Anatomy Explored: What is below your breasts in the middle?

October 1, 2025 •

4 min read

The sternum, or breastbone, is a long, flat bone that forms the central part of the chest. The area directly below your breasts in the middle is known as the epigastric region, an anatomical landmark defined by the end of your sternum, where several vital organs and musculoskeletal structures reside.

Quick Summary

The area below the breasts is anatomically complex, involving the lower end of the sternum, the xiphoid process, and the epigastric region of the abdomen. It houses vital organs and is prone to various musculoskeletal and gastrointestinal issues that cause pain or discomfort.

Key Points

Xiphoid Process: The lowest, pointed section of your breastbone (sternum) is the xiphoid process.
Epigastric Region: The upper part of your abdomen, located beneath the sternum and between the ribs, is known as the epigastric region.
Costochondritis: A common cause of localized chest wall pain is the inflammation of the rib cartilage connecting to the sternum.
GERD (Acid Reflux): A burning pain behind the breastbone can be caused by stomach acid flowing back into the esophagus.
Serious Conditions: Pain in this area can sometimes indicate serious issues like a heart attack, especially if accompanied by pressure, radiating pain, and shortness of breath.
Multiple Origins: Discomfort in the mid-chest and upper abdomen can stem from musculoskeletal, gastrointestinal, and even cardiac problems, requiring a medical diagnosis to pinpoint the cause.

Understanding the Anatomy of Your Mid-Chest and Upper Abdomen

At the center of your chest, you can feel the bony structure known as the sternum, or breastbone. This flat, elongated bone connects to your ribs via cartilage, forming the front of your rib cage and protecting the heart, lungs, and major blood vessels. The area directly below your breasts in the middle is defined by the lowest part of this structure, known as the xiphoid process, and the upper section of your abdomen.

The Sternum and Xiphoid Process: The sternum is composed of three parts: the manubrium (top), the body (middle), and the xiphoid process (bottom). The xiphoid process is a small, pointed cartilage that eventually hardens into bone in adulthood and is a key anatomical landmark for healthcare providers. It sits right where the ribs from both sides come together.
The Costal Margin: The lower, curved border of the rib cage is called the costal margin, where the cartilage of the lower ribs converges near the sternum. This margin serves as a dividing line between the thoracic cavity and the abdominal cavity.
The Mediastinum and Epigastric Region: Behind the sternum lies the mediastinum, a central chest cavity that houses the heart, esophagus, and aorta. Below the rib cage is the epigastric region, the upper part of the abdomen containing the stomach, liver, and pancreas. The proximity of these structures means pain can originate from multiple places, making pinpointing the source challenging.

Common Musculoskeletal Causes of Pain

Many types of pain in the mid-chest area are not heart-related but stem from the muscles, bones, and cartilage in the chest wall. The following are common musculoskeletal causes:

Costochondritis: A very common cause of chest pain, costochondritis is the inflammation of the cartilage that connects your ribs to your sternum. It causes localized pain that can be sharp or aching and often worsens with deep breathing, coughing, or pressing on the area.
Xiphoid Process Pain (Xiphodynia): Inflammation or injury to the xiphoid process can lead to a condition known as xiphodynia. This can cause discomfort, swelling, and pain, sometimes described as a lump or swelling at the tip of the breastbone. It can be triggered by lifting heavy objects or minor trauma to the area.
Muscle Strain: Repetitive motions, heavy lifting, or even a severe coughing fit can strain the muscles that attach to the sternum and ribs, leading to localized soreness and pain.

Gastrointestinal Issues Affecting the Area

Pain that feels like it's coming from behind or below the sternum often has a gastrointestinal origin. This type of discomfort is called substernal pain.

Gastroesophageal Reflux Disease (GERD): This condition occurs when stomach acid frequently flows back into the esophagus, causing a burning sensation known as heartburn. The pain can be felt behind the breastbone and is often worse after eating, at night, or when lying down.
Gastritis and Peptic Ulcers: Gastritis is inflammation of the stomach lining, while a peptic ulcer is a sore that develops on the lining of the stomach or small intestine. Both can cause a gnawing, burning, or aching pain in the upper abdomen, or epigastric region, which can be mistaken for chest pain.
Hiatal Hernia: This occurs when a portion of the stomach pushes up through the diaphragm into the chest cavity. This can cause acid reflux, heartburn, and a full feeling after eating, leading to pain in the area.
Pancreatitis: Inflammation of the pancreas can cause intense upper abdominal pain that may radiate to the back and chest, potentially mimicking other conditions.

