Breast Pain: Which Specialist Should You Consult?

Unsure which specialty to consult?

1.
I have pain between my right breast and armpit, as well as underneath my right breast (not in the breast tissue itself).
The pain worsens with deep breathing and sneezing.
I can express a small amount of discharge from my breasts; the right side produces a clear fluid, while the left side produces a milky white fluid.
This symptom has persisted for three weeks.

2.
I have visited Chang Gung Memorial Hospital and consulted with the endocrinology and general surgery departments.
Blood tests and discharge analysis were performed, and a breast ultrasound was conducted, all of which returned normal results.
Prolactin levels were normal, and there were no signs of breast cancer.
The doctor advised me to try warm compresses and to monitor the situation.
3.
I am still experiencing pain and discharge.
I am unsure if I need to visit another hospital for a re-evaluation in the same two specialties or if I should consult a different specialty.

Ling Xiaowei, 30~39 year old female. Ask Date: 2000/11/30

Dr. Lin Mingxing reply Family Medicine

Based on the symptoms you described, there is a small amount of discharge from the breasts, with the right side producing a clear fluid and the left side producing a milky fluid.
This symptom has persisted for three weeks and may indicate inflammation or obstruction of the mammary ducts.
However, since this symptom has lasted for three weeks and you have not sought evaluation from a specialist, it is recommended that you visit a breast surgeon for a professional assessment.

Reply Date: 2000/11/30

More Info

When it comes to breast pain, it can be a complex issue that requires careful evaluation by a medical professional. Based on your symptoms, which include pain in the right breast and underarm area, as well as the presence of discharge from both breasts, it is crucial to consult with a specialist who can provide a thorough assessment and appropriate management.

Given that you have already seen a general surgeon and an endocrinologist, and have undergone tests including blood work and breast ultrasound with normal results, the next step would be to consult a breast specialist or a breast surgeon. These professionals are specifically trained to handle breast-related issues, including pain, lumps, and discharge. They can provide a more focused examination and may recommend additional imaging studies or procedures if necessary.

Breast pain, also known as mastalgia, can arise from various causes, including hormonal fluctuations, cysts, infections, or even trauma. In your case, the discharge you described—clear from the right breast and milky from the left—could indicate a condition known as galactorrhea, which is the inappropriate production of milk. This can be caused by hormonal imbalances, certain medications, or other underlying conditions.
It's also important to consider the possibility of a breast duct issue, such as a blocked duct or ductal ectasia, which can lead to pain and discharge. Since your symptoms have persisted for three weeks, and you are still experiencing pain and discharge, it is advisable to seek further evaluation. A breast specialist can perform a more detailed examination and may suggest a ductogram or MRI if they suspect a blockage or other issues that were not visible on the ultrasound.

In addition to consulting a breast specialist, you might also want to consider lifestyle factors that could be contributing to your symptoms. For instance, wearing a well-fitted bra can provide support and reduce discomfort. Avoiding caffeine and high-fat foods may also help alleviate breast pain for some individuals, as these have been linked to increased breast tenderness in certain cases.

If you are experiencing significant discomfort or if the discharge changes in color or consistency, it is essential to seek medical attention promptly. Your health and peace of mind are paramount, and persistent symptoms warrant further investigation.
In summary, based on your ongoing symptoms, I recommend that you consult a breast specialist or a breast surgeon for a comprehensive evaluation. They will be able to provide you with a tailored approach to your condition, ensuring that any underlying issues are addressed effectively. Remember, it is always better to seek a second opinion if you feel your concerns are not being adequately addressed. Your health is important, and you deserve thorough care and attention.

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