What could be causing burning pain in my left nipple and armpit?

Burning Pain in Left Nipple and Armpit

Your burning pain in the left nipple and armpit most likely represents noncyclical mastalgia with a specific subtype called duct ectasia with periductal inflammation, which characteristically presents as "exquisite continuous burning pain, usually behind the nipple" and requires evaluation to exclude underlying breast pathology. 1

Understanding Your Symptom Pattern

The burning quality and unilateral location (left side only) affecting both nipple and armpit strongly suggests noncyclical breast pain rather than hormonal cyclical pain. 1

• Noncyclical mastalgia accounts for 25% of breast pain cases and is predominantly inflammatory rather than hormonal in origin. 1
• This type is usually unilateral, more focal, and commonly located in the subareolar/nipple area. 1
• The burning quality is particularly characteristic of duct ectasia with periductal inflammation, which affects 25% of patients with noncyclical pain and is often associated with heavy smoking. 1

Critical Evaluation Needed

You need imaging evaluation because noncyclical breast pain, even without a palpable mass, may indicate an underlying benign or malignant breast lesion. 1

Recommended imaging approach:

• If you are ≥30 years old: diagnostic mammogram with ultrasound 2
• If you are <30 years old: ultrasound alone 2
• Mammography may reveal duct ectasia or secretory calcifications at the pain site. 1

Why imaging matters:

• Advanced cancers can present with pain as the only symptom, especially invasive lobular carcinoma and anaplastic carcinoma. 1
• However, the overall cancer risk with pain alone remains low (1.2-6.7%). 2

Alternative Causes to Consider

Since your pain extends to the armpit, extramammary (non-breast) causes must be evaluated:

Musculoskeletal causes (10-15% of "breast pain"):

• Costochondritis (Tietze syndrome) - inflammation of chest wall cartilage 1
• Nerve entrapment - particularly the lateral cutaneous branch of the third intercostal nerve 1
• Pectoral muscle strain or spasm 1
• Cervical or thoracic nerve root syndrome 1

Other serious causes requiring exclusion:

• Mondor disease (thrombophlebitis of chest wall veins) - can present initially as breast pain 1
• Shingles (herpes zoster) - can cause burning pain before rash appears 1
• Cardiac ischemia - left-sided chest/breast pain warrants cardiac evaluation 1

Immediate Management Steps

Before imaging results:

1. If you smoke, stop immediately - smoking is strongly associated with the burning periductal inflammation pattern you describe. 1, 2

2. Over-the-counter NSAIDs (ibuprofen, naproxen) for symptomatic relief 2

3. Apply ice packs or heating pads for comfort 2

4. Wear a well-fitted supportive bra, especially if you have large breasts 2

What NOT to do:

• Do not eliminate caffeine - despite popular belief, there is no scientific evidence this helps breast pain. 1
• Do not assume this is just hormonal pain - the burning quality and unilateral location require evaluation. 1

Common Pitfalls to Avoid

• Never dismiss unilateral burning breast pain without proper evaluation, as some cancers present with pain alone. 1, 3
• Do not accept treatment for presumed yeast infection without proper diagnosis - burning pain is often mistakenly treated as Candida infection. 4
• Always consider extramammary causes if breast examination and imaging are normal - the nerve supply to the breast (intercostal nerves T3-T5) means irritation anywhere along their course can cause perceived breast pain. 1

Expected Outcomes

• If benign: 50% of noncyclical mastalgia resolves spontaneously within a reasonable timeframe. 1
• Noncyclical mastalgia tends to be of shorter duration than cyclical mastalgia. 1
• Reassurance after negative imaging resolves symptoms in many patients. 1