Abscess

Question 1

What condition is a breast abscess associated with?

Answer 1

· Mastitis.

· A breast abscess may or may not be associated with mastitis.

Question 2

What is mastitis?

Answer 2

· Inflammation of the breast with or without infection.

Question 3

Mastitis with infection can be what two things?

Answer 3

Lactational (puerperal) or non-lactational (duct ectasia).

Question 4

Who is affected?

Answer 4

· Typically affects women 15-45 years of age.

· Breast abscess develops in 3-11% of women with mastitis.

Question 5

What is the pathophysiology of lactational mastitis?

Answer 5

Milk stasis or overproduction, coupled with infection from bacteria entering the breast via a traumatised nipple and/or the infant’s mouth, can lead to mastitis.

Question 6

Lactational mastitis is most commonly associated with which organism?

Answer 6

Staph Aureus or some strains of MRSA.

Question 7

A lactational abscess tends to be located where?

Answer 7

In the peripheral breast.

Question 8

An abscess unrelated to breastfeeding tends to be located where?

Answer 8

The sub-areolar location.

Question 9

What are the 2 types of infections that can accompany mastitis?

Answer 9

1. Central/Subareolar Infection – usually secondary to periductal mastitis.
2. 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 10

List the risk factors of an abscess/mastitis in a lactating female.

Answer 10

· Female.
· Women 15-45 years of age.
· Infants <2 months and adolescent girls. 
· Poor breastfeeding technique. 
· Lactation.
· Prior breast abscess.

Question 11

List the risk factors of an abscess/mastitis in a non-lactating female.

Answer 11

· Smoking.
· Nipple damage.
· Trauma.
· Underlying breast abnormality.
· Immunosuppression.
· Shaving or plucking areolar hair.
· Foreign body (implants).

Question 12

What are the typical signs and symptoms of mastitis?

Answer 12

· Flu-like symptoms, malaise and myalgia. 
· Fever. 
· Breast pain. 
· Decreased milk outflow. 
· Breast warmth. 
· Breast firmness/swelling. 
· Breast erythema. 
· Lump.

Question 13

What investigations would you request if you suspected a patient had mastitis?

Answer 13

· Breast USS.
· Diagnostic needle aspiration drainage.
· Cytology of nipple discharge or from FNA.
· Pregnancy test.
· Blood cultures.
· FBC.

Question 14

Why might you do a pregnancy test?

Answer 14

If mastitis develops unexpectedly in an adolescent.

Question 15

Why might you request blood cultures?

Answer 15

If systemic infection is suspected.

Question 16

List some differential diagnoses.

Answer 16

· Breast engorgement.
· Galactocele.
· Fibrocystic breasts. 
· Breast trauma. 
· Primary invasive breast cancer. 
· Fibroadenoma.

Question 17

What is the treatment option of a breast abscess with no MRSA present?

Answer 17

· 1st line - IV/Oral abx with activity against methicillin-sensitive staph plus supportive care.
· Plus - Reassess diagnosis and treatment.
· Adjunct - Surgical intervention.

Question 18

What is the treatment option of a breast abscess with confirmed MRSA?

Answer 18

· 1st line - Non-beta-lactam abx plus supportive care.
· Plus - Reassess diagnosis and treatment.
· Adjunct - Surgical intervention.

Question 19

What surgical intervention is performed to treat a breast abscess?

Answer 19

Ultrasound-guided needle aspiration.

Question 20

List some complications that may arise.

Answer 20

· Cessation of breastfeeding. 
· Abscess (from mastitis). 
· Sepsis.
· Scarring. 
· Breast hypoplasia. 
· Necrotising fasciitis. 
· Fistula.