This document is designed to aid practitioners in providing appropriate obstetric and gynecologic care. (“SASGOG”) is committed to accuracy and will review and validate all Pearls on an ongoing basis to reflect current practice. The Society for Academic Specialists in General Obstetrics and Gynecology, Inc. Originally titled “Cystic Breast Masses in Young Women” – Renamed March, 2021. Original approval August 2015 Revised September 2016, January 2018, Minor revision July 2019 Minor Revision March 2021, Minor Revision September 2022. 164: Diagnosis and Management of Benign Breast Disorders. NCCN Clinical Practice Guidelines in Oncology, Version 1.2020 – Septem[after login, Available at: Īmerican College of Obstetricians and Gynecologists’ Committee on Practice Bulletins-Gynecology. On exam, a malignancy will often feel hard and immobile with diffuse edges. Breast malignancies can be associated with nipple discharge, skin changes, or new nipple inversion. Diagnostic mammography can be performed in people over 30 or if there are other concerning features on ultrasound in younger patients. No further workup is necessary.īreast malignancy is uncommon in young patients, but thorough evaluation of a breast mass is warranted. The diagnosis can be made by aspiration revealing a milky substance. On exam, they are soft, cystic, and typically systemic findings are absent. Galactoceles are caused by obstruction of milk ducts, often during weaning. Areas of fat necrosis can become fibrotic and appear immobile and diffuse, similar to malignancy. It can also occur following injections or placement of foreign substances, including breast implants. Incision and drainage may be necessary for larger abscesses or if conservative management fails.įat necrosis occurs rarely, usually as a result of trauma. Puerperal abscesses can be managed with antibiotics and ultrasound guided aspiration. On exam, erythema, skin warmth and thickening, and tenderness are characteristic. Non-lactation abscesses have been associated with tattoos, nipple piercings, and after radiation or surgery. The incidence of lactation abscesses in breastfeeding people is up to 3% in the setting of mastitis. Complex cysts may require frequent ultrasonographic follow-up, aspiration, or even removal depending on the complexity or radiological features.īreast abscesses can be classified as either lactation or non-lactation related. If the mass is still palpable after aspiration or if it recurs, further evaluation is indicated. Office aspiration may be warranted for severe persistent pain. If the cyst is simple, repeat breast exam can be performed in 2-4 months and the patient can return to routine screening if the cyst remains stable or resolves. Simple cysts are mobile, with discrete borders, and feel fluctuant or even “elastic.” Ultrasound can differentiate a simple from a complex cyst. The mass size, ultrasonographic features, and level of patient concern often determine need for excision. Breast imaging can be helpful, but biopsy may be necessary to confirm the diagnosis. They present as solid, nontender, firm, mobile, rubbery masses and may be multiple in 15-20% of cases. A persistent unexplained mass should be biopsied or excised.įibroadenomas are commonly found in young patients. Further evaluation is influenced by ultrasound findings. The increased density of the breast tissue in patients under the age of 30 makes mammography less accurate and should not be used as an initial test. If a discrete mass is present, ultrasound is the imaging technique of choice. Elimination of caffeine-containing foods may improve symptoms. Physical exam reveals diffuse small cystic masses, often described as “peas on a plate.” History and physical is usually diagnostic. Breast pain from fibrocystic changes can be cyclical or constant, bilateral or unilateral, or focal. The most common etiology of a benign cyst is fibrocystic change, occurring in approximately 50% of patients. The size, shape, location, consistency, mobility, and delimitation (presence of borders and edges) of a breast mass are important considerations. Examination should include careful assessment of entire breast, the axilla, supraclavicular area, and evaluation for skin retraction. Evaluation should include history, exam, and ultrasound if necessary. The differential diagnosis of a breast mass in a young patient includes benign cyst, fibrocystic changes, fibroadenoma, breast abscess, galactocele, fat necrosis, and malignancy.
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