A 35-year-old woman, gravida 1 para 1, who is 8 weeks postpartum comes to the office with multiple painful lumps in her breasts for the past week. She is breastfeeding and is otherwise healthy. Her only medication is a prenatal vitamin. The patient's mother had postmenopausal breast cancer.
Vital signs are normal. Physical examination reveals multiple small and tender masses in bilateral breasts; there is no surrounding erythema. Milky discharge is expressed bilaterally.
Which of the following is the most likely cause of this patient's symptoms?

Question

A 35-year-old woman, gravida 1 para 1, who is 8 weeks postpartum comes to the office with multiple painful lumps in her breasts for the past week.  She is breastfeeding and is otherwise healthy.  Her only medication is a prenatal vitamin.  The patient's mother had postmenopausal breast cancer.
Vital signs are normal.  Physical examination reveals multiple small and tender masses in bilateral breasts; there is no surrounding erythema.  Milky discharge is expressed bilaterally.
Which of the following is the most likely cause of this patient's symptoms?

Quizplus · Accepted Answer

11ec193a_97e0_75f6_853d_49bc4866551d_MD0002_00 Breastfeeding women with plugged milk ducts typically have breast pain and tenderness, palpable masses, and no signs of infection. Poor feeding technique, a decrease in feeding, inadequate emptying, and stasis can lead to breast engorgement (ie, breast tissue distension) and subsequent blockage of milk ducts. Treatment of plugged ducts includes optimizing feeding technique, continued breastfeeding, and symptomatic relief (eg, warm compresses, manual massage, nonsteroidal anti-inflammatory drugs). (Choice A) A galactocele is a large, milk-retaining cyst due to a blocked milk duct. Galactoceles are painless and typically resolve. If the galactocele persists, ultrasound (with or without aspiration) may be used to differentiate it from malignancy. galactocele (Choice B) Inflammatory breast cancer is more common in postmenopausal women; however, it presents as mastitis that does not resolve with antibiotics. In addition to a palpable breast mass, patients often have a painful, enlarged, pruritic breast with skin thickening ("peau d'orange" appearance). Due to rapid metastasis, axillary lymph nodes are also typically palpable. Patients with suspected inflammatory breast cancer require diagnostic mammography and core needle biopsy. Inflammatory breast cancer (Choices C and D) During lactation, breast pain can occur due to engorgement of normal breast tissue; however, there are no associated lumps. Lactational mastitis is a complication of engorgement and plugged milk ducts. Patients typically have fever, localized breast pain, and erythema, not a mass. Lactational mastitis requires no imaging. Treatment is symptomatic (eg, nonsteroidal anti-inflammatory drugs, continued breastfeeding) and a course of antibiotics (eg, dicloxacillin, cephalexin) that provides coverage against Staphylococcus aureus. Untreated lactational mastitis can progress to abscess. Lactational mastitis Educational objective: Plugged milk ducts are localized areas of milk stasis that cause distension of breast tissue, resulting in pain, tender and palpable masses, and no signs of infection in breastfeeding women. Treatment is supportive and includes optimizing breastfeeding. __________ References: Management of common breast-feeding problems. (http://www.ncbi.nlm.nih.gov/pubmed/8027734) Common breast problems. (http://www.ncbi.nlm.nih.gov/pubmed/22963023)

A 35-Year-Old Woman, Gravida 1 Para 1, Who Is 8