your body, and chest pain is not uncommon. Fibromyalgia can affect muscles, joints, and connective tissues, creating generalized pain or focused pain.

Airway Causes

  • Bronchitis is a painful inflammation of the airways that lead into your lungs. The pain of bronchitis is worse when you cough or try to strain for breath, but it can feel like breast pain.
  • Pneumonia can also cause breast pain since your lungs are in your chest area underneath your breasts.
  • Blood clots in your legs that break off and travel to your lungs, pulmonary emboli, may cause pain that feels like it is coming from your breast.

Heart Attack
If you believe there is any chance your symptoms could be related to your heart, please seek medical attention right away. Potential symptoms of a heart attack may include:

  • Chest pain or pressure—be aware, though, that a fourth to a third of people having a heart attack do not experience any chest pain or pressure.
  • Pain in your neck, jaw, or left arm
  • Shortness of breath—this is common in women who are having a heart attack
  • Sweating
  • Nausea
  • Lightheadedness or passing out
  • A feeling that something just isn't right or a sense of impending doom

It's important to note that symptoms of a heart attack in women are often very different than those in men. Rather than crushing chest pain, the symptoms in women can be vague, such as just not feeling well or pain which might be dismissed as being breast pain.

But by virtue of childbirth alone, women are often inclined to dismiss pain as a nuisance or annoyance, rather than heed it as a sign that something serious is happening. The first few minutes can be critical in surviving a heart attack. If you are at all uncertain, call 911 immediately.

Esophageal Causes
Since your esophagus runs below your left breast, gastroesophageal reflux disease can occasionally feel like breast pain. Pain related to the esophagus may feel more like a burning pain, and you may have an acidic taste in your mouth, but not always.

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

Shingles
Sometimes women develop pain often like a burning or tingling which feels like it is either in the skin or on the outer surface of the breast. This may be shingles, a skin condition that tends to affect people over the age of 60 but can occur in anyone. With shingles, the pain may precede the onset of the rash by several days.

A Word From Verywell

When you're trying to get a clear diagnosis of your breast pain, take charge. Keep a chart of your menstrual periods and breast pain cycle so you can judge whether or not the pain is related to your hormonal cycle. Then, consult your doctor and have a clinical breast exam done. During your visit, your doctor will also review your health history and list of medications.

If more information about the pain is needed, you may be referred for a mammogram or breast ultrasound, as well as other tests, if your doctor suspects a non-breast related cause. 

Sources:

Al Sharydah AM, Al-Abdulwahhab AH, Alghinimi IM, El Shawarby MA, Katbi FA. Mastalgia as an Atypical Presentation of Hepatocellular Carcinoma: A Case Report. World Journal of Surgical Oncology. 2017. 15:58.

Breast Pain; Pp. 77-85. Dr. Susan Love's Breast Book. Susan M. Love, M.D. Fifth Edition, 2010.

Kasper, Dennis L.., Anthony S. Fauci, and Stephen L. Hauser. Harrison's Principles of Internal Medicine. New York: Mc Graw Hill Education. 2015. Print.

U.S. National Library of Medicine. (2016). Breast Pain

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