Breast Swelling – Tender, Sore & Painful Swollen Breasts

Definition of Breast Swelling

Breast swelling is an enlargement of the breast or both breasts compared to the regular breast size and may be accompanied by other symptoms like tenderness (soreness), pain, lump(s), changes of the areola or nipple and any secretion from the nipple. Swollen breasts may be a normal physiological process as seen in puberty or pregnancy or may be a sign of a medical disorder.

Tender or Sore Breast

Breast tenderness or soreness is a mild to moderate discomfort of the breast, sensitive to touch or pressure and often accompanied with redness. Tenderness and soreness should be differentiated from breast pain although this may be subjective and dependent on an individual’s pain tolerance levels.

Breast Pain

Breast pain should be differentiated from soreness or tenderness of the breast. Pain usually  indicates serious pathology that needs to be investigated and treated. Breast pain may be referred to other areas on the body like the axillae (armpits), abdomen, neck and back.

Causes of Swollen Breasts

Symptoms associated with the following conditions may not be present with every case of breast swelling. Always consult with your medical practitioner  for further investigation or to confirm a diagnosis.

Sx = symptoms. Ddx = differential diagnosis.

  • Puberty. Sx may include increasing bust size, androgenic hair (pubic hair and/or hair of the armpits), onset of menstruation (menarche), fat accumulation on the thighs, buttocks and/or lower abdomen. (1) Ddx = use of oral contraceptives.
  • Menstrual Cycle. Sx may include irritability and mood changes (premenstrual syndrome/PMS, premenstrual tension/PMT), bilateral (both sides) breast swelling and tenderness prior to menses, period pain (menstrual pain), discomfort or cramping, headache, leucorrhea / leucorrhoea (vaginal discharge). Ddx = use of oral contraceptives, fertility drugs.
  • Pregnancy. Sx may include breast tenderness, amenorrhea / amennorrhoea (cessation of menstruation – regular periods), nausea and vomiting (morning sickness), lactation, leucorrhea (clear vaginal discharge), frequent urination, darkening and/or enlargement of the areola (area around the nipple), headache, fatigue. (2) Ddx = use or contraceptives, gonadotropin releasing hormone drugs (like goserelin acetate), premature ovarian failure, menopause.
  • Lactation (breast feeding). Sx may include milk production and secretion, colostrum production and secretion before and after delivery, tender or sore breasts, palpable nodules in the breast. A differential diagnosis (ddx) would only be considered if there are other signs and symptoms like excessive pain, unilateral (one-sided) breast swelling or pus secretion from the nipple. Breast swelling and tenderness is a normal symptom of pregnancy and post-delivery.
  • Menopause. Sx include erratic periods or amenorrhea (cessation of periods), breast tenderness, weight gain,  hot flushes/flashes, mood changes. Ddx = pregnancy, premature ovarian failure, gonadotropin releasing drugs, hormone replacement therapy (HRT).
  • Drugs like gonadotropin releasing hormone, contraceptives, hormone replacement therapy (HRT), anabolic steroids.
  • Lymphadenopathy & Lympedema. Sx include enlarged lymph nodes/glands (lumps in the breast) that is usually movable. Ddx = breast infection (mastitis), breast abscess, pregnancy, lactation and most other causes of breast swelling.
  • Mastitis (breast infection) often occurs when breastfeeding. Sx may include breast pain, tenderness/soreness, redness, heat or warmth of affected area. Ddx = breast abscess, drugs. (3)
  • Breast Abscess is a collection of pus within the breast tissue. Sx = severe breast pain, fever, chills, redness, heat/warmth, discharge of pus, deviated nipple, visible lump or ‘bump’ on breast surface, deviated nipple and/or areola. Ddx = breast cancer, mastitis.
  • Breast lump. Most breast lumps are benign and may appear or disappear spontaneously.  Sx may include palpable breast lump, fixed or movable lump, visible lump or ‘bump’, single enlarged lump or many small breast lumps and bumps. Ddx = breast swelling and lumps due to lactation, lymphadenopathy, breast abscess, breast cancer, breast fat necrosis, breast cyst, fibroadenomas, papillomas.
  • Breast cancer. Sx may include painless breast lump, usually fixed and increasing in size. May be visible on the surface as a lump or bump. Deviated nipple and/or areola. Swollen lymph nodes of  the surrounding area – around the clavicle, axilla (armpit) or even of the upper arm. Ddx = benign breast lump, breast fat necrosis, papilloma, fibroadenomas, lymphadenopathy, breast abscess, swelling and lumps due to lactation. (4)
  • Breast Augmentation (enlargement or implants). Breast swelling is an enlargement due to elective cosmetic surgery. Postoperative breast infection (mastitis), breast abscess or allergic reactions may be possible and can cause further breast swelling with breast pain, tenderness or soreness.
  • Breast Reduction. Breast swelling may occur due to inflammation of breast tissue. Postoperative infection of the breast is also possible.
  • Gynecomastia is the abnormal breast swelling in males. May occur at any stage of life and should be clearly differentiated from enlarged pectoral muscles (‘pecs’) in muscular males.

