A very common cause for concern among our patients is breast pain. This is particularly common in perimenopausal women. Breast pain is invariably due to hormonal stimulation of the breast tissue, which causes it to swell and become tender and lumpy to the touch. Fifty percent of the time, breast pain is in one breast only and localized to a certain area of that breast. It is most common in the upper, outer aspect of the breast, often radiating into the under arm area. The second most common area to experience breast pain is deep to the nipple. Breast pain or tenderness can be very variable in character. Patients often describe it as tingling sensations, dragging sensations, pins and needles sensations, dull constant pain, and sharp intermittent pain.

More rarely, the breast pain is due to other causes such as shingles, costochondritis, referred nerve pain, abscess, mastitis, and severe fibrocystic changes. If pain is only on the left side, cardiac pain has to be ruled out.

If the breast tissue is "fatty" and the mammogram is normal, no further diagnostic work-up is necessary. If you have a dense breast, i.e., a lot of normal fibroglandular tissue, which can obscure underlying lumps on a mammogram, we will usually perform an ultrasound to exclude the possibility of an underlying lump. Occasionally, the pain can be due to a cyst and rarely an unsuspected breast cancer is found in the area of the pain. Breast cancer is not painful, but an unsuspected breast cancer can be present in a dense breast, so we will usually perform ultrasound to exclude this possibility.

Reducing your caffeine intake, which includes chocolate, often significantly decreases the pain. Hopefully this information will answer some of your concerns.

Best regards,
Belinda Barclay-White, MD