Breast Abscess/Mastitis

Question 1

Define Breast abscess/Mastitis

Answer 1

Mastitis is defined as a inflammation of the breast, with or without infection
With infection can be lacterional (puerperal) or non lactetional (duct ectasia)
Non infection can be idiopathic granulomatous or other (foreign body)

Breast abscess means a localised infection with a walled off collection of Pus-may or may not be associated with mastitis

Question 2

Aetiology and risk factor of Breast abscess/Mastitis

Answer 2

Infectious mastitis/abscess is most often causes by staph aureus, after coag neg staphylococci , TB
Can also be polymicrobial (anaerobe and aerobe)-especially in smokers
Usually the accumulation of milk for any reason causes a good place for bacteria to infect
lactational mastitis-in relation to breast feeding

Non infectious mastitis can be caused by duct ectasia (non cancerous thickening of ductal walls leading to a fluid build up), or foreign bodies
Granulomatous (lobular) is of unknown aetiology

Risk factors:
Women
Breast feeding (bad technique)/lactating
Hx of duct ectasia
Over 30-
Nipple injury
Hx of mastitis/prior abscess
piercings
Immunosupression
MRSA 
absecces-prolonged mastitis

Question 3

Epidiemology of Breast abscess/Mastitis

Answer 3

mastitis in breast feeding women is 1-10%
duct ectasia occurs in 10% of women,
and abscesses develop in 10% of women with mastitis-3% of breast feeding women

50% of children with neonate mastitis will develop abscess

Question 4

Signs and Sx of Breast abscess/Mastitis

Answer 4

Focused Hx=
breast inflam-warmth, pain, swelling, firmness, erythema
abscess-tender lump
Milk stasis-decreased output
systemic infection signs-fever, myalgia, chills, malaise
Nipple discharge-normal would be more duct ectasia, but purulent suggest mastitis/infection
Inverted nipples
extra-mammary skin lesion (golden MRSA crust)

Examination:
Temperature-fever
systemic/skin lesions (MRSA)
Lymphadenopathy-tender axillary nodes
lactational mastitis-tend to be peripheral area of beast-wedge shape)
fluctuant mass can be felt-non pulsatile, but warm, tender
rarely-nipple inverstion

Question 5

Investigations of Breast abscess/Mastitis

Answer 5

Pregnancy test if nothing suggest why lactating-esp in youth

USS-very easy to see abscess area
needle aspiration-drainage and culture

Histopathology-cancer, granulomatous, infective etc

Question 6

Management of Breast abscess/Mastitis

Answer 6

lactational mastitis-remove milk via aspiration -if not too bad, can do with pump on own
+ Sx relief

in more severe patients-abx-
if NOT -MRSA would mean fluclox
If MRSA-trimethoprim 2/3 days

but can’t wait for cultures if severe-

Question 7

Complications of Breast abscess/Mastitis

Answer 7

Cessation of breastfeeding-

Abscess and spesis

scarring
unable to make milk again
breast hypoplasia
fistula-break in abscess-drain

Question 8

Prognosis of Breast abscess/Mastitis

Answer 8

most resolve without complications If they are treated -2/3 days of Abx is enough

can still breast feed
even when on abx
except if baby is jaudcined/liver meh