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BREAST PAIN

Overview

Breast pain is a pain in one or both breasts that may vary in severity. The clinical term used for this condition is known as mastalgia. It occurs mostly in women, but it can also affect men and transgender people. The majority of the cases of breast pain can be managed well if they are mild. If breast pain is persistent or accompanied by discharge, it may point towards a serious underlying condition that needs proper medical attention. Unlike the common assumption, breast pain is not usually a presenting sign of breast cancer and occurs due to various other causes.

Causes

One of the most common causes of breast pain is fluctuating hormone levels. This can occur during premenstrual syndrome (PMS), menstruation, and pregnancy. Changes in the levels of estrogen and progesterone affect the milk glands and milk ducts within breasts. This may cause mild to moderate breast pain. Hormonal fluctuations can also occur due to stress or anxiety. Men may also experience breast pain due to varying hormonal levels. Transgender men and women are likely to experience breast pain due to a significant change in normal hormonal levels.
Another cause of breast pain is breast cysts which commonly occur with increasing age. After menopause, mammary tissues get replaced by fat tissues over time. During this process, cyst formation may occur, which causes pain. It may affect one or both of your breasts. A certain majority of lactating mothers also experience breast pain. It can be due to breast engorgement, infection of the milk glands, obstruction of the milk ducts, or other factors.
Other causes for breast pain include infections, excessively tight bras, dietary insufficiency, obesity, smoking, medications (hormonal therapy, antidepressants, antibiotics, etc.), and history of previous breast surgery.

Types

Breast pain can be divided into two: cyclic breast pain and non-cyclic breast pain.
Cyclic breast pain is most often related to the menstrual cycle. It may occur before or during menses and affects both breasts. The pain can be a dull ache along with a sensation of heaviness. It can also happen after menopause due to fibrocystic changes.
Non-cyclic pain is not associated with the menstrual cycle or hormone levels. It can occur due to infection of the mammary glands or ducts, hormonal therapy, medications, previous breast surgery, or other factors. This type of pain may be a sharp ache limited to the affected breast region. It is more localized and occurs in one of the breasts in the majority of the cases.

Risk Factors And Epidemiology

Aging is an important risk factor for breast pain as breast cells go through certain changes as the person ages. Changes in hormonal level at puberty or menopause are another risk factor. Females with diseases like polycystic ovary syndrome (PCOS) etc. may experience breast pain due to fluctuant hormonal levels. Smoking, alcohol, caffeine, and intake of greasy food may also be contributing factors. People who are undergoing gender transformation are also at risk.
Cyclic breast pain can occur at any age, but non-cyclic breast pain usually occurs after menopause. Women and transgender people are more likely to experience breast pain than men.

Signs And Symptoms

Pain in one or both breasts is a symptom of some underlying condition. This pain may vary in duration, severity, location, and recurrence. Breast pain linked with the menstrual cycle is recurrent and affects both breasts. Cysts or mass within breast tissues may cause pain and tenderness in the affected breast. In lactating mothers, breasts may appear engorged and become sensitive to touch in some cases. If an underlying infection is present, there may be pus discharge from the nipples and pain.

Diagnosis

Diagnosis of breast pain requires a detailed history of the person followed by a clinical examination of the breasts. Onset, duration, severity, and recurrence patterns are noted down. Breasts are palpated to observe tenderness or any underlying mass. If an infection is suspected, your doctor may require routine tests such as CBC, ESR, etc., along with a sample test if pus discharge is present. Radiographic imaging techniques are used in certain cases to identify the cause. These may include ultrasound, mammography, CT scans, and MRIs. If a tumor is suspected, your doctor will perform a biopsy in which a section of tissues is taken from the affected breast region and examined for the presence of cancerous cells.

Differential Diagnosis

Causes of breast pain should be differentiated from other causes of chest pain such as heart attack, lipoma, herpes zoster infection, rib fractures, fat necrosis, Mondor’s disease, etc.

Treatment

Treatment of breast pain depends on its underlying cause. Mild to moderate breast pain associated with the menstrual cycle or pregnancy can be managed with supportive care. It includes intake of diet supplements if necessary, warm oil massages, placing ice packs, wearing supportive bras, and intake of mild pain killers. Severe breast pain requires medical attention to identify the causative factor first. A strong dose of analgesics may be prescribed along with medications that balance your hormonal levels. Dietary changes are recommended to women who lack essential nutrients in their bodies. Counseling and reassurance by a specialist are also needed to ensure that the condition will resolve independently and is not related to breast cancer.

Medication

Analgesics such as acetaminophen, diclofenac etc. are given to relieve severe pain. In certain cases, estrogen-blockers such as tamoxifen may be given to balance hormonal levels.

Prognosis

The majority of breast pain cases recover on their own and do not require any particular treatment. Breast pain is not usually associated with breast cancer. Cyclic or recurrent breast pain can be managed well with medicines and supportive care.

Prevention

It is difficult to prevent most causes of breast pain. Still, some degree of prevention can be achieved by wearing a supportive bra, managing weight, improving dietary intake, avoiding oily or greasy foods, limiting smoking and caffeine intake, and avoiding using medications without prescription (contraceptives, hormone therapy, etc.). Heavy weight lifting or strenuous physical activity involving arms and chest muscles should be limited.

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