Breast pain (mastalgia) can be described as tenderness, throbbing, sharp, stabbing, burning pain or tightness in the breast tissue. The pain may be constant or it may occur only occasionally, and it can occur in men, women and transgender people.

Breast pain can range from mild to severe. It may occur just a few days in a month, in the two to three days leading up to a menstrual period. This normal, mild-to-moderate pain affects both breasts. It may also occur a week or longer each month, starting before a period and sometimes continuing through the menstrual cycle. The pain may be moderate or severe, and affects both breasts. The pain may also be throughout the month, not related to a menstrual cycle.

In men, breast pain is most commonly caused by a condition called "gynecomastia". This refers to an increase in the amount of breast gland tissue that's caused by an imbalance of the hormones estrogen and testosterone. Gynecomastia can affect one or both breasts, sometimes unevenly.

Breast pain is very common. It affects approximately two-third of females during their reproductive years, and it is one of the most frequent complaints of those aged 15–40 years.

Breast pain is not commonly a symptom of breast cancer, but if a person has pain alongside other breast changes, such as a lump or discharge, they should see a doctor. Most times, breast pain signals a noncancerous (benign) breast condition and rarely indicates breast cancer. Unexplained breast pain that doesn't go away after one or two menstrual cycles, or that persists after menopause, or breast pain that doesn't seem to be related to hormone changes needs to be evaluated.

Breast pain can be cyclic or noncyclic. Cyclic means that the pain occurs on a regular pattern. Noncyclic means that the pain is constant, or that there's not a regular pattern.                                                                                  

Cyclical breast pain is clearly related to the menstrual cycle and changing hormone levels. Described as dull, heavy or aching. Often accompanied by breast swelling, fullness or lumpiness.

Usually affects both breasts, particularly the upper, outer portions, and can radiate to the underarm. Intensifies during the two weeks leading up to the start of the menstrual period, then eases up afterward.

More likely to affect people in their 20s and 30s, as well as people in their 40s.

Non cyclical breast pain is unrelated to the menstrual cycle. Described as tight, burning, stabbing or aching sensation. Constant or intermittent.

Usually affects one breast, in a localized area, but may spread more diffusely across the breast. In women, most likely to occur after menopause.                                                                                                                                         

Make an appointment with your doctor if breast pain: continues daily for more than a couple of weeks, occurs in one specific area of your breast, seems to be getting worse over time, Interferes with daily activities, awakens you from sleep.

Causes of breast pain.

Hormonal changes. Tender or swollen breasts are usually related to the hormonal changes that take place before a period. This type of breast pain usually causes tenderness in both breasts, and it may extend to the armpit.

When breast pain is related to the menstrual cycle, it is known as cyclic breast pain. Cyclic breast pain can be part of a set of symptoms that occur before a period, known as premenstrual syndrome (PMS), or it may occur on its own. Other symptoms of PMS: Moodswings, acne, headaches, bloating, diarrhea or constipation, tiredness and trouble sleeping. PMS is temporary, and it usually goes away several days after a period begins. In the meantime, people can treat the symptoms by taking pain relievers, wearing a comfortable and supportive bra, and using gentle heat to soothe the pain.

Breast pain can also occur due to other hormonal changes, such as those that take place during pregnancy or in the first stage of menopause.

 Bra fit. Bras can cause breast pain if they are too tight or they contain an underwire that digs into the skin or breast tissue. If a person gets cyclic breast pain, they may also find that at certain times in their menstrual cycle, their usual bras feel too small or are uncomfortable.

 Fibrocystic breast changes. These are harmless but potentially uncomfortable symptoms that cause the breasts to feel lumpy or otherwise different in texture due to hormonal fluctuations. Fibrocystic breast disease is the most common type of noncancerous breast condition. The symptoms may include: Breasts that feel firmer or thicker than usual, tenderness, lumps or cysts, sensitive nipples and itchiness. The symptoms may get worse before a period, and they will usually stop after menopause.

 Mastitis. Mastitis is the term for inflammation or swelling in the breasts. The usual cause is an infection. Although the condition most often affects those who are breastfeeding, it can occur in people who are not. The symptoms of mastitis include: Swelling, pain, and warmth in part of the breast. There could also be fever and headaches. The treatment is antibiotics. A person who is breastfeeding will also need to empty the breasts of milk. If an abscess is present, it should be drained surgically or aspirate with a needle.

 Medications. Some medications can contribute to the development of breast pain. These include: Digoxin, which treat congestive heart failure and abnormal heart rhythm, chlorpromazine, a medication for mental health disorders, potassium-sparing diuretics, such as    spironolactone (Aldactone) and methyldopa (Aldomet), which is a treatment for high blood pressure.

 

 Scar tissue. Both surgery and radiation therapy for breast cancer can cause scar tissue formation. This can result in: Numbness or pain, if the scar tissue develops around nerves and formation of a lump if the scar forms around a surgical stitch.

Treatment options include: Surgical removal of scar tissue, if it is very painful and use of creams and ointments to lessen the appearance of scars, if a person finds them bothersome.

 Extramammary breast pain. The term "extramammary" means "outside the breast." Extramammary breast pain feels like it starts in the breast tissue, but its source is actually outside the breast area. Pulling a muscle in the chest, for example, can cause pain in the chest wall or rib cage that spreads (radiates) to the breast.

Back, neck, or shoulder sprains. Breast pain can originate from outside the breast, rather than within it. For example, sprains or injuries in the back, neck, or shoulder might cause pain that a person feels in the breast.

Cervical root disorders, which people sometimes refer to as a pinched nerve, can cause breast pain. These disorders involve damage to or inflammation of a nerve root in the neck.

When people perceive pain in a broader area than the site where it originates, this is known as referred pain. The treatment relies on finding the underlying problem.

 Costochondritis. This is inflammation of the costal cartilage, which connects the ribs to the breastbone. The condition can cause sharp chest pain and tenderness, and it may have a gradual or sudden onset. The following factors may worsen the pain: Pressure on the chest, such as when wearing a seat belt, physical activity and deep breathing, sneezing, or coughing.

 Chest wall pain. A range of conditions can cause pain in the wall of the chest. This pain can sometimes feel as though it is coming from the breast, even though it is not. The pain can vary in extent, ranging from one specific area to a wide area of the breast. A person may experience: Burning or sharp pain, pain that spreads down the arm, pain that occurs when someone applies pressure to the chest wall and pain that worsens upon movement. Possible causes include: Bruising, fractured ribs, gallstones, angina and autoimmune diseases, such as rheumatoid arthritis.

The treatment will vary based on the cause, but it may involve pain management and avoiding movements that make the pain worse until the root cause has improved.

Breast cysts. These are fluid-filled sacs. They are noncancerous, relatively soft, and more common in premenopausal females. Some cysts do not produce symptoms, but others may cause pain and nipple discharge.

Unless the cysts are particularly large or painful, they do not need treatment. If treatment is necessary, it involves draining the fluid out with a needle.

Breast cancer. This occurs when cells in the breast mutate and begin growing uncontrollably. Pain in the breast is not usually due to cancer, but this is a possible cause. Other symptoms may include: a lump in the breast, any nipple discharge — bloody, clear, or otherwise, dimpling or irritation of breast skin, pulling in at the nipple or pain in the nipple, thickening or swelling of part of the breast and change in the shape or size of the breast.