Lactational abscess and mastitis

Question 1

What is a lactational breast abscess?

Answer 1

Infectious mastitis may lead to an accumulation of pus in an area of the breast, which can lead to the development of a lactational breast abscess.

Question 2

What is the most common cause of a lactational breast abscess?

Answer 2

The most common causative agent is staphylococcus aureus, which enters via a crack in the nipple skin or through a milk duct.

Question 3

What are clinical features of a lactational breast abscess?

Answer 3

Fever or rigors
Malaise
Pain and erythema over an area of the breast
There may a fluctuant mass present, but this is not always palpable.
History of recent or current mastitis

Question 4

How would you manage a lactational breast abscess?

Answer 4

Incision and drainage or needle aspiration (with or without diagnostic ultrasound)

Question 5

What is mastitis?

Answer 5

When inflammation of the breast (mastitis) is associated with lactation in postpartum women it is known as puerperal mastitis.

Question 6

How would you diagnose mastitis?

Answer 6

Diagnosis is usually made clinically based on the following symptoms:

1. Localised symptoms include a painful, tender, red and hot breast
2. Systemic symptoms include fever, rigors, myalgia, fatigue, nausea and headache
3. Normally unilateral and presents 1 week post-partum

Question 7

What are features of a breast abscess?

Answer 7

In some cases of mastitis, there may be development of a breast abscess which presents as a fluctuant, tender mass with overlying erythema.

Ultrasound can reveal a collection of pus.

Early referral to secondary care is required for a suspected abscess.

Question 8

How would you mastitis?

Answer 8

1. Continue breast-feeding, analgesia

2. If first line options fail, consider a coure of flucloxacillin or erythromycin

Question 9

What is puerperal mastitis?

Answer 9

When inflammation of the breast (mastitis) is associated with lactation in postpartum women it is known as puerperal mastitis.