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Routine referral |
Primary care management - issue relevant advice leaflet (if available) |
| Lump |
- Any new discrete lump in patients under 30 years with no other suspicious features
- New asymmetrical nodularity that persists at review after two to three weeks (in patients under 35 years)
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- Women with longstanding tender lumpy breasts and no focal lesion
- Tender developing breasts in adolescents
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| Nipple Symptoms |
- Persistent unilateral spontaneous discharge sufficient to stain outer clothes
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- Transient nipple discharge which is not bloodstained
- Check prolactin levels in persistent bilateral discharge
- Longstanding nipple retraction
- Nipple eczema if eczema present elsewhere
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| Skin changes |
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- Obvious simple skin lesions such as epidermoid (sebaceous) cysts
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| Abscess/infection |
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- Abscess or inflammation - try one course of antibiotics as per local guidelines
- Any acute abscess requires immediate discussion with secondary care
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| Breast pain |
- Unilateral pain persisting over three months in post-menopausal women
- Intractable pain that interferes with the person’s lifestyle or sleep
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- Women with moderate degrees of breast pain and no discrete palpable lesion
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| Gynaecomastia |
- Exceptional aesthetics referral to plastic surgery
pathway if appropriate (i.e. NOT to the breast service)
- Exclude or treat any endocrine cause prior to referral
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- Examine and exclude abnormalities such as lymphadenopathy or evidence of endocrine condition with blood tests as per local guidelines.
- Review to exclude drug causes
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| Breast implants |
- If appropriate, refer to the service that first inserted the implant (usually plastic surgery)
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- Reassurance is often appropriate if symptoms relate to the implant alone and not to underlying breast tissue
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