Breast Pathology

Question 1

What is a breast abscess and what is it caused by?

Answer 1

A collection of pus in the breast, most commonly a complication of mastitis.

Question 2

How common are breast abscesses?

Answer 2

Occur in 30-60% of women

Question 3

Who does it most commonly affect?

Answer 3

Lactating women and women of childbearing age

Question 4

As mastitis leads to breast abscess, what causes mastitis?

Answer 4

In lactating women, milk stasis in the primary cause of mastitis. The milk stasis causes an inflammatory response that may or may not progress to infection.

Question 5

Which bacteria is the most common cause of mastitis?

Answer 5

Staph. aureus

Question 6

What are the risk factors for developing mastitis in lactating women? (3)

Answer 6

1. Poor infant attachment
2. Reduced number/duration of feeds
3. Being aged between 30-34

Question 7

What are the risk factors for developing mastitis in non-lactating women? (6)

Answer 7

1. Smoking (greatest cause)
2. Nipple damage (e.g. eczema, piercing, Raynaud’s, trauma, infection)
3. Immunosuppression
4. Shaving or plucking alveolar hair
5. Foreign body (e.g. implants)

Question 8

What are the risk factors for a breast abscess? (6)

Answer 8

1. Previous mastitis
2. Sudden cessation of breastfeeding in women with lactational mastitis
3. Stap. aureus
4. Poor socioeconomic status
5. Poor hygiene

Question 9

What are the symptoms of a breast abscess?

Answer 9

History of recent mastitis, fever, malaise, painful swollen lump in breast with redness, heat and swelling of the overlying skin.
-Symptoms may have subsided if the woman has been prescribed antibiotics to treat infectious mastitis

Question 10

What signs might the patient have on examination of a breast abscess?

Answer 10

The lump may be fluctuant with skin discolouration

Question 11

Which other conditions may present similarly to a breast abscess?
3 conditions associated with lactation
6 conditions not associated with lactation

Answer 11

Conditions associated with lactation: 
1. Full breasts 
2. Galactocele (milk cyst)
3. Infection of mammary ducts 
Conditions not associated with lactation:
1. Breast cancer
2. Duct ectasia 
3. Cellulitis 
4. Fibroadenosis 
5. Breast cyst 
6. Fat necrosis

Question 12

How would a suspected breast abscess be investigated?

Answer 12

Ultrasound and culture fluid from abscess

Question 13

What treatments would be discussed with a patient with a breast abscess?

Answer 13

Drainage of the abscess via guided ultrasound needle aspiration or surgical drainage. A lactate women would be advised to continue breastfeeding if possible (including from the affected breast).