Breast Pain Flashcards
(28 cards)
What is mastalgia?
Breast pain
Categories of breast pain
- cyclical: occurring at specific time of the menstrual cycle (most common)
- non-cyclical: unrelated to menstrual cycle
Describe cyclical breast pain
- occurs at specific time of the menstrual cycle
- most common
- typically generalised aching, heavy feeling bilaterally
- normally starts before menstruation, subsiding during the menstrual period
Describe non-cyclical breast pain
- more common in women 40-50
- more localised than cyclical pain
- can be due to: medications eg. COCP, infection e.g. mastitis, pregnancy, antidepressants e.g. sertaline, extramammary pain e.g. costrochondritis
Causes of non-cyclical breast pain
- medications eg. COCP
- infection e.g. mastitis
- pregnancy
- antidepressants e.g. sertaline
- extramammary pain e.g. costrochondritis
Diagnosis of breast pain
breast pain diary
Pregnancy test
What are the main things to exclude when some presents with breast pain?
- cancer
- infection (mastitis)
- pregnancy
Management of mastalgia
- wear a supportive bra
- NSAIDs
- reassurance
- avoid caffeine
- apply heat to the area
- referral to specialist for hormonal treatments e.g. danazol + tamoxifen
What is mastitis?
Inflammation of breast tissue
What is the most common microorganism causing mastitis?
Staphylococcus aureus
Causes of mastitis
- infection
- obstruction
Classification of mastitis
- lactational mastitis (most common)
- non lactational mastitis
Describe lactational mastitis
- 1/3 breastfeeding women
- presents during first 3 months of breast feeding
- associated with cracked nipples + milk stasis
- more common with 1st child
Describe non-lactational mastitis
- especially in women with other breast conditions e.g. duct ectasia
- tobacco is a factor
What is a risk factor of non-lactational mastitis + why?
Tobacco smoking
Damage to the sub-areolar duct walls > increased risk of infection
Presentation of mastitis
- unilateral breast pain + swelling
- erythema
- local warmth + inflammation
- nipple discharge
- fever
Management of mastitis
- continue breastfeeding, expressing milk + breast massage
- heat packs + warm showers
- simple analgesia
- if not improved after 24 hours, nipple fissure present, systemically unwell or infection suspected, start abx
- flucloxacillin first line 10-14 days
- erythromycin if allergic
What abx is first line in mastitis management?
Flucloxacillin
Erythromycin if allergic
Describe a breast abscess
- a collection a pus within the breast lined with granulation tissue
- develop secondary to acute mastitis
- tender, fluctuant, erythematous mass
Risk factors of breast abscess
- smoking
- damage to nipple e.g. nipple eczema, candida, piercings
- underlying breast disease e.g cancer
Presentation of breast abscess
- often secondary to acute mastitis
- tender, fluctuant, erythematous lump
- localised pain, tenderness, warmth
- puncutum +/- pus discharge
- assocaited systemic symptoms
What are the common microorganisms that cause a breast abscess?
- staph aureus (most common)
- strep species
- enterococcal species
- anaerobic bacteria
Diagnosis of breast abscess
- clinical presenation
- USS
- US guided needle aspiration
Treatment of breast abscess
- antibiotics
- surgical incision + drainage under LA if advanced
- microscopy, cultures + sensitivity of drained fluid
- continue breast feeding
