Breast pain and discharge
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- Breast pain is a common symptom in general surgical practice
- Breast pain is also referred to as mastalgia
- Is easily diagnosed with a thorough history and physical examination
- Breast discharge is rarely normal except for lactating and pregnant women
Differential Diagnosis
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
Diagnosis
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)
- Follice 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
- Antiobiotics 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
References
Acknowledgements
The content on this page was first contributed by
List of contributors:
Suggested Reading and Key General References
Suggested Links and Web Resources
For Patients
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
