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Flashcards in Breast pain Deck (12):
1

Painful breast history

SOCRATIES
relationship to menstrual cycle
associated breast symptoms
FH
reproductive history
PMH
DH
ICE

RARELY a sign of breast cancer

2

Common causes of breast pain

pregnancy
mastitis
costochondritis
medication - OCP, antidepressants

3

Cyclical vs Non cyclical

cyclical - linked to change in hormone levels during menstrual cycle, heaviness in one or both breasts, may radiate to axilla and down into arms

non cyclical - unrelated to menstrual cycle from extra mammary cause that's referred to the breast e.g. costochondritis. Causes often unclear

4

Investigations in painful breasts

bilateral mammogram - screening tool

5

Management for painful breasts

reassurance
well fitting bra
lifestyle and diet changes
topical NSAIDs
if pain started commencing on COP - change pill
if pain is severe and prolonged hormone suppressing drugs may be considered - tamoxifen, danazol

6

Mastitis

inflammatory condition of interlobular connective tissue

main underlying cause is milk stasis caused by overproduction or insufficient milk removal

may be infectious or not infectious

complication: breast abscess

staph aureus most common causative organism

7

symptoms of mastitis

painful area in breast
red, tender lump
tired and unwell

Look for signs of abscess: redness, swelling, tender on palpation, temperature, US to look for it

8

predisposing factors to mastitis

tight bra
nulliparty
baby not attaching well to breast
use of a dummy or bottle

9

management of mastitis

analgesia
advise to continue breastfeeding
manage predisposing factors - tight bra
if nipple soreness treat that
oral AB if infected
milk culture
seek immediate medical advice if not resolving after 48 hours after AB

Look for signs of abscess: redness, swelling, tender on palpation, temperature, US to look for it

10

Managment of breast abscess

AB and drainage - US guided
flucloxacillin first line - suitable if breast feeding
arrange for reassessment and potential further aspiration in 2 days
advice about attachment and positioning during breastfeeding by a breastfeeding counselor
encourage to keep breasts empty to avoid mastitis- preferably by continuing breast feeding but if too painful express milk on affected side until pain lessons

11

physiological changes to breast during lactation and affect on US/Mammogram

breasts feel larger, firmer and more nodular

may be an increased alveolar and nipple pigmentation, and Montgomery tubercles may become more prominent

On mammogram breast size and density is increased

On US, glandular enlargement and engorgement of breast tissue results in increased echogenicity of breast parenchyma

12

If a patient who isnt lactating presents with a mastitis or breast abscess

abscess may occur in smokers, DM and those who are immunocompromised

nipple piercing predisposing factor

inflammatory breast cancer is an important differential not to miss