Management of Patients with Breast disorders

Nipple Discharge

 Nipple discharge in a woman who is not lactating may be related to many

causes, such as carcinoma, papilloma, pituitary adenoma, cystic breasts, and
medications.
 Oral contraceptives, pregnancy, HT and chlorpromazine medications, may be
contributing factors.
 In athletic women, nipple discharge may occur during running or aerobic
exercises.
 Clear discharge is usually normal. A green discharge could indicate an
infection.
 Any discharge that is spontaneous, persistent, or unilateral is of more concern.
 Bloody discharge can indicate a malignancy or a benign wart like intraductal
papilloma.
 Nipple discharge should be evaluated for the presence of occult (hidden) blood
by performing a guaiac test.
 A surgical biopsy called a duct excision may be indicated.
Fissure

 A fissure is a longitudinal ulcer that may develop in breastfeeding women.

 If the nipple becomes irritated, a painful, raw area may form and become a site
of infection.
 Nipple irritation can result from improper positioning (the infant has not
grasped the areola fully).
 Daily washing with water, massage with breast milk or lanolin, and exposure to
air are helpful.

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 Breastfeeding can be continued with the use of a nipple shield.
 Severe or extremely painful, the woman is advised to stop breastfeeding.
 A breast pump can be used until breastfeeding can be resumed.
 Persistent ulceration requires further diagnosis and therapy.
Mastitis

 An inflammation or infection of breast tissue, occurs most commonly in

breastfeeding women.
 The infection may result from a transfer of micro-organisms to the breast by the
patient’s hands or from a breastfed infant with an oral or skin infection.
 Mastitis may also be caused by bloodborne organisms.
 Breast texture becomes tough and dull to severe pain in the infected region.
 A nipple that is discharging purulent material, serum, or blood should be
investigated.
 Treatment consists of antibiotics and local application of cold compresses to
relieve discomfort.
 A broad-spectrum antibiotic agent for 7 to 10 days.
 Adequate rest and hydration are important.

Breast Pain

 Breast pain (mastalgia) may be cyclical or noncyclical.

 Cyclical pain is usually related to hormonal fluctuations and accounts for nearly
75% of all complaints.
 Noncyclical pain is less common and does not vary with the menstrual cycle.
 Women who experience injury or trauma to the breast or those who had a breast
biopsy may experience noncyclical pain.
 Breast pain is rarely indicative of cancer.
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Nursing Management
o Decrease her salt and caffeine intake.
o Take ibuprofen as needed for its anti-inflammatory actions.
o Vitamin E supplements or oil of evening primrose may also be helpful.