Dedicated to the care of breast cancer and all breast conditions
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info@raynebreastcare.co.za
Parklane Hospital Women’s Wellness Centre
Waterfall Hospital (North): Rooms 210, South Block
 
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Breast Pain  
Breast pain, or mastalgia, is a really common breast symptom that accounts for nearly half of all breast-related visits to doctors. It can be a very difficult problem to treat because there are lots of different reasons that breast pain can occur, and there are not good proven methods of treating every type of pain.Whenever you have a problem with your breasts sometimes people wonder “Could this be cancer?”. It is really rare for pain alone to be the first sign of breast cancer but it is always wise, whenever there is a change in the breast, to get it checked out. This should include a thorough consultation and examination and will include some investigations, depending on your symptoms and age.

The main causes can be separated into three groups, although as an individual patient you might find that you experience elements from more than one group. Read more about what your breast pain could be by clicking on the links below.

Cyclical mastalgia (related to your period)
Non-cyclical mastalgia (can happen at any time during the month)
Non-breast causes and large breasts
Cyclical breast pain
This type of pain is related to the monthly hormonal balance in the body and your monthly period. It is most common in women in their 20s and 30s and can get better with pregnancies and the menopause. Normally the pain is felt as a heaviness, an uncomfortableness or an aching in the breasts, particularly in the upper outer areas closest to the armpits. It might spread to the shoulder or arm.

Sometimes pain like this can be trivialised and see as a normal part of a woman’s life, but it can be really debilitating: it interferes with sleep, work physical activity and interferes with sexual activity in nearly 50% of women who have it. It is also associated with increased levels of anxiety and depression.

During the second half of the monthly cycle there is a swelling of the breast tissue as fluid is retained and blood supply increases. This appears to be the direct cause of the pain butdespite lots of studies, there is still a debate as to what causes this type of pain in some women and not others. Some studies blame fibrocystic changes in the breast, although these are as common in women without pain, and other studies have looked at hormonal imbalances in oestrogen and progesterone. Dietary fat, abnormal levels of fat and the breakdown of fats in the body do appear to be related to this type of breast pain.

After a full history, examination and investigations to ensure no other cause and to rule out cancer, often the reassurance that this is a normal part of the menstrual cycle is enough to manage the pain. However if the pain last for more than 7 days or is severe there are a number of treatments that may help. Simple measures include a well-fitting bra ( Are you wearing the right size? Check here[to add link]), a low-fat diet, simple exercise (with a good sports bra), night-time support and simple painkillers. While the evidence for these supplements is lacking, Evening Primrose Oil and Vitamin E are found to help by some women and flaxseed supplements or using flaxseed in your diet can reduce the pain.

More severe pains may respond to stronger prescription medicines such as Danazol and Tamoxifen but these have significant side-effects and should only be started by a specialist and used for a short period of time. Using oral contraceptives may make this pain better or worse.

This type of pain normally gets better with age and will improve after the menopause.
 
Non-cyclical mastalgia
Non-cyclical mastalgia involves occasional or long-lasting pain that is unrelated to the menstrual cycle. It can occur in women before or after the menopause but normally a little later in life than cyclical pain. It affects one-third of women with breast pain. Non-cyclical pain may be similar to cyclical pain, with diffuse heavy uncomfortable feelings in both breasts, tenderness and/or feeling engorged, or it may be more focal: the pain can be burning, aching, sore or jagging pin-point pains.

There are lots of reasons why this type of pain occurs. It may have a hormonal cause like cyclical pain but where the breasts have become sensitised to the normal levels of hormones circulating, or it can be associated to hormone replacement therapy (HRT). It may also have an anatomical reason and be related to dilatation of the breast ducts (called duct ectasia- typically a burning shooting pain around the nipples), or related to cysts in the breast.

One-sided focal intense pain was associated to breast cancer in 2-7% of women with breast pain in one study, and it is particularly important to rule out cancer through clinical examination and mammogram. In most women, once cancer is excluded, simple measures can help. These includes well-fitting bra ( Are you wearing the right size? Check here, a low-fat diet, simple exercise (with a good sports bra), night-time support and simple painkillers. While the evidence for these supplements is lacking, Evening Primrose Oil, Vitamin E and flaxseed supplements have all been described as useful, but true evidence is lacking. Avoiding caffeine is also sometimes advised but there is no evidence to support this either.

More severe pains may respond to stronger prescription medicines such as Danazol and Tamoxifen but these have significant side-effects and should only be started by a specialist and used for a short period of time.
 
Extramammary pain
When is a breast pain not a breast pain?... when it doesn’t come from the breast.

There are lots of structures which surround the breast that can cause pain which feels as if it is related to the breast. That is why a good consultation and examination looking at the whole chest and body can help.

Most common is pain from the chest wall- called costochondritis- where there is an inflammation of the muscles and bones of the rib cage causing pain in the whole chest. Caused by repetitive sports using these muscles, a viral infection or simply with no cause, the junctions of the rib cage can become inflamed and cause a tenderness, making it difficult to be touched, sometimes difficult to move easily and cause a general aching all over the breast region. Rest, a course of anti-inflammatory medications and reassurance often help although these problems can reoccur.

Other more distant causes of pain can include reflux, heartburn and indigestion; heart problems such as angina and inflammation of the heart; and shingles- especially if the pain is really really sore on one side only.
 
Increased breast size
The breasts need support, especially if they are large, otherwise they will pull on the muscles, bones and skin of the chest wall. This can cause pain inside the breast, most commonly towards the end of the day, and pain in the back and shoulders.

The first step in combatting this is getting a good well-fitting bra (Are you wearing the right size? Check here, paying particular attention to the cup size, wide shoulder straps, and making sure your breasts are supported from below. If your breasts are very large or uncomfortable, breast reduction surgery may be a possibility. This is carried out by a plastic surgeon, and is available to government and private patients, although most medical aids do not routinely cover this procedure.
 
 
 
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