Breast abscess/ mastitis

Question 1

Breast abscess

Answer 1

Collection of pus within an area of the breast

Usually caused by bacterial infection

Lactational or non-lactational

Question 2

Mastitis

Answer 2

Inflammation of breast tissue

Often related to breast feeding

If caused by infection it may become an abscess

Question 3

Risk factors

Answer 3

Smoking

Damage to the nipple (eczema, candidal infection or piercings)

Underlying breast disease can affect drainage of the breast so predisposed to infection

Question 4

Bacterial causes

Answer 4

Staph aureus (most common)

Strep spp.

Enterococcal spp.

Anaerobic bacteria

Question 5

Presentation of mastitis

Answer 5

Acute onset

Nipple changes

Prurulent nipple discharge

Localised pain

Tenderness

Warmth

Erythema

Hardening of the skin or beast tissue

Swelling

Question 6

Key features of abscess

Answer 6

Swollen, fluctuant, tender lump within the breast

Generalised symptoms of infection (muscle aches, fatigue, fever, signs of sepsis)

Question 7

Management of lactational mastitis

Answer 7

Conservative

Continue breast feeding and expressing milk

Breast massage

Heat packs, warm showers and simple analgesia

Antibiotics if infection (flucloxacillin or erythromycin/ clarithromycin)

Question 8

Management of non-lactational mastitis

Answer 8

Analgesia

Antibiotics

Treat underlying cause (e.g. eczema or candidal infection)

Question 9

Antibiotics for non-lactational mastitis

Answer 9

Need to be broad spectrum

Co-amoxiclav

Erythomycin/ clarithromycin plus metronidazole

Question 10

Management of breast abscess

Answer 10

Referral to on-call surgical team

Antibiotics

US (confirm diagnosis and exclude other pathology)

Drainage (needle aspiration or surgical incision and drainage)

Microscopy and culture