Pain or a lump beneath the right breast is a common concern. This anatomical region is complex, encompassing the lower chest wall, the rib cage, and the upper right abdominal area. Sensations may originate from the skin, muscles, ribs, breast tissue, or the internal organs situated directly underneath the rib cage. This article provides general information about potential sources of pain and lumps, but it is not a substitute for a professional medical evaluation.
The Anatomy of the Right Upper Quadrant
The space beneath the right breast is a crossover point between the thoracic and abdominal cavities, often called the right upper quadrant (RUQ). This area is structured by the lower ribs (seven through ten), which connect to the breastbone via costal cartilage. Beneath the chest wall muscles lies the diaphragm, a sheet of muscle separating the chest from the abdomen.
Several major internal organs are tucked immediately below the diaphragm and under the rib cage. The largest is the liver, which occupies a significant portion of the RUQ. Directly beneath the liver sits the gallbladder, which stores bile. The RUQ also contains the hepatic flexure (a bend in the large intestine) and a portion of the right kidney.
Musculoskeletal and Superficial Causes
Pain frequently originates from the body wall itself. A common cause is costochondritis, which is inflammation of the cartilage connecting the ribs to the breastbone. This inflammation causes a sharp, sudden pain that worsens with deep breathing, coughing, or pressure. Costochondritis is benign, but its symptoms can sometimes mimic serious heart or lung issues.
Pain may also result from muscle strain in the intercostal muscles or upper abdominal muscles, often following heavy lifting or prolonged coughing. This muscle pain is tender to the touch and improves with rest, unlike the persistent ache of internal organ issues. Localized skin and nerve problems, such as the blistering rash and sharp pain of Shingles (herpes zoster), can also manifest here. Rib fractures or bruising from trauma are direct causes of pain exacerbated by movement or breathing.
Digestive and Organ-Related Causes
Since the RUQ contains several digestive organs, many causes of pain relate to the gastrointestinal system. Gallbladder issues, such as gallstones or inflammation (cholecystitis), are a common cause of severe pain beneath the right breast. This sharp or cramping pain typically occurs after eating fatty meals and may radiate to the back or right shoulder blade. Gallbladder attacks can last for several hours and may be accompanied by nausea and vomiting.
Liver inflammation (hepatitis) or enlargement (hepatomegaly) can also produce discomfort in the RUQ. Liver pain is often a dull, non-localized ache that may worsen with movement or after eating. Other liver conditions, such as fatty liver or cirrhosis, can present with fullness, loss of appetite, or jaundice (yellowing of the skin and eyes).
Digestive conditions like acid reflux (GERD) and peptic ulcers can cause a burning or pressure-like pain that feels high in the chest, sometimes beneath the breastbone or right breast. Gas and bloating related to the hepatic flexure of the colon can also cause cramping or sharp, intermittent pain relieved by passing gas or having a bowel movement.
Breast Tissue Concerns
Although discomfort may feel like it is “under” the breast, the breast tissue itself can be the source. Breast pain, or mastalgia, is common and categorized as cyclical or non-cyclical. Cyclical pain is linked to hormonal fluctuations during the menstrual cycle, often resulting in a dull, heavy, or aching sensation that can radiate downwards. This hormonal tenderness is most pronounced in the two weeks leading up to a period.
Non-cyclical pain is not related to the menstrual cycle and is often localized, sometimes described as a tight, burning, or stabbing sensation. Lumps are a frequent concern, especially in the lower outer quadrant, which is prone to benign fibrocystic changes. These changes involve fluid-filled cysts or fibrous tissue that may feel tender or increase in size before menstruation. Any new or distinct lump that is hard, fixed, or immovable should be promptly evaluated, as should signs of infection like mastitis (redness, warmth, swelling, and pain).
When Symptoms Require Immediate Medical Evaluation
While many causes of pain beneath the right breast are benign, certain symptoms indicate a need for immediate medical attention due to the presence of vital organs. Severe, sudden, or crushing pain that does not resolve quickly is a significant red flag. This is especially true if the pain is accompanied by systemic symptoms such as a high fever, shaking chills, or persistent nausea and vomiting.
Signs of severe organ distress, such as new-onset jaundice or pale stool color, suggest a serious issue with the liver or gallbladder. Any pain accompanied by signs of internal bleeding, such as vomiting blood or material that looks like coffee grounds, or passing black, tarry stools, requires an emergency room visit. Severe pain accompanied by confusion, lightheadedness, a fast heart rate, or a feeling of being generally unwell also signals a medical emergency.