Abcess

Question 1

How common is it?

Answer 1

3-11% of women with mastitis, and about 10-33% of ladies lactating get mastitis

Question 2

Who does it affect?

Answer 2

Lactating women

Question 3

What causes it?

Answer 3

In lactating women, milk stasis is the primary cause of mastitis. The milk stasis causes and inflammatory response that may or may not progress to an infection. Most common organism is Staphylococcus aureus or possibly strains of MRSA.

In non-lactating women, mastitis is usually accompanied by infection, which can be categorized as either central/subareolar or peripheral.

Central/subareolar infection: Is usually secondary to periductal mastitis or duct ectasia

Peripheral non-lactating infection: Has been associated with diabetes mellitus, rheumatoid arthritis, trauma, corticosteroid treatment, and granulomatous lobular mastitis, but often there is no underlying cause

Question 4

What risk factors are there in lactating women?

Answer 4

Poor infant attachment to the breast

reduced number or duration of feeds (e.g. partial bottle feeding, painful breasts, maternal stress + fatigue etc.)

No evidence that breast size is related

30-34 years of age is the most likely time

Question 5

What are the risk factors for mastitis in non-lactating women?

Answer 5

Smoking is the biggest

nipple damage (piercing, eczema, infection, Raynaud’s),

trauma

underlying breast abnormality

immunosuppression, shaving or plucking areolar hair

foreign body (implants)

Question 6

What are the risk factors for breast abscesses?

Answer 6

Previous mastitis

sudden cessation of breastfeeding in women with lactational mastitis

Staph aureus carriage.

Poor socio-economic status.

Poor hygiene

Question 7

How does it present?

Answer 7

History of recent mastitis. Fever or general malaise (these may have subsided if the women has taken antibiotics for suspected infectious mastitis. Painful swollen lump in the breast, with redness, heat, and swelling of the overlying skin.

Question 8

Signs on examination?

Answer 8

The lump may be fluctuant with skin discolouration

Erythema

Question 9

Investigations?

Answer 9

Ultrasound

Culture fluid from abcess

Question 10

Treatment?

Answer 10

Drainage of abscess, by ultrasound-guided needle aspiration or surgical drainage. Advise lactating women to continue breastfeeding if possible (including from the affected breast). If this is too painful or the infant refuses the milk, express the milk either by hand or by pump until she is able to resume.

Question 11

Differential diagnosis?

Answer 11

onditions that cause breast pain and are associated with lactation: Full breasts, engorged breasts, a blocked duct, galactocele and infection of the mammary ducts.

Conditions that cause breast pain that are not associated with lactation include: Breast cancer, duct ectasia, cellulitis, fibroadenosis, ruptured breast cyst, necrotising fasciitis of the breast, fat necrosis of the breast.

Conditions that cause nipple pain include: Poor infant attachment, candida infection of the nipple, blanching of the nipple, bacterial infection of the nipple, Raynaud’s disease of the nipple.