Breast pain and discharge

Breast pain and discharge

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and key words: Mastalgia

Breast pain is a common symptom in general surgical practice. Breast discharge is rarely normal except for lactating and pregnant women.

Differential Diagnosis

In alphabetical order.

Breast Discharge

• Breast Abscess
• Breast Cancer
• Chronic nipple stimulation
• Cirrhosis (or other hepatic disease)
• Duct ectasia
• Early pregnancy
• Fibroadenosis
• Fibrocystic change
• Galactorrhea
• Hypothalamic and pituitary abnormalities
• Hypothyroidism
• Intraductal papilloma
• Lactation
• Lactorrhoea
• Late pregnancy
• Medications
• Mondor's Disease
• Paget's Disease of the Nipple
• Prolactinoma
• Puberty
• Pseudocyesis
• Retroareolar Abscess
• Sarcoidosis
• Systemic lupus erythematosus
• Tuberculosis

Breast Pain

• Breast Abscess
• Breast Cancer
• Cyclical mastalgia
• Cyst
• Duct ectasia
• Extramammary causes of pain
• Fat necrosis
• Fibroadenoma
• Fibrocystic changes
• Herpes Zoster
• Intraductal papilloma
• Lactation
• Lipoma
• Mastitis
• Mondor's Disease
• Non-cyclical mastalgia
• Pregnancy
• Phylloides tumor
• Rib secondaries
• Tietze's Disease
• Trauma
• Unilateral or bilateral gynecomastia

History and Symptoms

• Thorough history examination

  • Family history
  • Menstrual history
  • Pregnancy history

Physical Examination

• Pattern and duration of pain (and/or discharge)
• Complete breast examination after menstrual flow (at least 7-9 days)

Laboratory Findings

• Complete blood count (CBC)
• Erythrocyte sedimentation rate (ESR)
• Follicle stimulating hormone (FSH)
• Thyroid stimulating hormone (TSH)
• Liver function tests (LFTs)
• Prolactin levels
• Calcium
• Beta-human chorionic gonadotropin (HCG)
• Luteinizing hormone (LH)

Chest X Ray

• Chest x-rays may be indicated to rule out secondaries in lungs or ribs.

• Chest x-rays also show pleural effusion in cancer

Echocardiography or Ultrasound

• Ultrasounds distinguish between a cyst or a solid mass

Other Imaging Findings

• In patients older than 30 years, a diagnostic mammogram is indicated
• If available, compare with previous mammogram

Other Diagnostic Studies

• Breast biopsy
• Galactogram
• Ductogram
• Fine needle aspiration
• Cytologic exam (of discharge)

Treatment

• Avoid caffeine for those patients with fibrocystic changes (decreases pain)
• Routine follow-up
• Warm compress for those patients with mastitis

Pharmacotherapy

• Medical therapies as a means of pain relief for those patients with fibrocystic changes

Acute Pharmacotherapies

• Radiation, chemotherapy, hormonal therapy for those patients with breast cancer
• Antibiotics for those patients with a cyst or for those with mastitis (to take care of streptococci and Staphylococcus aureus)

Surgery and Device Based Therapy

• Aspirations for fibrocystic changes and for cysts
• Surgery may be required for those patients with breast cancer
• For patients with an abscess, incision and drainage are indicated

Acknowledgements

The content on this page was first contributed by

List of contributors:

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