Breast tenderness Flashcards

1
Q

What are the causes of breast tenderness and pain

A

Breast engorgement
Mastitis
Breast abscess
Mastodynia
Trauma
Pregnancy
Fibrocystic disease.
Malignancy.
Stretching of Coopers ligaments.
Diabetic mastopathy.

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2
Q

Define breast engorgement

A

breasts become large, hard, uncomfortable and painful ± fever up to 39, often very early e.g. 2nd day postpartum, usually bilateral BUT there will not be erythema or discharge

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3
Q

What is the management for breast engorgement

A

CONTINUE breastfeeding
Manual/electric expression
Firm support
Cabbage leaves
Ice bags

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4
Q

Define mastitis

A

A blocked duct obstructs the flow of milk and distends the alveoli, if pressure persists the milk extravasates into the perilobular tissue → inflammation of the breast with or without infection

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5
Q

What are the causes of mastitis

A

Either lactational or non-lactational

Infectious:
- Staphylococcus
- Coagulase negative staphylococci e.g. epidermis
- MRSA

Non-infectious:
- Duct-ectasia
- Foreign material e.g. nipple piercing, implant, silicone
- Granulomatous mastitis

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6
Q

What are the risk factors for mastitis

A

Lactational: poor breastfeeding technique, milk stasis
Female
>30
Nipple injuries
Previous mastitis/abscess
Shaving/plucking areola hair
Foreign bodies

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7
Q

What are the symptoms of mastitis

A

Often develops later than engorgement (3rd-4th week), usually unilateral
Breast:
- Pain - Usually sharp, shooting, or throbbing breast pain, especially with breastfeeding, may indicate mastitis
- Warmth
- Tenderness
- Firmness
- Swelling
- Erythema
Fever
Lactation issues: Reduced milk outflow (milk stasis) - involves more peripheral wedge-shaped areas.
Systemic: fatigue, myalgia, flu-like symptoms
± nipple discharge, inversion/retraction, lymphadenopathy, skin lesions

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8
Q

What are the signs of mastitis on examination

A

Obs: pyrexia, tachycardia
Breast: Wedge-shaped area of tenderness, warmth, swelling, erythema, and firmness
Tender axillary lymph nodes
± nipple discharge, retraction/inversion

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9
Q

What investigations should be done for mastitis

A

Usually clinical diagnosis
1. Examine the breast
2. Record the temperature
3. Consider pregnancy test if unexpected e.g. in adolescent
4. Refer for USS of the breast

Bedside: urine dip, pregnancy test, nipple discharge for MC&S, milk for MC&S
Bloods: Blood cultures, FBC
Other:
- USS (abscess may appear as well-circumscribed, macrolobulated, irregular, or ill-defined echo-poor compound cystic lesion
- needle aspiration for cytology: ?Abscess
- Mammography: ?cancer

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10
Q

What is the management for lactational mastitis

A

Supportive:
- Paracetamol or ibuprofen
- Breastfeeding should continue frequently (e.g., breastfeeding 8-12 times per day)
- Breast pumping on the affected side if indicated and/or massage, if tolerated, may also be used
- Counselling on importance of milk expression
- Increase fluid intake and to try warm/cold compress
- Massage towards the nipple

Severe/prolonged/systemic signs: empirical Abx
MRSA confirmed: clindamycin, trimethoprim (non beta-lactam)

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11
Q

What is the management for nipple candidiasis

A

Topical antifungal e.g. nystatin or miconazole

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12
Q

What is the management for non-lactational mastitis

A

MRSA excluded: empiric Abx e.g. flucloxacillin
MRSA confirmed: Non-beta-lactam antibiotic e.g. clindamycin, trimethoprim, vancomycin

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13
Q

What is the management for breast abscesses

A

MRSA excluded:
- Needle aspiration and send for culture
- Oral/IV ABx
- Supportive care

MRSA confirmed:
Non-beta-lactam antibiotic e.g. clindamycin, trimethoprim, vancomycin
- Needle aspiration and send for culture
- Oral/IV ABx
- Supportive care

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14
Q

What re the complications of needle aspiration from the breast

A

The risk of failure for needle aspiration is greater with abscesses >5 cm in diameter.
Breast tissue destruction → functional mastectomy
Injury to the breast bud in pre-pubertal children → Breast hypoplasia
Post-operative scar

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