How to Care for Your Two Breast Friends

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, people with breasts are bombarded with information — and innuendo — about their breasts throughout their lives.

Yet where within the information overload do you ever hear about the breasts that aren’t getting enhanced or reduced or irradiated or chafed? Breasts that 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 breast. So we read your mind — and your emails — and asked Dr. Katherine Johnson, a gynecology specialist and unit director for the OB-GYN Clinic at Hall Health Center, which provides healthcare to the University of Washington community, to address your concerns. 

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 Dr. Johnson to drill down on the kinds of breast pain that you 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: the hormones estrogen and progesterone.

“Breast pain or tenderness can occur in healthy breasts during a menstrual cycle,” says Johnson.

At the start of your cycle, estrogen produced by your ovaries stimulates the growth of milk ducts in the breast. Levels of estrogen peak midcycle, which could make your breasts sensitive and sore at that time.

This type of pain is cyclic in nature, is usually present in both breasts and most notable during the three to five days before menstrual flow begins, Johnson explains.

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.

But if the breast pain associated with your menstrual cycle is difficult to bear, see your doctor. You may also need to see a breast health specialist to explore solutions.

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 can be 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, topical hormones and some diuretics may contribute to breast pain, again depending on the individual and their sensitivity. Another culprit? Hormonal contraception methods like the birth control pill, patch or ring. Though, Johnson notes that breast pain may be less common with a lower hormone dose method like the progesterone IUD (Mirena, Kyleena, and Skyla).

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. According to Dr. Johnson, it may be worth reducing or eliminating caffeine from your diet … at least right before your period.

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. 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. Tender breasts are most notable during the first trimester of pregnancy.

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. Which is why it’s often best to enlist the help of bra-fitting expert.

And don't forget about your sports bra.

"During exercise it is important to wear a sports bra that is the right fit and provides adequate support, especially for larger-breasted people. This pain may be more noticeable after prolonged, vigorous exercise,” says Johnson.

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.

This can sometimes be caused by breast trauma or injury (like bumping your breast during exercise, while you’re moving furniture, etc.) and might take a couple of weeks to resolve itself.

Another cause could be the growth of a breast cyst. Since breasts are made of milk ducts and glands, those parts can sometimes make a simple fluid-filled cyst.

“You may not be able to feel a small breast cyst, but it can cause a focal area of breast pain,” says Johnson. “This type of breast pain can be diagnosed by having a breast ultrasound. Breast cysts may resolve on their own, or sometimes larger breast cysts need to be drained by a procedure called cyst aspiration.”

And we know, cancer is always a concern. But the kind of pain we’re talking about here is more likely a cyst or benign growth, so it’s best to let a doctor investigate that one for you.

Lumpy, bumpy breasts and fibrocystic breast changes

Many people find their breasts to be lumpy. In fact, some 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.

It’s important to figure out which lumps to worry about, and only focus on the ones that are firmer or just feel a little ‘different’ than the rest of your breast. Those are the ones you can speak to your breast health expert about.

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.

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 during breastfeeding but can also occur in other situations.

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.

"It is important to have new changes of your breast, like persistent pain, skin changes, lumps or other changes in the appearance of your breast checked out by your primary care provider, OB-GYN or breast health specialist,” says Johnson.

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.

However, if you’re experiencing persistent nipple pain, nipple swelling or bleeding and other strange discharge from the piercing — get thee to your primary care provider clinic. And if your doctor seems tentative about the issue, see a breast health specialist.

Open up the discussion

Johnson also points out that we need to include transgender people in these discussions.

“Transgender women and nonbinary people on estrogen therapy may experience breast tenderness when first beginning HRT [hormone replacement therapy] as their breasts grow,” she says.

She also explains that sometimes transgender men who have had top surgery may experience localized chest pain from having a small amount of residual breast tissue — further supporting the stance that breast and chest health is a conversation that should include everyone.

Staying abreast of your health

Even though most medical organizations no longer recommend performing routine breast self-examinations, Johnson does think it’s important to be familiar with how your breasts look and feel.

“That way you can identify new changes to your breasts and discuss them with your healthcare provider,” she explains.

And when it comes to looking out for each other — isn’t that what (breast) friends are for?