What is this sharp pain under my left breast?

Chest wall pain

Chest wall pain may feel as though 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 a number of 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

Breast pain can have a number of other causes, but on its own is not usually a sign of breast cancer.

2. Symptoms of chest wall pain

The pain can be on one 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.

This type of pain can also be felt if pressure is applied to the area on the chest wall.

3. Diagnosing chest wall pain

See your GP if your breast pain is new and carries on.

Your GP will examine your breasts and take a history of the type of pain you have and how often it occurs. To check how long the pain lasts for, how severe the pain is or if the pain may be linked to your menstrual cycle, 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 assess 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.

If it’s found that your breast pain is caused by a pulled muscle in your chest, this is likely to improve over time and can be treated with pain relief.

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’s syndrome – inflammation of the costal cartilages and swelling

Your GP or specialist may be able to tell that the costal cartilages are painful if pressure is put on them. Sometimes this inflammation can feel similar to heart (cardiac) pain. You may feel tightness in the chest and a severe, sharp pain. The pain may also spread down the arm and can be worse when you move.

You may find it helpful to rest and avoid sudden movements that increase the pain. Pain relief such as paracetamol or a non-steroidal anti-inflammatory such as ibuprofen (as a cream, gel or tablet) may help.

Your specialist may suggest injecting the painful area with a local anaesthetic and steroid.

Smoking can make the inflammation worse, so you may find that your pain lessens if you cut down or stop altogether.

The NHS website has more information about costochondritis and Tietze’s syndrome.

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.

5. Coping with chest wall pain

Any type of breast pain can be very distressing, and many women worry they may have breast cancer. However, in most cases pain in the breast isn’t a sign of breast cancer.

Having breast pain doesn’t increase your risk of breast cancer. However, it’s still important to be breast aware and go back to your GP if the pain increases or changes, or you notice any other changes in your breasts.

Pleurisy

Pleurisy is inflammation of the sheet-like layers that cover the lungs (the pleura).

The most common symptom of pleurisy is a sharp chest pain when breathing deeply. Sometimes the pain is also felt in the shoulder.

The pain may be worse when you cough, sneeze or move around, and it may be relieved by taking shallow breaths.

Other symptoms can include shortness of breath and a dry cough.

Visit your GP if you experience the above symptoms. Seek immediate medical help if your chest pain is severe, particularly if you also have other symptoms, such as coughing up blood, nausea or sweating.

Seeing your GP

Pleurisy can usually be diagnosed by studying your symptoms. Your GP can listen to your chest to check for the distinctive dry, crunching sound that suggests you may have pleurisy.

Further tests may be needed to identify the underlying cause of your pleurisy and to assess how severe it is. These can include:

• blood tests to determine whether you have an infection or an autoimmune condition
• chest X-rays
• an ultrasound scan
• a computerised tomography (CT) scan
• a biopsy – a small sample of pleural or lung tissue is removed for further testing

What causes pleurisy?

Most cases are the result of a viral infection (such as the flu) or a bacterial infection (such as pneumonia).

In rarer cases, pleurisy can be caused by conditions such as a blood clot blocking the flow of blood into the lungs (pulmonary embolism) or lung cancer.

Pleurisy can affect people of all ages, but people of 65 years and over are most at risk, because they’re more likely to develop a chest infection.

How is pleurisy treated?

Treatment for pleurisy depends on the underlying cause.

For example, pleurisy caused by a viral infection will often resolve itself without treatment. However, pleurisy caused by a bacterial infection is usually treated with antibiotics, and people who are frail or already in poor health may be admitted to hospital.

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are often used to relieve the chest pain associated with pleurisy.

If excess fluid builds up between the pleural layers, it may be necessary to drain the fluid to prevent breathing difficulties.

Causes of pleurisy

Pleurisy is inflammation of the pleura. It’s usually caused by another condition, such as an infection, but sometimes no cause can be identified.

The pleura are two thin sheets of tissue that separate the lungs and ribcage. One is attached to the ribcage and the other is attached to the lungs.

