BREAST ABSCESS

Question 1

What is an abscess?

Answer 1

A painful collection of pus that forms in the breast.

Question 2

Where do most abscesses develop?

Answer 2

Most abscesses develop just under the skin

Question 3

What general group of organisms causes

Answer 3

bacterial origin

Question 4

What is the typical presentation/ profile of patient?

Answer 4

Women. Breastfeeding. 18-50yrs.

Question 5

How many women get mastitis during pregnancy? How many of these develop a breast abscess?

Answer 5

1/10 women get mastitis during breastfeeding, and this is linked to that. 3% of women with mastitis treated with antibiotic medicines develop a breast abscess, research suggests.

Question 6

Presentation

Answer 6

If linked to mastitis (pain and swelling/ inflammation)

Question 7

What are the most common bacteria that cause it?

Answer 7

Most common bacteria: staph aureus. Can also be Staphylococcus albus and streptococci or Meticillin-resistant Staphylococcus aureus (MRSA) (more common in C-sections).

Question 8

How does breastfeeding cause the abscess?

Answer 8

• During breastfeeding bacteria can enter the breast tissue or occurs if the milk ducts become blocked –> leading to mastitis –> and if not treated becomes an abscess.
o An overgrowth of bacteria can occur if stagnant milk collects in a blocked milk duct.

Question 9

How does it occur if you’re not breastfeeding?

Answer 9

It can also occur if you are not breastfeeding: bacteria can also enter the milk ducts through a sore or cracked nipple, or nipple piercing.

Question 10

Who has an increased risk of non-breastfeeding mastitis?

Answer 10

Women who smoke have an increased risk of developing non-breastfeeding mastitis: known as periductal mastitis.

Question 11

How are white cells involved in process?

Answer 11

The WBC’s that the body produces to deal with the infection, create a hollow area which becomes full with pus, and causes the abscess.

Question 12

What are the risk factors?

Answer 12

• Infant not attaching properly during feeding i.e. technical or anatomical reasons (tongue-tie or cleft-lip)
• Less feeds, or reduced duration = accumulation of milk
o Partial bottle feeding/ changes in regime/ rapid weaning/ painful breasts/ preferred breast, leading to accumulation on one breast.
• Nipple fissures, cracks or sores
• Trauma to breast
• Blocked milk ducts.
• Smoking

Question 13

Presentation

Answer 13

Painful swollen lumps that may be red/ hot/ cause surrounding skin to swell/ cause pyrexia.

Question 14

How quickly after postpartum does it normally present?

Answer 14

Normally present ≥1 week postpartum, usually just in one breast.

Question 15

How would the area be described?

Answer 15

painful/ tendor/ red and hot

Question 16

What systemic features may be present?

Answer 16

fever, rigors, muscle pain, lethargy, depression, nausea and headache.

Question 17

What would breast examination reveal?

Answer 17

Breast examination reveals unilateral oedema, erythema in a wedge-shaped area, and tenderness. The affected area feels firm and hot.

Question 18

It is possible to distinguish clinically between infectious and non-infectious mastitis?

Answer 18

No

Question 19

How else could it be diagnosed?

Answer 19

Milk cultures

Question 20

If a breast abscess had developed, how would it be described?

Answer 20

If a breast abscess has developed, there will be a fluctuant tender lump, with overlying erythema.

Question 21

What else might be palpable?

Answer 21

Axillary lymphadenopathy may be palpable

Question 22

What differentials?

Answer 22

It should be distinguished from congestive mastitis (breast engorgement) which usually presents on the second or third day of breast-feeding. The complaint in this case is of swollen and tender breasts bilaterally, without fever or erythema.

Question 23

What is the treatment?

Answer 23

Need drainage. Small abscesses with a needle + syringe. Large abscesses may need a small incision to drain. Local anaesthetic is given during both these procedures. When you think you have an abscess you should stop feeding from that side, but continue to express and discard the milk to stop swelling and engorgement.