Breast Pain
Breast pain (mastalgia) is the most common breast related complaint among women; nearly 70% of women experience breast pain at some point in their lives. Breast pain may occur in one or both breasts or in the underarm (axilla) region of the body. The severity of breast pain varies from woman to woman; approximately 15% of women require treatment. Though breast pain is not normally associated with breast cancer, women who experience any breast abnormalities, including breast pain, should consult their physicians.

What Causes Breast Pain?

There are two main types of breast pain:

Cyclical

Non-cyclical

Cyclical breast pain is related to how the breast tissue responds to monthly changes in a woman’s estrogen and progesterone hormone levels. If breast pain is accompanied by lumpiness, cysts (accumulated packets of fluid), or areas of thickness, the condition is usually called fibrocystic change. During each menstrual cycle, breast tissue sometimes swells because hormonal stimulation causes the breast’s milk glands and ducts to enlarge, and in turn, the breasts retain water. The breasts may feel swollen, painful, tender, or lumpy a few days before menstruation. Breast pain and swelling usually ends when menstruation is over. The average age of women who have cyclical breast pain is 34 years old. Cyclical breast pain may last for several years but usually stops after menopause unless a woman uses hormone replacement therapy (HRT). Cyclical breast pain accounts for nearly 75% of all breast complaints. Of all women who experience breast pain, two thirds experience cyclical breast pain. Physicians often have patients chart their pain to determine whether the pain is cyclical. Though cyclical breast pain is usually related to the menstrual cycle, stress may also affect hormone levels and influence breast pain. Physical activity, especially heavy lifting or prolonged use of the arms, has also been shown to increase breast pain (pectoral (chest) muscles may become sore from physical activity).

Non-cyclical breast pain is far less common than cyclical breast pain and is not related to a woman’s menstrual cycle. Women who experience non-cyclical breast pain often experience pain in one specific area of the breast(s). Woman who experience injury or trauma to the breast or those who undergo breast biopsy sometimes experience non-cyclical pain. The condition may occur in both pre-menopausal and post-menopausal women and usually subsides after one to two years. Non-cyclical pain is most common in women between 40 and 50 years of age. Usually, non-cyclical breast pain does not indicate breast cancer, though women should discuss the condition with their physicians. Another type of non-cyclical pain called costochondritis does not actually occur in the breast; however, the condition may feel as though it is coming from the breast. This type of arthritic pain occurs in the middle of the chest where the ribs and the breast bone connect. Costochondritis may occur as the result of poor posture or aging. Women who experience costochondritis usually describe it as a burning sensation in the breast.

Other factors that may contribute to breast pain in some women include:

Oral contraceptive pills

Hormone replacement therapy

Weight gain

Bras that do not fit properly

Tumors (most painful tumors do not usually indicate breast cancer; however, all abnormalities should be examined by a physician. For example, some patients with inflammatory breast cancer describe "stabbing pains" in the breast.)

Evaluating Breast Pain

Women should report all complaints of persistent breast pain to their physicians. Physicians will evaluate the pain, taking into account the woman’s personal history, family history, the area of pain, the intensity and duration of the pain, and the extent to which the pain interferes with her lifestyle. Physicians will also perform clinical breast examinations, and if necessary, order additional breast imaging exams (such as mammography or ultrasound) to help determine whether the pain is related to another breast condition or possibly cancer. If no breast abnormality is indicated, the physician and woman should decide together whether drug treatment is necessary.

Treating Breast Pain

Most women with moderate breast pain are not treated with medications or surgical procedures. The following suggestions have been shown to reduce breast pain in some women (although there is not sufficient scientific evidence to establish the effectiveness of any of these suggestions):

Wear a good, supportive bra to reduce breast movement. Many women with breast pain find it comfortable to also wear a bra while they sleep.

Limit sodium intake.

Reduce caffeine intake (coffee, tea, soft drinks, chocolate).

Maintain a low fat diet rich in fruits, vegetables, and grains.

Maintain an ideal weight. Losing excess weight may reduce breast pain by stabilizing hormone levels.

Occasionally use over-the-counter pain-relief drugs such aspirin, acetaminophen, or Motrin.

Take vitamins. Some women have found that taking Vitamin B6 (pyridoxine), Vitamin B1 (thiamine), and Vitamin E relieves breast pain.

