Breast tenderness

screen-shot-2017-02-21-at-10-48-11Sensitivity and tenderness of the breast tissue itself are common before puberty, during pregnancy and at certain times of the menstrual cycle. At other times, breast tenderness may reflect an underlying problem such as:

  • Trauma and bruising
  • Infection
  • Benign fibocystic disease
  • Breast cancer
  • Reaction to surgery or radiotherapy

Unexplained tenderness, should be reported to your doctor and investigated especially if associated with concerning symptoms such as:

  • Lump(s) in the breast or under the arm
  • Swelling of the breast
  • Tethering of the skin
  • Inversion of the nipple,
  • Nipple discharge
  • Discolouration of the skin

After breast surgery a variety of different pains can occur caused by a disruption of the normal architecture of the breast, disturbing the flow of fluid around it. Not only will this cause a throbbing, aching discomfort in itself, but it also make the breast heavier and hotter, straining the underlying muscles. Surgery also cuts the minor nerves in the breast and under the arm, often causing numbness. When these attempt to repair themselves, the numbness usually gives way to a burning, over-sensitive pain (hyperaesthesia), which can last for several years. In addition, the disrupted nerves, not infrequently, send sharp, lightening, jabbing pains into the breast. These neuralgic pains may only last a few seconds, but they are enough to make your toes curl! If these neuralgic pains get severe, medication can be prescribed such as gabapentin.

After surgery for breast cancer, radiotherapy is often recommended. Although technology has improving to reduce side effects, the skin can still become red and itchy for 3-6 weeks. In the long-term, radiotherapy can contribute to the underlying thickening and fibrosis of the tissues leading to shrinkage of the breast and further discomfort. Some of these pains can still be cyclical, exacerbated at different times of the month as your hormone levels go up and down even if the periods have finished.

What can you do to help?

For puberty, premenstrual and pregnancy pains, there are very few lifestyle strategies, which could help apart from avoiding trauma and wearing a comfortable, well fitted bra. For chronic pains caused by benign fibrotic disease or previous breast treatment there is a lot, which can be done, to reduce current pain and fibrosis and prevent future deteriation of symptoms. These can be broadly split into the following strategies:

  • Local exercises and stretches
  • Local massage
  • General lifestyle measures

Local strategies to help reduce breast discomfort:

Whatever the cause of the breast pains, it’s important to break down scars and fibrosis between the breast tissue and the surrounding skin, muscles, joints and nerves. If performed regularly, these will improve the blood supply, aid lymphatic drainage, and improve the mobility, flexibility and compliance of the breast tissue, skin, the underlying muscle and ribs. It is important to realise that this is a slow process. Most people give up stretching and exercise by 6 weeks if they cannot feel a benefit but clinical trials show us that improvements are usually only noticed several months later and exercises need to be continued daily and indefinitely. In fact, women may not notice any perceivable improvements at all but are helping themselves by preventing further deterioration.

Local exercises and stretching to help relieve breast pains.

After surgery, moving your arm or upper chest is often associated with an aggravation of the pain, because the tissues do not glide smoothly across each other. Gradually, the discomfort will ease but they have to be continued for the long term, even when the tenderness appears to have resolved. The aims are to move the tissues across the chest wall, strengthen the muscle and put the joints through the full range of movement. The following exercises are recommended:

screen-shot-2017-02-17-at-08-55-11Finger walking (neck): Stand straight, with your head slightly bent forward and shoulders back. Take each hand to the back of your neck alternately. Walk fingers down your spine as far as comfortable. Walk them back up to your head. As well as good for the rotator muscles of the shoulder it stretches the muscles and tissues in the front of the chest and lifts the breasts. Aim to repeat ten times in one session.

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Finger walking (back): Now do the same thing to the lower back. Lower your hands to the base of the spine. Walk your fingers up and down the spine, to bra level. Repeat adding a bit of a twist to the spine by pushing the tips of the fingers across midline of the spine and rotating your body in the same direction. This is good for the back and also adds an extra stretch across the chest wall. Aim to repeat ten times.

screen-shot-2017-02-17-at-09-10-45

 

Big bird: Place arms by the side of your body, standing upright. Raise and lower your straight arms as high as possible. This should look like a big bird flapping its wings slowly. Aim to repeat ten times.

screen-shot-2017-02-17-at-09-17-28Small bird: Place your hands on your shoulders. Move your elbows sideways and upwards, then back down. This should look like a small bird flapping its wings slowly. Aim to repeat ten times.

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Twist and fan:
With your arms out in front of you, turn your palms up then facing down. Then, with straight arms, raise your hands above your head, as straight as possible. You should feel a stretch on the side of your chest wall and the muscles aching in your upper back – aim to repeat ten times.

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The hand over: Put your right hand behind your back. Pass a small, light object across your back, over your left shoulder to the other hand. Repeat and swap hands. The ability to do this may depend on your previous flexibility. Alternatively you could use an exercise band, which are available in most sports shops. As you get better, the length of band between the hands could shorten until they are able to touch.

Massage

Gentle manipulation of the breast and surrounding skin can also help to stimulate blood supply and break down adhesions. Although this should be avoided during radiotherapy, when the skin may be a little red and sore, there is no evidence at all that massage is harmful or should be avoided after a diagnosis of cancer. Use a natural oil, such as extra virgin olive oil, rather than commercial oils containing perfumes and additives. Apply the oil with the fingers gently, trying to roll the skin over the ribs – you should be as firm as possible but not causing any pain or bruising, as this would be counter-productive. At first there will not be any noticeable improvement, but with daily persistence the pain and mobility will improve. As an added bonus, let your partner have a go.

