Mastitis

Question 1

What is mastitis?

Answer 1

Inflammation of the breast tissue, both acute or chronic

Question 2

What is the most common cause of mastitis?

Answer 2

Infection (typically by S. Aureus, but occasionally granulomatous)

Question 3

How can mastitis be classed?

Answer 3

By lactation status:

• Lactational mastitis
• Non-lactational mastitis

Question 4

How common is lactational mastitis?

Answer 4

More common than non-lactational mastitis

Seen in up to a third of breastfeeding women

Question 5

When does lactational mastitis typically present?

Answer 5

During the first 3 months of breastfeeding or during weaning. Most common with first child.

Question 6

What associated features does mastitis typically present with?

Answer 6

Cracked nipples & milk stasis (often caused by poor feeding technique)

Question 7

What are the risk factors for non-lactational mastitis?

Answer 7

• Duct ectasia (presents as peri-ductal mastitis)
• Tobacco smoking

Question 8

How does smoking increase the risk of developing non-lactational mastitis?

Answer 8

Causes damage to the sub-areolar duct walls and predisposes to bacterial infection.

Question 9

What are the clinical features of mastitis?

Answer 9

• Tenderness
• Swelling
• Induration
• Erythema

It is important to ensure there is no localised abscess formation occurring.

Question 10

How is mastitis managed?

Answer 10

1. Systemic antibiotic therapy & simple analgesics.
2. Continued milk drainage / feeding
   * In lactational mastitis
3. Cessation of breastfeeding with dopamine agonists (e.g. Cabergoline)
   * In women with persistent / multiple areas of infection.

Question 11

What is a breast abscess?

Answer 11

A collection of pus within the breast lined with granulation tissue, most commonly developing from acute mastitis.

Question 12

How do breast abscesses present?

Answer 12

• Tender fluctuant & erythematous masses
• Puncutum potentially present
• Associated systemic symptoms
  
  • Fever
  • Lethargy

Question 13

What investigation can confirm a suspected abscess?

Answer 13

USS

Question 14

How are breast abscesses managed?

Answer 14

1. Empirical antibiotics
2. US-guided needle therapeutic aspiration
3. Incision & drainage under local anaesthetic
   * For more advanced abscesses

Question 15

What is an important complication of drainage of non-lactational abscess?

Answer 15

Formation of a mammary duct fistula (a communication between the skin and a subareolar breast duct)

Can be managed surgically with a fistulectomy & antibiotics, but can often recur.