Between the pleural sheets is a thin layer of liquid that lubricates the pleura, helping to reduce friction when you breathe in and out.

When there’s inflammation, the surfaces of the two layers can become rough and the fluid can become sticky. This can cause the layers to rub together, resulting in pain and discomfort.

Infection

An infection is the most common cause of pleurisy. Any type of infection has the potential to spread to the pleura, but viral infections are usually responsible. Viruses known to cause pleurisy include:

• the influenza (flu) virus
• the Epstein-Barr virus – which causes glandular fever
• cytomegalovirus (CMV) – a common virus found in most people, which doesn’t usually cause any noticeable symptoms
• parainfluenza – the virus that causes the childhood condition croup

In some cases, pleurisy is caused by bacteria, such as:

• streptococcal bacteria – often associated with pneumonia, throat infections and some types of skin infections, such as impetigo and cellulitis
• staphylococcal bacteria – often associated with skin infections, food poisoning and, more seriously, blood poisoning (sepsis)

Meticillin-resistant Staphylococcus aureus (MRSA) can cause pleurisy, especially in hospital patients. MRSA is a type of bacteria with a resistance to a number of commonly used antibiotics.

Other causes

Other possible causes of pleurisy include:

• injury – if the ribs are bruised or fractured, the pleura can become inflamed
• pulmonary embolism – a blood clot developing inside the lungs
• sickle cell anaemia – a blood disorder that usually affects people of African or Caribbean descent
• chemotherapy and radiotherapy
• HIV or AIDS
• lung cancer
• mesothelioma – a type of cancer caused by inhaling asbestos

Autoimmune conditions, such as rheumatoid arthritis and lupus, are other possible causes of pleurisy. In these conditions, something goes wrong with the immune system (the body’s natural defence against infection and illness) and it begins to attack healthy tissue.

Treating pleurisy

Treatment for pleurisy usually involves relieving pain and treating the underlying cause of the condition.

If treated promptly, pleurisy often resolves without any lasting damage to the lungs.

Treating pain

The chest pain associated with pleurisy can be treated using a type of painkiller known as non-steroidal anti-inflammatory drugs (NSAIDs). Most often, ibuprofen is used.

If NSAIDs are ineffective or unsuitable, you may be prescribed another painkiller, such as paracetamol or codeine.

It may seem strange, but lying down on the side of your chest that hurts may also help to reduce the pain.

Treating the underlying cause

It may also be necessary to treat the underlying cause of your pleurisy.

If you have pleurisy caused by a bacterial infection, you’ll need a course of antibiotics. Depending on the severity of your symptoms, this may be either tablets or injections. Combinations of different antibiotics are sometimes used.

However, if your pleurisy is caused by a viral infection, further treatment may not be required, as the infection usually resolves itself after a few days.

In cases where your symptoms are particularly severe or you’re already in poor health, you may need to be admitted to hospital so your body’s functions can be supported until your condition stabilises.

Pleural effusion

In some cases, pleurisy causes a build-up of excess fluid around the lungs called pleural effusion.

Pleural effusion can result in shortness of breath that gets progressively worse. This is more likely in cases of pleurisy caused by pulmonary embolism or a bacterial infection.

If pleural effusion doesn’t clear up as your pleurisy is treated, or if you’re very short of breath, a tube will need to be inserted so the fluid can be drained away.

The tube may be inserted using either general anaesthetic (where you’re asleep) or local anaesthetic (the area where the tube is inserted is numbed).

If a lot of fluid has to be drained away, you may need to stay in hospital for a few days.

Breast pain

The female breast is either of two mammary glands (organs of milk secretion) on the chest.

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

Some breast tenderness is normal. The discomfort may be caused by hormone changes from:

• 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.

Version Info

Last reviewed on: 10/10/2022

Reviewed by: Jonas DeMuro, MD, Diplomate of the American Board of Surgery with added Qualifications in Surgical Critical Care, Assistant Professor of Surgery, Renaissance School of Medicine, Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.