Breast pain Flashcards
Painful breast history
SOCRATIES relationship to menstrual cycle associated breast symptoms FH reproductive history PMH DH ICE
RARELY a sign of breast cancer
Common causes of breast pain
pregnancy
mastitis
costochondritis
medication - OCP, antidepressants
Cyclical vs Non cyclical
cyclical - linked to change in hormone levels during menstrual cycle, heaviness in one or both breasts, may radiate to axilla and down into arms
non cyclical - unrelated to menstrual cycle from extra mammary cause that’s referred to the breast e.g. costochondritis. Causes often unclear
Investigations in painful breasts
bilateral mammogram - screening tool
Management for painful breasts
reassurance
well fitting bra
lifestyle and diet changes
topical NSAIDs
if pain started commencing on COP - change pill
if pain is severe and prolonged hormone suppressing drugs may be considered - tamoxifen, danazol
Mastitis
inflammatory condition of interlobular connective tissue
main underlying cause is milk stasis caused by overproduction or insufficient milk removal
may be infectious or not infectious
complication: breast abscess
staph aureus most common causative organism
symptoms of mastitis
painful area in breast
red, tender lump
tired and unwell
Look for signs of abscess: redness, swelling, tender on palpation, temperature, US to look for it
predisposing factors to mastitis
tight bra
nulliparty
baby not attaching well to breast
use of a dummy or bottle
management of mastitis
analgesia advise to continue breastfeeding manage predisposing factors - tight bra if nipple soreness treat that oral AB if infected milk culture seek immediate medical advice if not resolving after 48 hours after AB
Look for signs of abscess: redness, swelling, tender on palpation, temperature, US to look for it
Managment of breast abscess
AB and drainage - US guided
flucloxacillin first line - suitable if breast feeding
arrange for reassessment and potential further aspiration in 2 days
advice about attachment and positioning during breastfeeding by a breastfeeding counselor
encourage to keep breasts empty to avoid mastitis- preferably by continuing breast feeding but if too painful express milk on affected side until pain lessons
physiological changes to breast during lactation and affect on US/Mammogram
breasts feel larger, firmer and more nodular
may be an increased alveolar and nipple pigmentation, and Montgomery tubercles may become more prominent
On mammogram breast size and density is increased
On US, glandular enlargement and engorgement of breast tissue results in increased echogenicity of breast parenchyma
If a patient who isnt lactating presents with a mastitis or breast abscess
abscess may occur in smokers, DM and those who are immunocompromised
nipple piercing predisposing factor
inflammatory breast cancer is an important differential not to miss
