Breast Infection

Question 1

What is Mastitis?

Answer 1

Inflammation (with/without infection) of breast tissue.

Question 2

Aetiology of Mastitis.

Answer 2

1. Bacteria enter the duct through a break in the nipple of the skin e.g. nipple eczema, piercings, candida infection.
2. Obstruction in the ducts and accumulation of milk (regularly expressing breastmilk prevents this).

Question 3

Associations of Mastitis (2).

Answer 3

1. Puerperal Period (1-week).

2. Smoking.

Question 4

Clinical Presentation of Mastitis (6).

Answer 4

Acute (Few Days) :

1. Erythema.
2. Mastalgia and Tenderness.
3. Malaise.
4. Fever.
5. Nipple Changes and Purulent Discharge.
6. Hardening of Breast/Skin Tissue.

Question 5

Commonest Causative Bacteria in Mastitis (4).

Answer 5

1. S. aureus (main).
2. Streptococci.
3. Enterococci.
4. Anaerobic Species e.g. Bacteroides, anaerobic Streptococci.

Question 6

What is an Abscess?

Answer 6

Pus is thick fluid produced by inflammation, containing WBCs of the immune system and waste. When pus becomes trapped in a specific area and cannot drain, an abscess will form and gradually increase in size.

Question 7

Diagnosis of Mastitis/Breast Abscess.

Answer 7

Clinically with History and Examination.

Question 8

Management of Lactational Mastitis (blockage of ducts) (4).

Answer 8

Conservative :

1. Continued Breastfeeding.
2. Expressing Milk.
3. Breast Massage.
4. Symptomatic e.g. Heat Packs, Warm Showers and Simple Analgesia.

Question 9

Management of Non-Lactational Mastitis (4).

Answer 9

1. Analgesia.
2. 1st Line = Flucloxacillin. 2nd Line = Erythromycin. Antifungal = Fluconazole.
3. Treatment of Underlying Cause.
4. Continue Breastfeeding.

Question 10

Fungal Cause of Mastitis.

Answer 10

Candidal Infection of the Nipple.

Candida causes cracked skin on the nipple, which creates an entrance for infection.

Question 11

Presentation of Fungal Mastitis.

Answer 11

1. Bilateral Sore Nipples.
2. Nipple Tenderness and Itching.
3. Cracked, Flaky or Shiny Areola.
4. Symptoms in Baby e.g. Oral Thrush or Candida Nappy Rash.

Question 12

Management of Fungal Mastitis.

Answer 12

Topical Miconazole 2% to the nipple after each breastfeed and oral Miconazole Gel or Nystatin for infant.

Question 13

Management of Breast Abscess (5).

Answer 13

1. Referral to On-Call Surgical Team.
2. Antibiotics.
3. US to confirm Diagnosis.
4. Drainage (Needle Aspiration/Surgical Incision/Drainage).
5. MC&S of Drained Fluid.

Question 14

What is an indication for surgical debridement of Breast Abscess?

Answer 14

Overlying skin necrosis, which can be complicated by the development of a subsequent mammary duct fistula.