Breast Abscess

Question 1

How common is it?

Answer 1

• Between 10% and 33% of breast-feeding women develop lactation mastitis.

Question 2

Who does it affect?

Answer 2

Incidence highest in first few weeks following childbirth.

Question 3

What causes it?

Answer 3

Mastitis is an inflammatory condition of the breast. This may or may not be accompanied by infection of the breast.
In around 3% of patients, mastitis may be complicated by a breast abscess.
Common organisms responsible for mastitis and breast abscess are
• Staphylococcus aureus – most common
• Esherichia coli (or other gram negative bacteria)
• Bacteroides
• streptococci (alpha, beta and non-haemolytic)

Question 4

What risk factors are there?

Answer 4

• Nipple fissures, cracks and sores are predisposing factors.
• Breast engorgement and poor milk drainage.
• Maternal age over 30 years.
• Women with a past history of mastitis.
• Gestational age more than 41 weeks.
• Improper nursing technique, leading to incomplete emptying of the breast.

Question 5

How does it present?

Answer 5

Symptoms
• This normally presents ≥1 week postpartum with only one breast usually affected and often only one quadrant or lobule painful to touch, inflamed, swollen and hot.
• It should be distinguished from congestive mastitis (breast engorgement) which usually presents on the second or third day of breast-feeding. The complaint is of a swollen and tender breast which is often bilateral and without fever or erythema.

Signs
• Breast examination reveals unilateral oedema, erythema in a wedge-shaped area, and tenderness.
• There may be purulent drainage or pus obtained on aspiration.
• Axillary lymphadenopathy is palpable.
In a breast abscess, examination reveals a tender hard breast mass, which may be fluctuant, with overlying erythema.

Question 6

What other conditions may present similarly?

Answer 6

Fibrocystic disease

Question 7

How would you investigate the patient?

Answer 7

Ultrasound, cultures for bacteria. Fine needle aspiration?

Question 8

What treatments?

Answer 8

General advice
• Assessment of breast-feeding technique.
• Advise manual expression of milk to empty the breast after feeding; this allows proper drainage of the breast.
• Reassure the mother that continuing to breast-feed does not present any risk to the infant.
• Suggest supportive therapy such as bedrest, increased fluids, ice packs, analgesia and use of simple analgesia.
• Advise that she should stop breast-feeding if an abscess develops, although feeding is encouraged to restart once the abscess is treated.

Pharmacological
• Antibiotics, e.g. flucloxacillin or erythromycin should be prescribed. Early prescription is associated with reduced risk of progression to an abscess.

Surgical
• Incision and drainage of abscess.
• Any persisting mass will need investigating to rule out sinister causes.