Mastitis and Breast Abscesses

Question 1

Define mastitis and breast abscesses.

Answer 1

Mastitis is inflammation of the breast with or without infection. Mastitis with infection may be lactational (puerperal) or non-lactational (e.g., duct ectasia). A breast abscess is a localised area of infection with a walled-off collection of pus. It may or may not be associated with mastitis.

Question 2

Explain the aetiology/risk factors of mastitis and breast abscesses.

Answer 2

Female sex
Women aged >30 years
Poor breastfeeding technique
Lactation
Milk stasis
Nipple injury
Shaving or plucking areola hair
Anatomical breast defect, mammoplasty, or scar
Other underlying breast condition
Staphylococcus aureus carrier
Immunosuppression

Question 3

Summarise the epidemiology of mastitis and breast abscesses.

Answer 3

The global prevalence of mastitis in lactating women is approximately 1% to 10% but may be higher. Breast abscess develops in 3% to 11% of women with mastitis with a reported incidence of 0.1% to 3.0% in breastfeeding women.

Question 4

Recognise the presenting symptoms of mastitis and breast abscesses. Recognise the signs of mastitis and breast abscesses on physical examination.

Answer 4

Flu-like symptoms, malaise, and myalgia
Fever
Breast pain
Decreased milk outflow
Breast warmth, tenderness, erythema and swelling
Breast firmness
Breast mass
Nipple discharge
Nipple inversion/retraction

Question 5

Identify appropriate investigations for mastitis and breast abscesses and interpret the results.

Answer 5

Breast ultrasound
Diagnostic needle aspiration drainage
Cytology of nipple discharge or sample from fine-needle aspiration
Milk, aspirate, discharge, or biopsy tissue for culture and sensitivity
Histopathological examination of biopsy tissue

Question 6

Generate a management plan for mastitis and breast abscesses.

Answer 6

Antibiotic therapy e.g. Flucloxacillin
Effective milk removal and supportive care e.g. paracetamol

Question 7

Identify the possible complications of mastitis and breast abscesses and its management.

Answer 7

Cessation of breastfeeding
Abscess (complicating mastitis)
Sepsis
Scarring
Functional mastectomy
Breast hypoplasia
Necrotising fasciitis

Question 8

Summarise the prognosis for patients with mastitis and breast abscesses.

Answer 8

When treated promptly and appropriately, most breast infections, including abscess, will resolve without serious complications. Resolution of mastitis after 2-3 days of appropriate antibiotic therapy is expected among most patients.