Related Articles :

References :

1. Symptoms of Puberty. NHS Choices.

2. Pregnancy Symptoms. American Pregnancy Association.

3. Breast Infection (Mastitis). Emedicinehealth.com.

4. Breast Cancer. Merck.

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  • mjcwolfe

    I have had a abnormal crazy increase in my both of my breasts, they are very firm and if touched painful. Is this serious? I thought at first i was just gaining weight because i quit smoking about a month ago but i haven’t gained a pound. Why would my breasts do that? Should i consult a doctor?

  • Dr. Pravith

    Hi mjcwolfe

    A sudden increase in breast size could be weight gain which is common in smokers who quit. Even if the pounds are not showing on your scale, you could have gained fat and lost some muscle bulk simultaneously. Hormonal changes can occur after lifestyle changes, like quitting smoking and these hormonal fluctuations could contribute to both breast swelling and tenderness.

    I would advise that you consult with your gynecologist immediately to exclude pregnancy or other breast problems.

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  • roody

    I have had, for the past two weeks, some tenderness in both breast, sharp pain – like stabbing in the left breast, swollen gland with a very sore knot underneath my armpit – by my right breast, and swollen glands in my throat area. Now I’ve awaken with a sore throat. My energy level is the same as before…nothings changes. My eating habits are normal but I’m very worried. I’ve been on Augmentum for a little over a week and the swelling has decreased slightly but not as much as I would like. Any thoughts on what this could be. BTW, I have no pain or issues in my groin area.

  • Dr. Chris

    Hi Roody

    You may have experienced an infection of the respiratory tract which will cause swollen lymph nodes is all these areas. If you picked up the flu or the cold, many other lymph nodes will also be swollen and this can persist for a week or two after the infection has resolved. It is not a cause for concern as yet but as a precaution, you should visit a gynecologist and undergo a breast examination. Your age, health status, family history and previous medical history will determine whether further testing is required but this should be decided upon by your gynecologist after a consultation and physical examination.

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  • jsmusic

    I woke up yesterday and my breasts on both sides hurt really bad. It felt just like it did after I had my daughter. However I did not breast feed and my daughter is a year and a half old. It hurts not to wear a bra, it hurts when I do any motion that involves my breasts moving even a little. And it REALLY hurts if you touch my nipple. FYI, I had the depo shot in May 2010 & never followed up for a second one. I have not had a period since July and not been on any birth control either. What is going on with my body? They pregnancy test says negative. Please help.

  • Dr. Chris

    Hi JSMusic

    There is no way of telling you what is going on without examining the area, running further tests and taking your medical history into consideration. This can only be done by a doctor. The fact that the symptoms are affecting both breasts simultaneously makes it more likely that it is a systemic cause, possibly hormonal. It could be pregnancy so don’t rule that out just yet until you see a doctor and have a blood test.

  • Carole Heath

    Since i went into the menopause my breasts are normally swollen all the time, i don’t get any pain and i have regular mamograms and they were all clear glad to say. I take evening of primrose tablets as i read this help’s this problem but it doesn’t really do much to help the swollen breast problem so far. I did have swollen breast with my monthly period but once the period stopped they returned to their normal size. Can you suggest any thing i could take to help stop the breast swelling thank you Carole Heath.

  • Dr. Chris

    Hi Carole

    Breast swelling may occur if you are on HRT (hormone replacement therapy). It may be due to the type of HRT you are using as well as the dosage and you should discuss this with your gynecologist. Some women do experience breast swelling in menopause and this is just part of the process. While it is uncomfortable, there is little that can be done. Regular checks and mammograms as you are doing now are important to exclude any underlying and potentially serious conditions. Conversely, some women may find that their breast swelling eases when they start on HRT. Your gynecologist will be able to advise your further and we cannot make any other recommendations.