When to Seek Medical Attention

While many causes of mid-chest discomfort are not life-threatening, some are serious and require immediate medical evaluation. Seek prompt medical care if you experience pain in this area along with:

Chest pressure or tightness
Pain that radiates to the jaw, back, or arm
Shortness of breath
Nausea, dizziness, or cold sweats
Bloody vomit or bloody, tarry stools

Comparing Causes of Mid-Chest Pain

To help distinguish between common causes, here is a comparison of pain characteristics. However, this is for informational purposes only, and any severe or persistent chest pain should be evaluated by a healthcare professional.


Feature	Musculoskeletal Pain (e.g., Costochondritis)	Gastrointestinal Pain (e.g., GERD)	Cardiac Pain (e.g., Heart Attack)
Symptom Character	Sharp, stabbing, or achy; localized; worsens with movement or pressure.	Burning sensation (heartburn); gnawing or aching pain.	Squeezing, pressure, or tightness; may feel like an elephant is on your chest.
Triggers	Deep breathing, coughing, heavy lifting, direct pressure on the chest.	Eating, lying down, bending over.	Exercise, stress, or sometimes no specific trigger.
Associated Symptoms	Tenderness at the joint.	Belching, bloating, trouble swallowing, indigestion.	Shortness of breath, sweating, nausea, pain radiating to the jaw/arm.
Duration	Can last for days or weeks.	Can be intermittent or chronic.	Sudden onset; persists until treated.
Urgency	Non-emergent, but see a doctor if unsure.	Varies, but urgent if severe or accompanied by other symptoms.	Medical emergency. Call 911 immediately.

Conclusion

Understanding what is below your breasts in the middle is crucial for recognizing the source of any pain or discomfort in that region. The area is a complex intersection of the skeletal system, including the sternum and xiphoid process, and the upper abdominal organs. While many causes of pain are benign, such as costochondritis or acid reflux, the potential for more serious conditions, like heart issues, means that persistent or severe symptoms should always be medically evaluated. Knowing your anatomy empowers you to have more informed conversations with your healthcare provider and seek appropriate care when needed.

For more information on the intricate anatomy of the trunk, you can consult resources like the Cleveland Clinic's detailed articles.

Frequently Asked Questions

That is likely your xiphoid process, the pointed tip at the bottom of your sternum. While typically painless, it can become swollen or tender due to injury or inflammation, a condition known as xiphodynia.

Yes, many gastrointestinal issues can cause pain in this area, including acid reflux (GERD), gastritis, and peptic ulcers. A hiatal hernia, where part of the stomach pushes into the chest, is another possible cause.

No, while chest pain should always be taken seriously, pain in this area is not always a heart attack. Musculoskeletal issues like costochondritis or digestive problems like GERD are more common culprits. However, heart attack symptoms can be atypical, so persistent or severe chest pain warrants immediate medical attention.

Costochondritis pain is often sharp, localized, and worsens with movement or pressure on the chest. A heart attack is more likely to feel like crushing pressure or tightness and may radiate to the arm, neck, or jaw, often accompanied by shortness of breath or sweating.

The costal margin is the curved, lower border of the rib cage formed by the convergence of the lower rib cartilages. It is the boundary between your chest and abdominal cavities and provides attachment points for abdominal muscles and the diaphragm.

You should seek medical attention if the pain is persistent, severe, or accompanied by alarming symptoms such as chest pressure, shortness of breath, dizziness, or pain radiating to other areas. Immediate emergency care is necessary if a heart attack is suspected.

Yes, stress and anxiety can manifest as chest or upper abdominal pain. Anxiety can trigger esophageal spasms that feel like chest pain. However, it is essential to rule out other medical causes before attributing the pain to stress alone.