Mastitis / Breast Abscess

Question 1

Clinical features

Answer 1

a lump and then soreness (at first)

a red tender area

• (possibly) fever
• tiredness
• muscle aches and
• pains

Question 2

Treatment (systemic symptoms)

Answer 2

Antibiotics:

resolution without progression to an abscess will usually be prevented by antibiotics;

• di(flu)cloxacillin 500 mg (o) qid for at least 5, and up to 10 d (IV if severe)
• if hypersensitive to penicillin cephalexin 500 mg (o) qid for at least 5 d

Therapeutic US (2 W/cm2 for 6 mins) daily for 2–3 d

Ibuprofen or paracetamol for pain

Question 3

Instructions to patients

Answer 3

Keep the affected breast well drained

Continue breastfeeding: do frequently and start with the sore side

Heat the sore breast before feeding (e.g. with hot shower or hot face washer)

Cool the breast after feeding: use a cold face washer from the freezer

Empty the breast well: hand express if nec.

Question 4

Breast abscess

Answer 4

• If tenderness and redness persist beyond 48 h and
• an area of tense induration develops

The preferred treatment is aspiration;

• with a large bore needle (with US guidance) under LA
• every second day until resolution

Antibiotics (e.g. dicloxacillin 500 mg (o) qid for 10 days)

Rest and complete emptying of the breast.

Continue breastfeeding from the affected side or express milk if this is not possible.

Avoid surgery if possible because fistula formation is common.