The nipple is a particularly sensitive area of the breast that can be subject to various pains. From puberty to menopause, and even after, these pains generally correspond to hormonal upheavals in the woman’s body. Nevertheless, if they are the most harmless, they can also manifest themselves in a pathological context. Hence the importance of regular monitoring. What to do in case of pain and when should you worry? Explanations with Martha Duraes, obstetrician-gynecologist at Montpellier University Hospital.
In case of nipple pain, it is often hormonal factors that are involved. When the breasts develop at puberty, the sudden release of estrogen and progesterone signals the first major hormonal upheaval in the child who begins his transition to adulthood. This is accompanied by discomfort and sometimes pain in the nipple area (sometimes including in boys). These pains are felt as long as the breast continues to grow, which can take more or less time depending on the woman, but they remain benign and transient.
Nipple pain can also occur throughout life, especially when menstruation approaches. If so, it’s likely a premenstrual symptom, the most common cause of nipple pain. Usually the pain affects both nipples simultaneously, lasts only a few days and occurs with each cycle. “This is linked either to an insufficient production of estrogens, or else to an excess so that there is not enough progesterone to precisely counterbalance the effect of estrogens”, explains Martha Duraes.
For other women, nipple pain also occurs during pregnancy, due to a large influx of hormones, or during breastfeeding due to breast engorgement or poor position of the baby during feeding. Even if they are annoying, these pains are most of the time not serious. Engorgement, however, may require a visit to the doctor and sometimes treatment.
Finally, at menopause, there is no reason to have localized pain in the nipple area since women gradually stop producing estrogen and progesterone, thus entering the sterile phase of their lives. Nevertheless, some postmenopausal women continue to take hormone replacement therapy based on estrogen and progesterone to relieve hot flashes and/or debilitating joint pain associated with menopause. “If the treatment is not adapted, there may be too much intake of estrogen compared to progesterone, a bit like in premenstrual syndrome” explains Dr. Duraes.
When the pain is due to premenstrual syndrome, the treatment will consist of applying a progesterone-based gel to the nipple. “If the patients are very embarrassed, we can prescribe or change their hormonal treatment to try to better regulate the balance of hormones,” says Martha Duraes. “Sometimes we will complete by adding anti-inflammatories,” she says. Same principle for postmenopausal women: in case of pain, it will be necessary to change hormonal treatment.
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If the pain is localized to a single nipple, it is much more likely that it is an abscess or the beginning of an abscess. In this case the symptoms will also be visual: a ball filled with pus and palpable to the touch forms under the skin of the areola causing redness, itching and fever, or even a discharge of pus. The cause is infectious and, if left untreated, can progress to severe sepsis, ie failure of other organs due to dysregulation of the response to infection. “This complication remains rare, reassures Martha Duraes. If you don’t take long to consult, the abscess heals very well. »
Breast abscesses can occur during breastfeeding, after injury, and after surgery. But nowadays, they affect more regular tobacco users because, at high doses over several years, this substance can reduce the immune defenses. “Even if the abscess heals well, there are many recurrences as long as the woman continues to smoke, which poses a completely different problem: that of treating the addiction,” raises the gynecologist.
Treatment consists of taking antibiotics. If this is not enough, a gynecologist can perform a needle puncture under local anesthesia or a surgical drainage, that is to say a small incision around the nipple to remove the pus. This procedure is done under general anesthesia. Professionals also encourage smokers to think about quitting in order to avoid relapses. For this, many aids exist such as support groups and mobile applications, not to mention the possibility of being supervised by an addictologist and other health professionals.
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Contrary to popular belief, breast cancer is almost never painful. With two exceptions: inflammatory breast cancer and Paget’s disease of the nipple.
Inflammatory breast cancer is an aggressive form of breast cancer that does not take the form of a distinct tumor but more insidiously affects the breast tissue. Characteristic symptoms include swelling, intense redness with heat, an “orange peel” texture and pain. Nevertheless, it represents 1 to 5% of breast cancers and therefore remains very rare.
As for Paget’s disease of the nipple, it is a variety of carcinoma that accounts for 1 to 3% of breast cancer cases. Its symptoms can be similar to those of other skin conditions like redness, itching, scabs, ulcerations. “This pathology is often associated with an underlying breast cancer, for example if the tumor has not been located by mammography,” explains Martha Duraes. Note that Paget’s disease of the nipple has nothing to do with bone pathology also called Paget’s disease.
In these two cases, the treatment will be the same as for any breast cancer and may include chemotherapy, radiotherapy, surgery with removal of the breast(s), possibly followed by reconstruction. This will depend on the type and stage of the cancer.
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Less commonly, nipple pain may be associated with a skin condition such as eczema or psoriasis, in which case dermatological management is required. This type of pain can also result from trauma to the chest such as an injury, very intense physical activity, a strong chest that stretches the tissues or even friction exerted by an unsuitable tissue.
Consult if the pain persists for several days, or if it is accompanied by oozing, swelling or a lump under the skin. But in case of discomfort, it is still better to turn to a gynecologist. During the consultation, the specialist will carry out various clinical examinations: a palpation of the breasts, an ultrasound coupled or not with a mammogram to rule out the cancer, or even sometimes a biopsy from a sample of a piece of breast tissue.