General lifestyle measures

It would be useful to reduce the amount of chronic inflammation in your body by reducing exposure to harmful chemicals and increasing natural foods and habits, which have anti-inflammatory properties:

 Smoking: It almost goes without saying, but smoking significantly increased the fibrosis and thickening of underlying tissues. It causes inflammation of the breast glands and an increased risk of fibrocystic disease leading to cysts and blocked ducts.

General exercise: Markers of chronic inflammation are higher, amoung individuals who are overweight, sedentary, those with poor diets. One reason for this stems from over compensation of an ailing immune system trying to maintain function. To compensate for this, higher levels of inflammatory biomarkers are produced, which increase concentrations of immune cells such as natural killer cells and T lymphocytes. Exercise is known to enhance natural killer cell activity and increase T-cell production reducing the need for the immune system to compensate by increasing circulating inflammatory biomarkers. Prostaglandins, which are biologically active lipids generated from arachidonic acid via the enzyme cyclo-oxidase (COX), also have an influence on chronic inflammation.  The COX-1 enzymes are present in normal tissues and up-regulate in response to trauma, infection or chemical injury, increasing prostaglandins, which in turn triggers an appropriate inflammatory cascade as part of a healthy immune response. Chronically increased overproduction of prostaglandins, generated via COX-2, has been implicated in tissue fibrosis and even cancer progression. Studies have shown that moderate, regular, non-traumatic exercise reduces serum prostaglandin levels. For example, a study involving overweight and normal sized people found that leisure-time physical activity was inversely associated with lower prostaglandin-2 concentrations. Overweight individuals (BMI >25 kg/m2) also had increased mucosal concentrations but most importantly, an increase in activity level was associated with a 28% decrease in mucosal PGE2 even before weight loss. This was confirmed in another study from Italy subjects with type 2 diabetes and the metabolic syndrome, which showed that the anti-inflammatory effects of exercise were independent to achieving weight loss.

Diet:

The aim of a dietary change is to reduce intake of foods which promote chronic inflammation and increase foods which have anti-inflammatory properties:

Carcinogens. It would be a good idea to reduce the number of man-made chemicals and additives in the food by omitting most processed foods and those with artificial colourings and flavourings. There are some reports that these set up an inflammatory reaction in the body.

Sugar: There are several laboratory studies, which show that processed sugar and carbohydrates with a high glycaemic index foods promote chronic inflammation. This was eloquently highlighted by an experiment where half a group of mice were fed sucrose with their usual meal at comparable levels of Western diets and the other half a normal diet. The western diet led to increased expression of inflammatory markers including 12-lipoxygenase (12-LOX) and its arachidonate metabolites [Yang].

Phytochemicals: Some phytochemical rich foods have direct anti-inflammatory properties via a number of beneficial mechanisms and it makes sense to try and increase these in the diet. The green tea polyphenol, epigallocatechin-3-gallate (EGCG), and quercetin found in onions have been shown to suppress activation of the NF-kappaB family of transcription fac­tors which in turn triggers immune and inflammatory pathways . Cruciferus vegetable are also potent inducers of transcription factors as demonstrated in a study which showed that rats fed a broccoli rich diet had reduced also had a reduction in the activation and production of inflammatory cytokines interleukin and tumour necrosis factor [Thomas]. Another recent animal trial, led by the School of Biological Sciences and Norwich Medical School, found that cruciferus vegetable extracts also blocked histone deacetylase (HDAC) inhibitor as well as matrix metalo-proteinase expression, which resulted in a protective effect on tissues and joints [Thomas]. Many dark green vegetables and herbs such as ginger and turmeric contain natural salicylates, which block both COX-1 and 2 reducing the inappropriate production of prostaglandins. Making a fresh ginger and turmeric tea daily is a good idea – an example is demonstrated below:

Fresh ginger, turmeric, mint and lemon tea – perfect after a meal – super healthy and tasty!

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Plant and fish oils. Omega 3, found in oily fish and grass fed meat, is felt to have anti-inflammatory properties but taking extra amounts in clinical trials have not as not shown significant benefits. Although studies have not been conducted in women with breast pain, studies of fish oil supplements have not shown any benefits for arthritis. Nevertheless, as well know from serum tests many people in the UK are deficient in omega 3 and increasing oily fish intake to at least three times a week is recommended. Omega 6, such as linoleic acid (LA) is thought to promote inflammation as it is a precursor for arachidonic acid. This is found in healthy nuts and vegetable oils and controversy exists over how much should be consumed in a healthy diet. In fact the data indicates that high LA in the diet or circulation is not associated with higher in vivo or ex vivo pro-inflammatory responses.

Summary

  • Regularly perform local breast exercises
  • Regularly perform shoulder and neck exercises
  • Consider physiotherapy if self measures fail
  • Improve your fitness, but wear a good fitting bra when exercising
  • Gently massage your breast with olive or another natural oil,
  • Gently massage the skin around your breast and armpit
  • If you smoke stop as this increases thickening in the breast
  • Consider an anti-inflammatory diet rich in healthy fish oils
  • Increase ginger in the diet such as in herbal teas
  • If these measures fails it May be worth trying a supplement of evening primrose or a phytochemical rich blend

References

  • Yang J et al. Sucrose-Enriched Diet Promotes 12-Lipoxygenase (inflammatory) pathway. 2015 Cancer Res; 76(1); 24–29.
  • Cooper R et al . Medicinal benefits of green tea: Review of non-cancer health benefits. J Altern Com Med. 2005;11:521–528.
  • Traka M et al 2009. Glucosinolates, isothiocyanates and human health. Phytochemistry Reviews 2009 (8), 269-282.
  • Thomas R et alPhytochemicals in cancer prevention and management? BJMP 2015 (8) 2, pp 34-38.
  • Thomas et al. Exercise-induced biochemical changes and their potential influence on cancer: a scientific review. 2016 British Journal of Sports Medicine