Breast Abscesses Flashcards
def
localised area of infection with a walled-off collection of pus in the breast tissue
may or may not be associated with mastitis
what are the two main forms of breast abscesses
1 peurperal (lactational) 2 non-peurperal
aetiology
1 peurperal (lactational)
-milk stasis is associated with infection
-infection (s. aureus, coagulase negative staphylococci)
2 non-peurperal
-s. aureus + anaerobes (enterococci)
-smoking
-mammary duct ectasia/periductal mastitis
-associated with wound infections after surgery, diabetes
epi
breast abscesses develops in 3-11% of women with mastitis
lactational breast abscesses are common, and often start after breast-feeding or weaning
non-lactational breast abscesses are common in 30-60yrs smokers
history
1 discomfort + painful swelling in breast
2 malaise + fever
what do women with a non-peurperal abscess have a history of
previous infections
examination
local area
- area of breast is swollen, warm and tender
- in non-peurperal cases there may be evidence of scars or tissue distortion from previous episodes, or signs of duct ectasia (nipple retraction)
investigations
1 clinical examination
2 USS
3 aspiration for microscopy, culture + sensitivity
management
medical
-antibiotics
-regular breast drainage in lactational abscesses to prevent milk stasis
surgical
-lactational: daily needle aspiration with antibiotics for small abscesses, incision and drainage is required for larger abscesses
management for non-peurperal abscesses
the definitive treatment involves antibiotics to first control the infection and then excision of the involved duct system
what antibiotics are used for lactational abscesses
flucloxacillin
what antibiotics are used for non-peurperal abscesses
flucloxacillin + metronidazole
complications
slow wound healing
difficulties breast feeding
poor cosmetic outcome
prognosis
if untreated breast abscesses can discharge
non-peurperal abscesses often recur
