There are many possible causes for breast pain. The presence of discomfort associated with menstrual periods or premenstrual syndrome (PMS) is well-known by women and adolescent girls. As their periods approach and occur, the breasts swell and become tender; this is a normal part of the female reproductive cycle. Breasts also swell and can become painful as a normal part of pregnancy and nursing.

Breast pain that is not associated with menses, PMS, pregnancy, or nursing can be a frightening experience. Because statistics indicate that 1 in every 8 women in the US will develop breast cancer at some point in her lifetime, many women think that breast pain other than the normal cyclic or pregnancy-related pain automatically means cancer. However, with breast cancer there is often no breast pain, and most patients with breast pain do not have breast cancer.

Breast pain or tenderness may also occur in an adolescent male in association with adolescent gynecomastia as a normal part of development.

• Chronic cystic mastitis
  • Involves tenderness at midcycle or just before a menstrual period, when estrogen levels are at their peak
  • Usually involves both breasts
  • Does not necessarily make the breasts lumpy
• Puberty
  • In girls, near the onset of menstruation (menarche)
  • In boys, usually goes away after a few months
• Approaching menopause
• Early pregnancy
• Estrogen therapy
• Milk engorgement after childbirth, especially if breast-feeding
• Normal hormonal fluctuations
• Medications
  • Digitalis preparations
  • Aldomet
  • Aldactone and other oral potassium-sparing diuretics
  • Anadrol
  • Chlorpromazine
• Alcoholism with liver damage
• Injury (such as a bite or trauma)
• Nipple problems
• Shingles (pain in only one breast)
• Premenstrual syndrome (PMS)

• Follow prescribed therapy to treat the underlying cause.
• Wear a well-fitting brassiere for support, especially if your breasts are large.
• A monthly breast self-examination is important.
• For mastitis, avoid caffeine and try vitamin E supplements and a diet low in fat and high in carbohydrates.

An injury to the breast surface that shows evidence of infection should be treated with antibiotics. Immediately after an injury to the breast occurs, apply a cold compress such as an ice pack for 20 minutes and take a nonsteroidal anti-inflammatory drug NSAID) such as iboprofen to reduce the likelihood of developing persistent breast pain.

• There is any prolonged discharge from the nipples
• There is persistent, unexplained breast pain
• If you notice a new lump associated with the pain that does not go away after your menstrual period

Your health care provider will obtain your medical history and will perform a breast examination.

Medical history questions documenting breast pain include include the following:

• Are both breasts affected?
• How long have you had the symptoms?
• What medication are you currently taking?
• Is there any nipple discharge?
• Do you perform breast self-examination?
• When was your last mammogram?
• Have you noticed any lumps or anything unusual when you examine your breasts?
• What other symptoms are present? Do you have fever?

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

Treatment may include the following:

• Analgesics may be prescribed.
• Changes to your diet may be suggested.
• Certain medications may be discontinued.

Your health care provider should schedule a follow-up visit if the symptoms have not rsolved in a given period of time. He or she may recommend consultation with a specialist if the symptoms do not go away or if you have a complicated condition.