Breast Abscess

Question 1

Define breast abscess?

Answer 1

Abscess formation in breast tissues

Question 2

What are the two main forms of breast abscess?

Answer 2

Lactational

Non-Lactational

Question 3

What are the main cause of breast abscess?

Answer 3

Caused by infection

Question 4

What are the causative organisms of Breast Abscess?

Answer 4

Lactational - Staphylcoccus Aureus
Non-Lactational -
Staphylococcus Aureus
Anaerobes

Question 5

What are the risk factors for breast abscess?

Answer 5

Lactation
Smoking
Mammary Duct Ectasia 
Periductal Mastitis
Wound Infections (e.g. from breast surgery)

Question 6

What are the epidemiology of breast abscess?

Answer 6

Lactational breast abscess are COMMON and tend to occur soon after starting breast feeding or weaning
Non-lactational breast abscesses are more common in 30-60 yr old smokers

Question 7

What are the presenting symptoms of breast abscess?

Answer 7

Breast Discomfort
Painful Swelling
Generally unwell and feverish
Non-Lactational - tend to present with a history of previous infections with less pronounced systemic upset

Question 8

What are the Local signs of breast abscess on physical examination?

Answer 8

Swollen, warm and tender area of the breast
Overlying skin may be inflamed
The nipple may be cracked
Non-lactational:
Scars or tissue distortion from previous episodes
Signs of duct ectasia (e.g. nipple retraction)

Question 9

What are the systemic signs of breast abscess on physical examination?

Answer 9

Pyrexia

Tachycardia

Question 10

What are the appropriate investigations for breat abscess?

Answer 10

Ultrasound

MC&S of pus samples

Question 11

What are the medical management plan for breast abscess?

Answer 11

Antibiotics:
Lactational - Flucloxacillin
Non-Lactational - flucloxacillin + metronidazole

Question 12

What is the surgical management plan for breast abscess?

Answer 12

Lactational - Incision and drainage
Non-lactational - open drainage should be avoided. The involved duct system should be excised once the infection has settled

Question 13

What are the possible complications of breast abscess?

Answer 13

Mammary Fistula

Overlying skin may (rarely undergo necrosis)

Question 14

What is the prognosis for patients with breast abscess?

Answer 14

If untreated, a breast abscess may discharge onto the skin surface
Non-lactational breast abscesses tend to recur