What could be causing a burning sensation on my right breast that occurs with deep breathing, as an adult female with no known medical history?

Burning Sensation on Right Breast with Deep Breathing

This burning sensation on your right breast that worsens with deep breathing is most likely musculoskeletal or nerve-related pain (extramammary cause) rather than true breast pathology, and you should be evaluated clinically to exclude costochondritis, intercostal nerve irritation, or other chest wall conditions before considering breast-specific causes. 1

Understanding the Pain Pattern

The key feature here—pain that occurs specifically with deep breathing—strongly suggests an extramammary (non-breast) origin rather than true breast tissue pathology. 1

• Extramammary causes account for 10-15% of perceived "breast pain" and include musculoskeletal conditions like costochondritis (Tietze syndrome), pectoral muscle strains or spasms, intercostal nerve entrapment, rib fractures, and referred pain from pulmonary or cardiac sources. 1

• The breast receives nerve supply from intercostal nerves T3-T5, and irritation anywhere along their course can produce breast or nipple pain that mimics true breast pathology. 1

• Pain that worsens with breathing, movement, or chest wall palpation is characteristic of musculoskeletal origin rather than breast tissue disease. 1

Critical Conditions to Exclude First

Before attributing this to benign musculoskeletal causes, several potentially serious conditions must be ruled out:

• Pulmonary causes including pleurisy, pulmonary embolus, or pneumonia can present as unilateral chest/breast pain worsened by deep breathing. 1

• Cardiac ischemia can occasionally present as breast pain, though this is less likely given your age and lack of other cardiac risk factors mentioned. 1

• Pre-eruptive herpes zoster (shingles) can cause severe dermatomal burning pain days before the rash appears, and if suspected, immediate antiviral therapy is warranted. 2

• Mondor disease (thrombophlebitis of the thoracoepigastric vein) can present as focal breast pain with a palpable cord-like structure. 1

When to Consider True Breast Pathology

While less likely given your symptom pattern, certain breast conditions should be considered:

• Noncyclical mastalgia accounts for 25% of breast pain cases, is typically unilateral and focal, and requires imaging to exclude underlying breast lesions. 1, 3

• Advanced breast cancers can rarely present with pain as the only symptom, especially invasive lobular carcinoma and anaplastic carcinoma, though pain alone as a presenting symptom carries only a 1.2-6.7% cancer risk. 1, 3

• Burning pain behind the nipple in smokers may indicate periductal inflammation, and smoking cessation should be advised. 3

Recommended Evaluation Approach

Physical examination should focus on:

• Palpating the chest wall, costochondral junctions, and intercostal spaces to reproduce the pain (suggesting musculoskeletal origin). 1

• Examining for visible cord-like structures (Mondor disease) or areas of focal tenderness. 1, 2

• Listening for any cardiac or pulmonary abnormalities. 1

• Checking for early signs of herpes zoster rash in a dermatomal distribution. 2

Imaging considerations:

• If clinical examination suggests musculoskeletal pain and is reassuring, imaging may not be necessary initially. 3

• If there is focal breast tenderness or concern for breast pathology, age-appropriate imaging should be obtained: ultrasound alone for women under 30 years, or diagnostic mammography with ultrasound for women 30 years and older. 3, 2

• Chest X-ray may be warranted if pulmonary causes are suspected. 1

Initial Management

For musculoskeletal/chest wall pain:

• NSAIDs (ibuprofen or naproxen) are first-line treatment for both musculoskeletal pain and breast pain. 3, 4

• Ice or heat application can provide symptomatic relief. 3

• Physical therapy with stretching exercises is effective for musculoskeletal symptoms. 3

Reassurance is crucial:

• Once serious pathology is excluded, reassurance alone resolves symptoms in 86% of mild cases and 52% of severe cases. 3

• The risk of breast cancer presenting with pain alone is very low. 3

Critical Pitfalls to Avoid

• Do not dismiss focal, unilateral breast pain without proper evaluation, as some cancers can present with pain alone. 3, 2

• Do not fail to consider extramammary causes when breast examination and imaging are normal—this is the most common oversight. 1, 3

• Do not overlook pulmonary embolus in patients with pleuritic chest pain, especially if there are risk factors for thromboembolism. 1

• Do not miss pre-eruptive herpes zoster, as early antiviral treatment significantly improves outcomes. 2