Breast: Breast abscess Flashcards
what is a breast abscess?
localised collection of pus
what causes breast abscesses to occur?
milk stasis or overproduction, infection
- major complication of mastitis
what organism commonly contributes to mastitis / breast abscesses?
Staph. Aureus
what are the risk factors for a breast abscess?
- female.
- age >30
- poor breast-feeding technique
- lactation
- milk stasis
- nipple injury
- previous breast abscess
- shaving/plucking areolar hair
- nipple piercing
- previous mastitis
- immunosuppression
- underlying breast condition
- MRSA
what are the clinical features of a breast abscess?
- painful swollen lump
- redness, heat
- fever or general malaise
what investigations would you conduct to confirm a diagnosis of a breast abscess?
- ultrasound
- ultrasound-guided needle aspiration, culture of fluid from the abscess (which will be used to guide the choice of antibiotic).
Investigations to consider alternatively: Pregnancy test, blood culture and sensitivity, mammogram, milk for leukocyte counts and bacteria quantification, culture from infants and mothers oral cavity, FBC, tuberculin skin test.
what would you advise women who are breast feeding and appear to have an abscess?
continue breastfeeding if possible (including from the affected breast)
what is the treatment for a breast abscess where MRSA is excluded?
Surgical intervention (Incision and drainage of abscess) and IV/oral antibiotic against methicillin-sensitive staphylococci (dicloxacillin/cephalexin/doxycycline/clindamycin/flucloxacillin)
what is the treatment for a breast abscess where MRSA is confirmed?
Surgical intervention – Incision + drainage of abscess (first-line) + non beta-lactam antibiotic (clindamycin).
what are complications of not treating a breast abscess?
Breast mass - Chronic pain, scarring or disfigurement, metastases, postsurgical complications (eg, ipsilateral lymphedema), and death.
