Learn the Basics

Breast Pain

Breast pain can be totally nothing or it can be a serious infection. Let’s figure out what’s going on with you.

Breast pain is any pain that you feel in your breast tissue, as opposed to your areola or nipple.

Breast pain falls into two main categories: pain accompanied by visible symptoms and pain without visible symptoms.  

When you can see or feel a troublesome spot and you feel breast pain, there are a few potential issues to consider:

  1. Engorgement: Shortly after your milk comes in, around three to four days postpartum, you may notice both of your breasts become very firm and tender. The skin on your breasts may feel very tight and your nipples and areola may flatten, and because your breasts are so full and the areola is so taught, you may find that baby has a difficult time latching or that latching has become newly painful. You may also develop a low-grade fever. After baby has nursed well or you have pumped your breasts, they still don’t feel soft. This is engorgement. You may also experience engorgement after the first week of breastfeeding if you go longer than usual between feedings, such as if the baby unexpectedly sleeps a longer stretch than usual.
  2. Plugged duct: A plugged duct can happen any time during breastfeeding. Sometimes, milk doesn’t drain well from your breast and it becomes “clogged.” The result is a firm section of your breast that may be tender to the touch. Some women describe this as a sphere, like a walnut, a golf ball, or even a tennis ball. Other women feel it as a long tube from their chest wall to their nipple. Others may experience a whole section of their breasts that just feels “hard.” This is a plugged milk duct. If you have a plug that lasts for more than four days without getting any smaller, go to your midwife or OB and have her look at it. This could turn into mastitis or an abscess if we don’t get it out.
  3. Mastitis: Also known as a breast infection, mastitis often feels like the flu. You may have body aches and chills. You may have a fever of 100.4 or higher. Your breast may be red and tender to the touch. Mastitis often comes with or after a plugged duct, but you don’t have to feel a plug to get mastitis. If you are at all suspicious that you may have mastitis, especially if you have a fever, call your midwife or OB on call. Yes, this is an emergency. No, you aren’t bothering her. Call. Mastitis can turn into an abscess, which can require a breast surgeon. Let’s avoid that, okay? Please call.

When you can’t see or feel a troublesome spot and you feel breast pain, consider these possibilities:

  1. Let-down pain: Not everyone can feel their let-down and that is perfectly normal. Others can, and they may describe it as painful, like a sharp stabbing pain in their breasts. Others say it is tingly or “like lightning.” Some describe it as a muscle cramp. Some say it is itchy. Others say it feels like a pulling sensation deep in their breasts. Some have no idea when they are letting down; others can tell the second it happens. Let-down pains happen randomly. It can happen in either breast or in both breasts at once. It may happen when your breasts are full and it is time to feed/pump or while the baby is feeding or you are pumping. 
  2. Random boob pain: “Zingers,” as we like to call them, are random, fleeting painful sensations in your breasts. There is often no consistency or pattern to them. They change locations in your breast. You cannot find any one spot on or in your breasts that seems to be the culprit. They are not a cause for concern.

Nipple pain causing breast pain: If you are having breast pain, but you aren’t able to find a clog or an area of fullness, nor do you see a red streak, and the pain seems to be originating from your nipple, you may be having pain radiating from your nipple. 

If you have had more than two plugged ducts since your baby’s birth, had mastitis even once, or aren’t sure what the heck is causing your breast pain, now is a good time to see your OB and your IBCLC.