Breast Lump

1
Breast Lump
Bilateral Breast Exam
No Palpable Mass
Palpable Mass
Aspiration in Primary Care or OB/GYN
Age lt 35
Age gt 35
Diagnostic Mammogram -- unless negative
mammogram within the past 6 months
Cystic (Fluid)
Solid (No Fluid)
Age gt 35
Age lt 35

• No Residual Mass
• Fluid not Bloody

• Residual Mass
• Bloody Fluid

Abnormal
Normal

• Diagnostic Mammogram --
• Unless
• negative
• mammogram
• within
• past 6 months
• Surgery Referral

Surgery Referral
Recheck 1 Month
Recheck Exam 1 Month
Surgery Referral
No Recurrent Mass
Recurrent Mass

• Diagnostic Mammogram -- Unless negative
  mammogram
• within past 6 months
• Surgery Referral

Age lt 40
Age gt 40
Patient Complaint Resolved
Unresolved
Screening Mammogram per Routine Guidelines
Refer to Surgery for Persistent Concern
of Patient or Provider

• Note Do not aspirate if patient has breast
  implants
• To Surgery
• Diagnostic Mammogram -- Unless negative
  mammogram within past 6 months

Abnormal
Normal

• Screening Mammogram per Guidelines for Age/Risk

• Screening Mammogram per Guidelines for Age/Risk

Follow Radiology Recommendation re Stereo vs. bx
vs. follow - up
Encourage Reduction in Caffeine, Vitamin E 800 u
daily
2
Breast Implants
Bilateral Breast Exam
Breast Lump
Possible Infection/Mastitis
Question of Implant Integrity
Age lt 35
Age gt 35 Diagnostic Mammogram --Unless negative
mammogram within past 6 months.
Assessment may include the following localized
redness, warmth, pain, swelling generalized
redness, warmth, pain, swelling nipple discharge
with pus, draining wound, fever
Assessment may include any of the following
change of breast contour, shape or softness,
patient concerns regarding possible leakage
Refer to Plastic Surgery
Treat with antibiotics per Infection/Mastitis Guid
eline with a recheck within 10 days Note
Inflammatory carcinoma should be considered
Surgical referral NO ASPIRATIONS WILL BE
ATTEMPTED
Symptoms resolved
Symptoms continue
Patient to be instructed to obtain a copy of
the medical record pertaining to
implant placement for the KP medical record if
done outside KP
Treat implant patients as per guidelines for
Mammography Follow-up/Breast Exam WNL Breast
pain Nipple Discharge
Refer to Plastic Surgery
Follow-up PRN
3
Mammography Follow-up Guidelines Breast Exam
Within Normal Limits
Negative
Probably Benign
Suspicious or Highly Suggestive of Malignancy
Schedule mammogram per risk status
Repeat abnormal side(s) at 3, 6 or 12 months per
Radiologist recommendation (usually 6 months).
Concomitant physical exam If recommended by
Radiologist
No mass palpable
Mass palpable
Surgery referral
Franklin Radiology referral for stereotactic or
ultrasound guided biopsy. Surgery referral for
needle localization biopsy as per Radiologist
recommendation
Stable
Schedule mammogram per recommendation
usually 6 months
Stable mammogram findings are followed up at the
Radiologist recommended intervals, usually
annually for a total follow-up period of 3 years.
Findings that are found to be negative or
suspicious during follow-up will be managed per
Radiologist recommendation and guideline
Negative biopsy Schedule mammogram per risk
status or Radiology recommendation
Surgery referral for positive biopsy