Breast Complaints Overview



Breast Complaints Overview





Breast complaints are highly charged issues. The increasing incidence of breast cancer with age, coupled with the high profile of this disease, creates anxiety in any woman discovering a breast problem. Often, this anxiety creates real barriers in eliciting information helpful in assessment.

Quick access to medical evaluation may provide the patient with the most immediate sense of relief. Most clinics and offices adopt a policy of seeing these patients within a timely fashion for anxiety’s sake alone. Letting patients know that it is your facility’s policy to see all patients with breast complaints promptly, and that an appointment is not being scheduled quickly because of your alarm over her symptoms, may help alleviate some concern.

It also may be helpful to outline for the woman what will take place at her appointment. Patients need to know that a physical examination may not provide all the data necessary to answer her concerns. Reassuring the patient that additional sonograms, mammograms, and surgical evaluation are commonly ordered and may provide helpful information. It is extremely important that young women understand that mammography may not be the most helpful tool in their evaluation. Breast density in young women can interfere with the accuracy of mammographic data. It is not unusual for a young woman in her 20s to be referred directly to a breast surgeon for the simplest of evaluations if sonography or other imaging (such as breast computed tomography [CT]) is not conclusive. Women in this age group need to know that this measure is routine practice and not caused by alarm over the patient’s individual situation.

Common presentation of various breast nodules (Table 15-1) is included in this section.









Table 15-1 Common Presentation of Various Breast Nodules





























Usual Age at Presentation


Shape and Consistency


Tenderness and Retractability


Common Features


Simple cysts


30-60 yr, decreasing after menopause except with hormone therapy (HT)


Round, soft, elastic, fluid filled


Often tender; no retraction


Borders well defined, very mobile, single or multiple in number


Fibroadenoma


Most common in young adults, range puberty to 55 yr


Round or lobular, firm


Usually nontender; no retraction


Usually very mobile and well defined


Cancer


30-90 yr; common in midlife and elderly


Irregular or fixed to skin or underlying structures, firm or hard


Usually nontender (except inflammatory); retraction may be present


May be fixed or partially mobile; not often well defined



» BASIC TRIAGE ASSESSMENT FORM FOR BREAST COMPLAINTS



  • How old are you? ___________________________________________________________


  • Do you have any history of breast problems? ________________________________


  • Are you still menstruating? ________________________________________________


  • When was the first day of your last menstrual cycle? _______________________


  • Are you taking any hormonal medication? If yes, what and for how long? _____


  • Have you recently stopped breastfeeding? ___________________________________


  • Have you recently had a mammogram? If so, where and when? __________________



Breast Discharge




» Actions


STEP A: Milky Discharge

Milky discharge (galactorrhea) is common in women who are breastfeeding, have recently given birth, or who experience frequent breast stimulation (e.g., during foreplay). Galactorrhea is also a side effect of many medications (particularly sedatives, antidepressants, antipsychotics, high blood pressure medications, and, rarely, oral contraceptives). Finally, galactorrhea can be indicative of a pituitary tumor.

Unless the patient has recently given birth and is breastfeeding, she should be referred to her provider for evaluation within the next 1 to 2 weeks.


STEP B: Unilateral Discharge

Unilateral discharge (particularly if the fluid is bloody, green, or tan) is highly suggestive of a breast problem. Refer the patient to her provider for evaluation within the next 2 to 3 days.


STEP C: Bloody or Discolored Discharge

Bloody or discolored discharge (whether unilateral or bilateral) is suggestive of a breast problem. Refer the patient to her provider for evaluation within the next 2 to 3 days.


STEP D: Discharge With Breast Stimulation

This is not an uncommon response to vigorous breast manipulation. Ask the patient to refrain from breast stimulation for the next 30 days. If the symptoms persist, instruct her to visit her provider for breast examination.



Breast Lump

May 8, 2019 | Posted by in OBSTETRICS | Comments Off on Breast Complaints Overview
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