1. What is chest wall pain?
Chest wall pain may feel like it’s coming from the breast, but really it comes from somewhere else. It’s also known as extra-mammary (meaning outside the breast) pain.
Chest wall pain can have several causes, including:
- Pulling a muscle in your chest
- Inflammation around the ribs, caused by conditions called costochondritis or Tietze’s syndrome
- A medical condition, such as angina or gallstones
2. Symptoms of chest wall pain
The pain can be on 1 side, in a specific area or around a wide area of the breast.
It may be burning or sharp, may spread down the arm and can be worse when you move.
You can feel this type of pain if pressure is applied to the area on the chest wall.
3. Diagnosing chest wall pain
Healthcare Information
What happens at a breast clinic appointment?
Learn what to expect at a breast clinic appointment and why you may have been referred. Find out how you’ll get your results and what to do .
See your GP if your chest wall pain is new and carries on.
Your GP will examine your breasts or chest and ask you about the type of pain you have and how often you get it.
To check how long the pain lasts for, how severe the pain is or if the pain may be linked to your periods, your GP may ask you to fill in a simple pain chart.
If your GP thinks you may have chest wall pain, they may ask you to lean forward during the examination. This is to help them work out if the pain is inside your breast or in the chest wall.
Your GP may refer you to a breast clinic, where you’ll be seen by specialist doctors or nurses for a more detailed assessment.
4. Treating chest wall pain
Treatment for chest wall pain will depend on what’s causing it.
Pulled muscle
If your pain is caused by a pulled muscle in your chest, it’s likely to improve over time and can be treated with pain relief.
Inflammation of parts of the ribs
Chest wall pain can also affect the area under the arm and towards the front of the chest, and this may be due to:
- Costochondritis – inflammation of parts of the ribs (called costal cartilages)
- Tietze syndrome – inflammation and swelling of the costal cartilages
When they examine you, your GP or specialist may be able to tell that the costal cartilages are painful.
You may find it helpful to rest and avoid sudden movements that increase the pain. Pain relief like paracetamol or ibuprofen (as a cream, gel or tablet) may help.
Your specialist may suggest injecting the painful area with a local anaesthetic and a steroid.
Smoking can make the inflammation worse, so you may find that your pain improves if you cut down or stop altogether.
Other medical conditions
Pain caused by other medical conditions, such as angina (tightness across the chest) or gallstones, may be felt in the breast.
Your GP or specialist will advise you on the most appropriate treatment.
Breast pain
Breast pain can be due to many possible causes. Most likely breast pain is from hormonal fluctuations from menstruation, pregnancy, puberty, menopause, and breastfeeding. Breast pain can also be associated with fibrocystic breast disease, but it is a very unusual symptom of breast cancer.
Considerations
There are many possible causes for breast pain. For example, changes in the level of hormones during menstruation or pregnancy often cause breast pain. Some swelling and tenderness just before your period is normal. Some women who have pain in one or both breasts may fear breast cancer. However, breast pain is not a common symptom of cancer.
Causes
- Menopause (unless a woman is taking hormone replacement therapy)
- Menstruation and premenstrual syndrome (PMS)
- Pregnancy — breast tenderness tends to be more common during the first trimester
- Puberty in both girls and boys
Soon after having a baby, a woman’s breasts may become swollen with milk. This can be very painful. If you also have an area of redness, call your health care provider, as this may be a sign of an infection or other more serious breast problem.
Breastfeeding itself may also cause breast pain.
Fibrocystic breast changes are a common cause of breast pain. Fibrocystic breast tissue contains lumps or cysts that tend to be more tender just before your menstrual period.
Certain medicines may also cause breast pain, including:
- Oxymetholone
- Chlorpromazine and other antipsychotic medicines
- Water pills (diuretics)
- Digitalis preparations
- Methyldopa
- Spironolactone
- Oral contraceptives
- Estrogen replacement therapy
- Selective serotonin reuptake inhibitors, such as fluoxetine
Shingles can lead to pain in the breast as there is a painful blistering rash that appears on the skin of your breasts.
Home Care
If you have painful breasts, the following may help:
- Take medicine such as acetaminophen or ibuprofen
- Use heat or ice on the breast
- Wear a well-fitting bra that supports your breasts, such as a sports bra
There is no good evidence to show that reducing the amount of fat, caffeine, or chocolate in your diet helps reduce breast pain. Vitamin E, thiamine, magnesium, and evening primrose oil are not harmful, but most studies have not shown any benefit. Talk to your provider before starting any medicine or supplement.
Certain birth control pills may help ease breast pain, although in other cases it may cause breast pain. Ask your provider if this therapy is right for you.
When to Contact a Medical Professional
Contact your provider if you have:
- Bloody or clear discharge from your nipple
- Given birth within the last week and your breasts are swollen or hard
- Noticed a new lump that does not go away after your menstrual period
- Persistent, unexplained breast pain
- Signs of a breast infection, including redness, pus drainage, or fever
What to Expect at Your Office Visit
Your provider will perform a breast examination and ask questions about your breast pain. You may have a mammogram or ultrasound.
Your provider may arrange a follow-up visit if your symptoms have not gone away in a given period of time. You may be referred to a specialist.
References
Family Practice Notebook website. Medication causes of mastalgia: breast pain due to medication.
. Accessed January 1, 2023.
Klimberg VS, Hunt KK. Diseases of the breast. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. St Louis, MO: Elsevier; 2022:chap 35.
Sandadi S, Rock DT, Orr JW, Valea FA. Breast diseases: detection, management, and surveillance of breast disease. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 15.
Sasaki J, Geletzke A, Kass RB, Klimberg VS, Copeland EM, Bland KI. Etiology and management of benign breast disease. In: Bland KI, Copeland EM, Klimberg VS, Gradishar WJ, eds. The Breast: Comprehensive Management of Benign and Malignant Diseases. 5th ed. Philadelphia, PA: Elsevier; 2018:chap 5.
