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Nipple Discharge

Nipple Discharge. Bilateral Breast Exam. Age > 35: Diagnostic Mammogram -- Unless negative mammogram within past 6 months. Non-Bloody. Bloody (<5% associated with malignancy). R/O Mechanical Stimulation R/O Medication Cause: Phenothiazine Reserpine Estrogen Opiates

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Nipple Discharge

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  1. Nipple Discharge Bilateral Breast Exam Age > 35: Diagnostic Mammogram -- Unless negative mammogram within past 6 months. Non-Bloody Bloody (<5% associated with malignancy) • R/O Mechanical Stimulation R/O Medication Cause: • Phenothiazine • Reserpine • Estrogen • Opiates • Check Prolactin Level Check TSH Surgery Referral Abnormal Normal Primary Care Physician to treat Recheck 1 Month: If Unchanged or Resolved Reassure • Consider • Single Duct (may be cancer) vs. Multiple Duct (not as worrisome) • Bilateral (not as worrisome) vs. Unilateral (may be cancer) • Ductograms do not R/O pathology and should not be ordered

  2. Breast Pain Occurs in 70% of Premenopausal Females Bilateral Breast Exam Assess currency with screening mammograms (see Breast Cancer Screening Guidelines) Negative Positive Refer to Breast Lump Algorithm Cyclic Pain Non-Cyclic Pain Mild to Moderate Moderate to Severe • Primary MD Assessment for: • Breast Disorder • Chest Wall Disorder • --Bone • --Muscle • --Joint • Pleural Disease • Cardiac Disease • GI Disease • Primary MD for possible hormone therapy: • Premenopausal--BCP • Perimenopausal-- consider low dose BCP • Postmenopausal--Decrease or stop Estrogen • Non-Hormonal Therapy for 4-6 Months: • Reassurance • Supportive & Well-Fitting Bra • NSAIDS • Caffeine Decrease • Oil of Primrose: 1500-3000 mg daily (contains gamolenic acid) • Vitamin E 800u daily

  3. Infection/Mastitis(Non-Breastfeeding Female) *Inflammatory carcinoma should always be considered. Bilateral Breast Exam Redness, Warmth, Swelling, Purulent Discharge, Draining Wound Warm Packs, NSAIDS, Antibiotics Cephalexin--500 mg po QID x 10 days Dicloxacillin--500 mg po QID x 10 days E-mycin--333 mg. TID x 10 days if allergic to penicillin Recheck within 7-10 days or sooner if new or increasing symptoms Signs and Symptoms Alleviated Signs and Symptoms Unchanged or Increased Instruct: Screening Mammogram per Age Guidelines Surgery Referral If breastfeeding, treat with antibiotics, as above. Continue breastfeeding. If patient has implants, consider longer course of antibiotics or referral to Plastic Surgery.

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