Breasts certainly get a lot of press. From boob jobs gone wrong to everything you wanted to know about breastfeeding (and then some) to breast cancer awareness, women are bombarded with information — and innuendo — about their breasts throughout their lives.
Yet where within that breast information overload do you ever hear about the ordinary breast? Breasts that aren’t getting enhanced or reduced or irradiated or chafed, but are doing quite nicely nonetheless, thanks for asking.
Chances are you still have the occasional question about your own unique combination of fat, connective tissue, mammary glands and milk ducts known as the female breast. So we read your mind — and your emails — and asked Mary Laya, M.D., breast health specialist at Women’s Health Care Center at University of Washington Medical Center-Roosevelt, to address your concerns.
Breasts sometimes hurt — and that’s normal
Let’s begin by assuring you that breast pain is rarely a sign of breast cancer. Phew, got that one out of the way.
Just like everything else in your body that can hurt upon occasion, breasts sometimes do, too. There’s even a special word for it: “mastalgia.” Yep, sounds like “nostalgia,” but so not.
Different kinds of pain can mean different things. So we asked Laya to drill down on the kinds of breast pain that women might experience and why.
Breast pain that corresponds with your menstrual cycle
Breast pain that corresponds with your menstrual cycle is usually caused by the same friends that bring us that monthly visit from Aunt Flo: the hormones estrogen and progesterone.
“Painful or tender breasts are part of the response to normal hormone fluctuations,” says Laya.
At the start of your menstrual cycle, estrogen produced by your ovaries stimulates the growth of milk ducts in the breast. Levels of estrogen peak midcycle, making some women’s breasts sensitive and sore at that time.
But the most common scenario is when breasts become sore and tender just before your period, says Laya.
You have progesterone to thank for that. Progesterone levels rise in the second half of your cycle, stimulating the formation of your breast’s milk glands, just in case you might need them should the stars (and sperm and egg) align.
To complicate matters, hormonal birth control can sometimes relieve breast pain and sometimes stimulate it, depending on the individual.
“Each woman is a little different in how she responds to hormones. This is where no one is exactly the same,” says Laya.
But if the breast pain associated with your menstrual cycle is difficult to bear, see your primary care provider. You may also need to see a breast health specialist to explore solutions.
“You don’t have to just live with it,” says Laya.
Noncyclic breast pain
Noncyclic breast pain is not related to your menstrual cycle or hormones (unless you are using a hormonal ointment of some kind). Instead, noncyclic breast pain is most often caused by medication, diet, your bra or — surprise! — early pregnancy.
Medications. Drugs to treat cardiovascular issues and high blood pressure as well as acne medication, birth control, topical hormones and some diuretics may contribute to breast pain, again depending on the individual and her sensitivity.
Diet. Yep, you guessed it: Your favorite foods are also the ones most likely to trigger breast pain. Caffeine-containing beverages and foods high in saturated fat are fun for taste buds but not so fun for breasts. And combining these two (chocolate java lava cake, anyone?) is a double whammy.
Ginseng. Certain herbs such as ginseng may increase breast tenderness. Remember that ginseng may be hiding in your energy drink or herbal supplement, too. But you can still use your ginseng-infused face cleanser because ginseng is not absorbed through skin.
Pregnancy. Wow, you’re in for it now. I mean, congratulations! One of the very first signs of pregnancy can be breast tenderness one to two weeks after you conceive. Say hello to your new bestie, progesterone, who will be your 24-hour companion for the next many long weeks. Progesterone helps to maintain your pregnancy until birth.
Your bra. Instead of supporting your breasts, an ill-fitting bra might lead to breast pain instead. Too tight is a problem and so is too loose; you want a bra that fits just right. If your breasts are on the large side, your back, neck and shoulders might also suffer.
“You would be surprised at the number of women who wear a bra that doesn’t fit. Women sometimes don’t believe that the solution to their breast pain can be that easy, but oftentimes, it really is. At the very least, it’s worth getting a professional bra fitting to find out,” says Laya.
It’s also important to get a well-fitting sports bra.
“Pay as close attention to your sports bra as you do your regular bra,” says Laya.
Breast pain in one specific spot
Focalized breast pain is pain that occurs spontaneously in a distinct area of the breast. It’s the kind of pain that doesn’t move around but is at one spot that you can point to.
“If you can say something like, ‘It’s the size of a silver dollar, right here on the side of my breast, and it hurts pretty consistently,’ then that’s the kind of pain you should see a doctor for,” says Laya.
While cancer is always a concern, that kind of pain is more likely a cyst or benign growth. Let a doctor investigate that one for you.
Lumpy, bumpy breasts and fibrocystic breast changes
Many women find their breasts to be lumpy. In fact, some women’s breasts are just generally lumpier than others, which has to do with the differing ratios of fat and connective tissue that are unique to each individual.
If you can feel the lumpiness consistently throughout the breast — and there’s nothing new or different about it — it is most likely normal breast tissue.
In the past, women with lumpy breast tissue that became sensitive before their periods were diagnosed with “fibrocystic breast disease.” Now, because most fibrocystic breast changes are normal and more than half of women experience fibrocystic breast changes at some point in their lives, medical professionals no longer refer to these characteristics as a disease.
“Lumpy breasts are just a part of the spectrum of breasts, and young women’s breasts tend to be lumpier than older women’s breasts. When you’re trying to figure out which lumps to worry about, pay attention to the ones that are firmer or just feel ‘different’ somehow from the others,” says Laya.
And remember that the lump may well be a benign cyst or a fibroadenoma, which is a disorganized collection of benign tissue that can form a little ball in the breast.
“Most lumps are not cancerous, but they need to be evaluated. Depending on what it is, then the discussion can begin on what to do next,” says Laya.
When your breasts swell or don’t look so swell
Swelling is most often associated with menstrual cycle changes. But if a breast is swollen, red, warm and tender to the touch, you may have mastitis.
Mastitis is caused when a milk duct becomes blocked and infected. It’s most common in women who are breastfeeding but can also occur in women who are not.
Treat swelling like you would any other change and get it looked at by a medical professional. Mastitis is most commonly treated with an antibiotic.
Same goes for any other change that you notice in your breast or nipple, such as dimpling, puckering, scaling, redness, itching, nipple discharge or nipple inversion.
“With an issue like this, go to your primary provider or a breast health specialist. That’s what we’re here for,” says Laya.
When your nipples are wearing jewelry
For the most part, well-cared-for and well-placed nipple piercings that were done professionally won’t lead to any problems.
“A lot of women come in with nipple piercings. People generally have no trouble with them, but they can occasionally introduce infection or impede drainage of normal secretions,” says Laya.
And if you or your partner’s version of fun is giving that nipple jewelry a tug, Laya says that it’s important to pay attention to your comfort threshold.
“If you’re still feeling the hurt four to six hours later, chances are you’ve overdone it.”
What should you do in such a case? You guessed it: Get thee to your primary care provider. And if your primary care provider seems tentative about the issue, see your breast health specialist.
“We’ve seen it all,” says Laya. “A woman should never be even a tiny bit shy about seeing a breast health specialist.”