What could be causing pain and burning on the side of my left breast?

Pain/Burning on Side of Left Breast

What This Likely Represents

Your unilateral, burning pain on the side of the left breast most likely represents noncyclical mastalgia, which is predominantly inflammatory rather than hormonal in origin and requires clinical evaluation to exclude underlying pathology. 1

Understanding Your Symptom Pattern

Key Characteristics to Identify

Your pain pattern determines the next steps:

• Noncyclical pain (your likely scenario) is unilateral, focal, precisely localizable, has no relationship to menstrual cycles, and may worsen in cold weather 1
• Burning quality specifically suggests possible periductal inflammation with duct ectasia, which causes exquisite continuous burning pain and is strongly associated with heavy smoking 1
• This type accounts for 25% of breast pain cases and occurs more commonly in women in their fourth decade of life 1

Cancer Risk Assessment

While the risk of cancer with isolated breast pain is extremely low (0-3%), noncyclical pain is more commonly associated with malignancy than cyclical pain and warrants appropriate evaluation 2, 3. Warning signs that increase cancer suspicion include:

• Pain that is persistent and well-localized to one specific area 2
• Associated skin changes, nipple retraction, or palpable abnormality 2
• Pain that doesn't resolve spontaneously over several weeks 2

Immediate Evaluation Required

Clinical Assessment

You need a focused breast examination to determine if the pain is:

• Focal (localized to one specific, reproducible spot) - requires imaging workup 4
• Diffuse (spread across the breast) - reassurance and symptomatic management without imaging 4

Imaging Recommendations Based on Age

If your pain is focal and you are ≥30 years old: Obtain diagnostic mammogram with ultrasound 5, 2

If your pain is focal and you are <30 years old: Obtain ultrasound only 5, 2

If your pain is diffuse (non-focal): No imaging is indicated regardless of age, as the American College of Radiology rates all imaging modalities as "usually not appropriate" for diffuse breast pain 5, 4

Specific Causes to Consider

Periductal Inflammation (Most Likely Given Burning Quality)

• Characterized by continuous burning pain, usually behind or around the nipple 1
• Strongly associated with heavy smoking 1
• If you smoke, cessation is essential 5
• Mammography may show duct ectasia or secretory calcifications at the pain site 1

Other Noncyclical Causes

• Mondor disease (thrombophlebitis of chest wall veins) - presents as sudden onset pain with possible palpable cord 1
• Trauma-related - accounts for 10% of noncyclical pain, including previous surgery, especially if you had postoperative infection or hematoma 1
• Medication-induced - particularly selective serotonin reuptake inhibitors, hormone replacement therapy, oral contraceptives, or infertility treatments 1

Extramammary (Non-Breast) Causes

Pain perceived in the breast but originating elsewhere accounts for 10-15% of cases 1:

• Costochondritis (Tietze syndrome) - chest wall inflammation 1
• Nerve entrapment - particularly the lateral cutaneous branch of the third intercostal nerve 1
• Musculoskeletal - pectoral muscle strains, fibromyositis 1
• Referred pain - from coronary ischemia, esophageal disease, gallbladder pathology, or shingles 1

Treatment Approach

First-Line Management

Reassurance alone resolves symptoms in 86% of mild cases and 52% of severe cases - this is the most effective initial intervention 5, 4

After excluding malignancy through appropriate evaluation:

• Over-the-counter NSAIDs (ibuprofen) for symptomatic relief 5
• Well-fitted supportive bra, especially during exercise 5
• Ice packs or heating pads for comfort 5, 4
• Regular physical exercise 5

What Does NOT Work

Eliminating caffeine has no convincing scientific evidence of benefit, despite widespread belief 1, 5

When Pain Persists

Noncyclical mastalgia spontaneously resolves in up to 50% of patients, but tends to be of shorter duration than cyclical pain 1, 2. If conservative measures fail after several weeks, consider:

• Topical NSAIDs as second-line therapy 6
• Physical therapy with stretching exercises for musculoskeletal components 5
• Referral to breast specialist for consideration of third-line therapies (danazol, tamoxifen, bromocriptine) only for severe, sustained pain due to serious adverse effects 3

Critical Pitfalls to Avoid

Never dismiss unilateral, focal breast pain without proper evaluation, as some cancers (especially invasive lobular and anaplastic carcinomas) can present with pain 5, 2

Do not order MRI for breast pain evaluation - there is no evidence supporting its use and it leads to unnecessary biopsies of benign findings without improving cancer detection 4, 3

Do not pursue cyst aspiration for small cysts found incidentally on ultrasound - these are unlikely to be the source of pain and aspiration provides no benefit 4, 3

Consider extramammary causes if breast examination and imaging are normal - failing to evaluate chest wall and musculoskeletal sources is a common error 1, 4