In a patient with a tender breast mass, what is the best initial management step?

In a patient presenting with a tender breast mass, the best initial management step is to perform a breast ultrasound. This imaging technique is particularly useful in differentiating between solid masses and cysts, which can help to determine the next steps in management. Ultrasound is non-invasive, readily available, and safe, making it ideal for evaluating breast masses, especially in younger women or when the characteristics of the mass need clarification.

While biopsies can ultimately provide a definitive diagnosis, they are not the first step in the management of a tender mass. Similarly, mammography, although important, may not be as helpful as an initial evaluation in younger patients due to denser breast tissue and may not provide as clear an image of the mass as ultrasound. Referral to surgery would also not be the initial step without prior imaging to assess the characteristics of the mass. By starting with breast ultrasound, the clinician can guide further management effectively based on the findings.