Breast pain and discharge

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
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