Breast Conditions
Nipple Discharge
Definition
Epidemiology
Aetiology - Hyperlacticaemia
- Mammary duct ectasia
- Infections
- Tumours
- Fibrocystic disease
- Pregnancy
Risk Factors
Symptoms - Colour of discharge – bloody = red flag
- Unilateral (red flag) vs bilateral
- Nipple changes
Signs
Investigations If age 50+ + unilateral discharge (± other nipple changes) > 2WWR
- Urine pregnancy test – if appropriate
- Serum prolactin – elevation > refer to endo for pituitary MRI
- TFTs (hypothyroidism)
- UEs
- LFTs
- Breast imaging
Management
Mastitis
Definition Inflammation of breast tissue with or without infection
- S. aureus commonest
1. Lactational – stasis/overproduction of milk + bacteria entering via
traumatised nipple
2. Non-lactational – smoking, immunosuppression, underlying breast
pathology, trauma
*Can cause breast abscess
Epidemiology
Aetiology
Risk Factors
Symptoms - Malaise/myalgia
- Breast redness, pain, swelling
- Purulent nipple discharge
- Fever
, - Breast inflammation (warmth)
- Breast firmness
- Breast swelling
- “Wedge shaped area” (lactational)
Signs
Investigations Clinical diagnosis:
- Nipple discharge culture/sensitivity can be considered
- If associated mass > 2WWE
Management Lactational:
- More frequent feeding
- Breast pumping
- Ibuprofen/paracetamol
- Flucloxacillin – if severe: infected nipple fissure, symptoms not
improving, breast milk culture +ve
Non-lactational:
- Ibuprofen/paracetamol
- Warm compress
- Predisposing factors (eczema/candida)
- Co-amoxiclav for all
Breast Abscess
Definition Localised collection of pus within breast tissue – secondary to infection
- S. aureus most common
*Usually caused by failed treatment of mastitis/cellulitis
Epidemiology
Aetiology
Risk Factors
Symptoms - History of mastitis (recent)
- Malaise
- Painful/swollen breast
- Redness
- Discharge
- Fever
- Inflammation/warmth of breast
- Purulent discharge
Signs
Investigations Refer urgently to secondary care
- Breast US
- MC+S of discharge
Nipple Discharge
Definition
Epidemiology
Aetiology - Hyperlacticaemia
- Mammary duct ectasia
- Infections
- Tumours
- Fibrocystic disease
- Pregnancy
Risk Factors
Symptoms - Colour of discharge – bloody = red flag
- Unilateral (red flag) vs bilateral
- Nipple changes
Signs
Investigations If age 50+ + unilateral discharge (± other nipple changes) > 2WWR
- Urine pregnancy test – if appropriate
- Serum prolactin – elevation > refer to endo for pituitary MRI
- TFTs (hypothyroidism)
- UEs
- LFTs
- Breast imaging
Management
Mastitis
Definition Inflammation of breast tissue with or without infection
- S. aureus commonest
1. Lactational – stasis/overproduction of milk + bacteria entering via
traumatised nipple
2. Non-lactational – smoking, immunosuppression, underlying breast
pathology, trauma
*Can cause breast abscess
Epidemiology
Aetiology
Risk Factors
Symptoms - Malaise/myalgia
- Breast redness, pain, swelling
- Purulent nipple discharge
- Fever
, - Breast inflammation (warmth)
- Breast firmness
- Breast swelling
- “Wedge shaped area” (lactational)
Signs
Investigations Clinical diagnosis:
- Nipple discharge culture/sensitivity can be considered
- If associated mass > 2WWE
Management Lactational:
- More frequent feeding
- Breast pumping
- Ibuprofen/paracetamol
- Flucloxacillin – if severe: infected nipple fissure, symptoms not
improving, breast milk culture +ve
Non-lactational:
- Ibuprofen/paracetamol
- Warm compress
- Predisposing factors (eczema/candida)
- Co-amoxiclav for all
Breast Abscess
Definition Localised collection of pus within breast tissue – secondary to infection
- S. aureus most common
*Usually caused by failed treatment of mastitis/cellulitis
Epidemiology
Aetiology
Risk Factors
Symptoms - History of mastitis (recent)
- Malaise
- Painful/swollen breast
- Redness
- Discharge
- Fever
- Inflammation/warmth of breast
- Purulent discharge
Signs
Investigations Refer urgently to secondary care
- Breast US
- MC+S of discharge
