Breast Pain, Fibrocystic Changes

Frederick R. Jelovsek MD

Nipple soreness
Dull constant pain behind in left breast
Breast soreness/possible infection
Painful mass/possible cancer
Lymphedema and pain following lumpectomy and radiation

Nipple soreness

Over the past couple of days my nipples have become very sore--like they are really irritated. At times, they feel almost as though they are on fire! If it gets cold in the room and they "pop up" so to speak, it is worse. I haven't had sex for quite some time (almost a year, by personal choice), so pregnancy isn't a concern here. I'm due to start my period on Thursday,and I realize that this could very well be PMS, but I don't usually have this as a symptom, not with this "irritated" feeling, anyway. Usually if my breasts are sore, they follow a dull ache. I'm not on the pill or any type of hormones, either. There is no discharge or swelling. What is going on?

I do not think what you describe is due to PMS symptoms. It sounds more like a reaction of the skin of the nipples such as an eczema or dermatitis. Are you using any different lotions or soaps (body or laundry) or is it possible the nipples are being irritated during exercise or daily activity? Do you have any other areas on the body that show unusual changes?

Dull constant pain behind in left breast

I have a dull fairly constant pain mostly in the upper left breast and directly behind it. I also have pain in the left arm. I had a normal 24-hour monitor EKG and Stress Test EKG to rule out cardiac problems. I have anxiety attacks and currently take 50 mg. of Luvox daily. I keep thinking this pain has to be my heart. Could it be that because I have large breasts (and the left is the larger of them), the pain is simply pulling on ligaments/tissue or whatever. All mammograms are normal.

The pain could be due to the weight of the breast especially if the bra size is a D or greater. Wearing a sports bra day and night, stopping all caffeine intake, and back muscle exercises for about one month may help identify if the pain is due to suspensory ligaments. If this helps, you may want to consider some resection of excess breast tissue if the pain is recurring and very bad. A plastic surgeon can tell you if removing some of the tissue is likely to help.

Breast soreness/possible infection

I am 34 and I go every year for a mammogram because of my family history and my problems with my breasts. (I had 2 biopsies in my left breast 2 years ago.) For the past week, my breasts have been very sore and swollen. I went to the doctor and he said the ducts are infected and he can feel a cyst or lump. He put me on antibiotics for a week and then I have to go back to see him. What causes ducts to get infected? Should I be concerned?

Yes, you do need to follow this up. Breast ducts rarely get infected in the absence of sucking such as when nursing an infant. If the antibiotics do not clear this up within 7 days, you need to see a breast specialist/surgeon to be sure that you do not have something else going on, such as an inflammatory carcinoma of the breast which can present like an infection (mastitis).

Painful mass/possible cancer

I have a painful area in my breast that the doctor says feels like a mass or a cyst and he is sending me to get a mammogram on Monday. I thought cancer would not cause pain. Is that true? Also, I heard cancer of the breast usually can be found in the upper outside quadrant. That is where my lump or cyst is. Thanks again for your help.

In general, cancer of the breast is less likely to be painful and is associated with pain in less that 10% cases. However, a cancer can sometimes cause pain, especially in younger women and especially if there is an inflammatory carcinoma.

Even if the mammogram is negative, be sure to have the mass evaluated by a breast surgeon. Mammograms are reported (false) negative 15-20% of time with a breast cancer and a palpable mass would need further attention.

Lymphedema and pain following lumpectomy and radiation

Last August I had a lumpectomy for breast cancer. I elected not to have chemotherapy because all axillary nodes were clear. I started radiation, but got a bad burn the first week and quit. Now 5 months later I have swelling of my arm and intermittent breast pain. My doctor prescribed pain meds, did a chest X-ray (which was negative), and referred me to physical therapy for lymphedema. Does the lymphedema cause the breast pain? Any recommendations on further diagnostic tests or therapy. I don't want to live on pain meds.

Lymphedema can cause breast pain although most of the time it is arm pain. As far as further studies, ask your breast surgeon if any further diagnostic studies are needed and whether the surgeon thinks you might benefit from a compression sleeve.

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