Try evening primrose oil. Some women have found that regular consumption of the herb, evening primrose oil, in liquid or tablet form reduces breast pain.

Cyst aspiration. Physicians sometimes drain benign (non-cancerous), fluid-filled cysts to relieve breast pain. It may not be possible to drain very small cysts.

Relax. Some breast pain can be caused by stress and may subside by reducing anxiety and tension.

If breast pain is severe and interferes with a woman’s daily activities, further treatment may be necessary. Diuretics, substances that remove excess fluid from the body in the form of urine, are the most commonly prescribed treatment for persistent, non-cyclical breast pain. The release of fluid in the body helps decrease breast pain and swelling.

Drug treatments for severe breast pain include:

danazol

bromocriptine

Bromocriptine and danazol both relieve cyclical breast pain by blocking certain hormones (such as estrogen and progesterone). However, these drugs may cause serious side effects in some women. Bromocriptine is poorly tolerated by many patients; side effects include nausea, dizziness, and fertility problems. Side effects of danazol may include weight gain, amenorrhea (absence of menstruation), and masculinization (such as extra facial hair) when given high doses. Other drugs, such as tamoxifen or goserelin, have been shown to have some effect on cyclical breast pain; however, these drugs are presently only approved for use in women with breast pain in the United Kingdom. In cases where non-cyclical pain occurs only in a specific area of the breast (localized pain), physicians may choose to inject anesthetics or corticosteriods in this "target area" to relieve the pain. In very rare cases, the painful area may be surgically removed. However, surgery usually leads to increased breast pain, and some women may develop non-cyclical breast pain at the site of previous surgeries on the breast.

Breast Pain While Nursing

While 80% of women experience mild breast pain during the first few days of breast-feeding, pain usually subsides within a few weeks. Chronic breast pain during nursing should be reported to a certified lactation consultant for clinical evaluation.
Persistent breast pain while nursing may result from:

Improper positioning. Leaning over the baby can lead to breast and back pain.

Engorgement. Engorgement is a build-up of fluids that occurs as milk converts from colostrum (nutrient produced during the first few days after birth) to mature milk. Engorgement is a temporary condition (lasting approximately 12 to 24 hours) and is most common during the first few weeks after pregnancy. If the breasts are becoming swollen, physicians recommend breast-feeding to avoid engorgement.

Strong milk ejection reflexes. The actual process of expelling milk from the breast is called milk-ejection reflex. Milk is ejected from the breast into the baby’s mouth. Normally, women feel a mild tingling sensation during milk ejection. However, some women have strong milk ejection reflexes and experience a painful tingling or stinging sensation during breast-feeding. This usually subsides after the first few weeks of nursing.

Nipple blanching (also called vasospasm). The nipples turn white during and often in between breast-feeding. Many women report burning sensations in the nipples. Nipple blanching may be relieved with warm compresses and good breast support.

Mastitis. This benign (non-cancerous) condition is common among women who breast-feed. Cracking of the skin around the nipple allows bacteria from the skin surface to enter the breast duct where it grows and attracts inflammatory cells. Inflammatory cells release substances to fight the infection but also cause breast tissue swelling and increased blood flow. Breasts infected with mastitis often swell, become red in color, and feel warm to the touch. Nasopharyngeal organisms from the infant's mouth, sinuses and other air passages are usually the source of breast infections in lactating women. Physicians recommend keeping the breast empty of milk helps to drain the culture medium (environment and food source) that is facilitating growth of organisms. Breast-feeding with mastitis is generally not harmful to the infant and may actually help speed up recovery. Mastitis is also treated with antibiotics.

Additional Resources and References

The North East Valley Anti-Cancer Council of Victoria, Australia provides information on breast pain at http://www.nevdgp.org.au/geninf/aca_htm/ac_mastalgia_breastpain.htm

British Columbia's Women's Hospital and Health Centre Society provides information on breast pain at http://www.cw.bc.ca/

So That's What They're For: Breastfeeding Basics by Janet Tamaro (1998) provides extensive information on breast-feeding and breast pain while nursing in an easy-to-read, comprehensive, and humorous format.

To learn more about breastfeeding please visit http://www.imaginis.com/breasthealth/breastfeeding/

For additional resources, please visit the Imaginis.com Breast Health Bookstore at http://www.imaginis.com/bookstore/breasthealth/