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BREAST CONDITIONS ARE THESE BREASTS NORMAL? WARNING SIGNS LUMP - firm, discrete, no change with menses NIPPLE D/C - SPONTANEOUS, unilateral, persistent, clear, bloody, amber, from one duct , guiac + DIMPLING/RETRACTION OF SKIN SKIN EDEMA/ERYTHEMA - not assoc. with fever, NO CHANGE WITH ANTIBIOTIC, usually painless. ULCERATED,SCALY NIPPLE/AREOLA - non-healing after course of cortisone-often bleeds if you try to remove it. Dimpling/retraction Peau de orange / Inflammatory Breast Ca MYSTERY SYMPTOMS EXPLAINED LUMPS AND BUMPS: NORMAL FIBROCYSTIC CHANGE FEELS LIKE LUMPY SQUISHY COTTAGE CHEESE SEE YOUR DOCTOR IF A LUMP IS FIRM, has IRREGULAR EDGES,DOESN’T MOVE PAINFUL-TENDER BREASTS-USUALLY DUE TO MONTHLY HORMONE CHANGES. RARELY SERIOUS ESPECIALLY IN ABSENCE OF A LUMP. Decrease caffeine TREATMENT: BREAST PAIN –Evening Primrose Oil 500mg po take 2-3 per day Anti-inflammatories CYSTS OR SWELLING – FIBROCYSTIC Vitamin E 400 IU/day Vitamin B6 100 mg/day PAIN IS RARELY A PRESENTING SYMPTOM FOR CANCER OF THE BREAST! CANCER OF THE BREAST RARELY HAS PAIN SEE YOUR PROVIDER IF THERE IS REDNESS, FEVER, SEVERE PAIN as this is sign of infection ! CHEST WALL PAIN Chest Wall Pain is commonly present and commonly mistaken for breast pain. Treatment : Anti-inflammatory like Ibuprofen 600 mg 3 x / day for 1-2 wks Warm moist compress 4 x/day LEAKY NIPPLES •NORMAL WHEN BREASTS ARE STIMULATED OR SQUEEZED/SUCKED •NORMAL COLORS : GREEN, GREY, WHITE, multi-colored •CAN BE THE SIDE EFFECT OF MEDICATIONS: HORMONES, ANTIDEPRESSANTS, ETC. CHECK WITH YOUR DOCTOR OR PHARMACIST •COMES OUT OF SEVERAL DUCTS •ABNORMAL: BLOODY, CLEAR, AMBER ; FROM ONE DUCT, SPONTANEOUS, PERSISTENT (GUIAC +) •BILATERAL MILKY D/C > 2 YRS POST BREASTFEEDING - check : TSH, PROLACTIN - meds that cause this* •Most common cause of unilateral nipple d/c IS NOT CANCER Meds assoc. with milky nipple discharge or galactorrhea *Estrogens, digitalis, marijuana, heroin, dopamine receptor blockers, phenothiazines, haloperidol, metoclopramide, isoniazid, CNS dopamine depleters, triacyclic antidepressants,reserpine, methyldopa, cimetidine, benzodiazepines. These increase prolactin levels which triggers the discharge (see gynecomastia too) Nipple Discharge cont’d. Duct Ectasia Permanantly distended ducts that collect fluid, cheesy material. Drains from nipple & may result in chronic inflammatory reaction Papilloma : a benign tumor with slight potential for malignant degeneration. Fluid seen from a single duct usually bloody, clear, amber. Guiac positive BREAST CANCER IS THE LEAST COMMON CAUSE OF NIPPLE DISCHARGE ! BREAST EXAMINATION MADE EASY………… VISUALLY EXAMINE THE BREASTS WITH HANDS ABOVE HEAD ,PRESS PALMS TOGETHER, HANDS ON HIPS, PRESS PADS OF 3 FINGERS OVERLAPPING CIRCLES, WORKING IN ROWS LIKE MOWING THE LAWN 3 DIME SIZE CIRCLES IN ONE PLACE USING LIGHT, MEDIUM, DEEP PRESSURE COVER FROM COLLAR BONE TO BREAST BONE TO BRA LINE TO MID-AXILLARY LINE-LIKE THE SIDE SEAM OF A SHIRT EXAMINE SUPRACLAVICULAR AND AXILLARY NODES GOOD CLINICAL EXAM INVERTED NIPPLES USUALLY FROM LAX ERECTILE TISSUE ABNORMAL : SUDDENLY ONE NIPPLE PULLS IN - will NOT evert Inverted Nipples Benign Lumps FIBROADENOMA common b9 tumor often teens to 30yo. May be found later on mammo. Painless, rubbery smooth round mobile Benign: CYSTS Cysts are fluid filled lumps that may or may not be tender. If palpable >= to 1cm can be aspirated if not resolving with end of menses. Vit. E 400 IU/d, B6 100mg/d