Breast Pain: Be Aware to Help Yourself

Dear Readers,

As we continue our fight against the COVID-19 pandemic and aim to get life back to normal with the “shot of hope”, we must also remember that COVID-19 apart, the health care system strives to bring back effective and safe deliverance of health care, particularly cancer care.

I am Dr Kirti Katherine Kabeer, a breast specialist and oncoplastic surgeon at Kauvery Breast Clinic. Over the next few months, we at Kauvery will be taking you through the various breast complaints a woman or man can face, besides breast cancer and being breast aware and routine screening through self-breast examinations and mammograms are not only to pick up breast cancers, but to know what is normal for an individual and identify and address several benign conditions of the breast. This month we are here to tell you all you need to know about the breast pain.

Breast pain, also known as mastalgia, is a common symptom seen among women of all age groups. Most women (>70%) experience frequent breast pain at different stages of life with a percentage suffering from constant pain.

What are the types of pain and what causes pain in the breast?

• Cyclical Breast PainCyclical breast pain appears as a dull ache or heaviness within the breast. It commonly occurs in both breasts (not at all times) and may radiate to the armpit. It is usually associated with your menstrual cycle. It can occur in the pre-menstrual phase and sometimes in the mid-cycle phase during ovulation.This type of pain is self-limiting and needn’t be of concern.
• Non-Cyclical Breast PainUsually appears as a shooting or sharp pain, occurring commonly in one breast and can also radiate to the armpit. The most common cause is referred pain (pain stimulated from a location apart from the breast like the chest wall). Other causes are hormonal variations, costochondritis (inflammation of the underlying ribs), muscular strain within the supporting and surrounding muscles, inflammation/infection within the breast, unsuitable breast support and stress. It is recommended to have this type of breast pain assessed without delay.
• Breast Pain and LumpsMost painful lumps are benign (non-cancerous).They still need to be evaluated to rule out underlying sinister features. Common painful lumps seen in the breast are:
  • Breast cysts are fluid-filled sacs seen within the breast, presenting as lumps.
  • Benign fatty lumps such as fibroadenomas in the breast can also be painful, particularly if a nerve is entrapped or compressed by the lump.
  • Infections in the breast can also present as painful lumps.
  • Rarely, painful lumps can indicate an underlying pre-cancerous or cancerous lesion.

  Pain associated with a breast lump, needs to be evaluated with a clinical breast examination done by a professional and imaging such as a mammogram and/or an ultrasound of the breast.

• Breast Pain and Other Clinical Signs
  • Breast pain associated with redness of the skin or discharge of any colour could indicate infection within the breast. Do not wait to consult your doctor. Early diagnosis and treatment can avoid surgical intervention.
  • Breast pain associated with bruising and thickening could indicate trauma to the breast. This is usually self-limiting. It is best to have a scan to clarifyno other underlying sinister pathology. More often itdoes not require further intervention.
  • Breast pain with skin changes (similar to orange peel) can be due to an underlying specific type of cancer mimicking inflammation of the breast.
  • This type of breast pain should not be ignored and needs to be assessed by a specialist.

Breast Pain in Breast Feeding Moms

• When your breasts are full and engorged, it is normal for them to feel heavy and painful.
• If you notice an area of redness associated with pain, there is a possibility of a brewing infection. This commonly occurs due to blocked milk ducts and collection of the milk within the breast glands leading to infection.
• If you notice a lump that may or may not be painful after a feed/emptying your breasts, you could have a small, closed pocket of milk (galactocele) caused due to blocked ducts.
  • Address this area with a hot pack, massage and attempt expressing. If it does not settle, consult a specialist. They may advise aspiration of the galactocele under image guidance.
• If you are not able to empty your breasts satisfactorily and you notice constant pain with or without redness of the skin, consult your lactation nurse or doctor.

If you are experiencing non-cyclical breast pain, pain associated with a known breast lump or other clinical signs, consult a breast specialist to know the cause and be treated on time.