Mastitis/ breast abscess Flashcards
What is mastitis?
Inflammation of breast tissue
Lactational (Puerperal- most common) or non-lactational
+/- infection
How does infection occur in mastitis?
Usually due to retrograde spread through lactiferous duct or traumatised nipple
What is a breast abscess?
localised collection of pus within the breast
Lactational or non-lactational
Describe the aetiology of puerperal mastitis
Milk stasis is most common cause
Accumulated milk causes an inflammatory response which may or may not progress to infection
Describe aetiology of non-puerperal mastitis
mastitis is usually accompanied by infection, either central/ subareolar or peripheral.
May result from underlying duct ectasia or foreign material e.g. piercing
What may mastitis lead to?
Abscess formation
What are the most common causes of infectious mastitis?
Lactational: Staphylococcus aureus
Non-lactational: staphylococcus aureus or anaerobes
List 3 risk factors for mastitis in lactating women
Milk stasis: poor infant attachment, reduced number/ duration of feeds, pressure on breast (tight clothing)
Age (21-35)
Non-lactational RFs
List 7 risk factors for non-lactational mastitis
SMOKING
Nipple damage: piercings/ skin conditions e.g. eczema
Trauma to breast
Underlying breast abnormality
Immunosuppression
Shaving/ plucking aerola hair
Foreign materials in breast augmentation/ reconstruction
List 4 risk factors for breast abscess
Previous mastitis/ breast abscess
Immunosuppression
S aureus carriage
Poor hygeine
Describe the epidemiology of mastitis and breast abscesses
L: common infers 2-3w postpartum
NL: less common, tends to occur in 30-60y smokers
Where do lactational vs non-lactational breast abscesses tend to occur?
L: peripheral, upper outer
NL: central/ sub-areolar/ lower quadrants
List 4 S/S of mastitis
Painful breast, esp. whilst breast feeding
Fever / Malaise
Tender, red, swollen, + hard area of the breast, usually in a wedge-shaped distribution.
Reduced milk secretion
What can non-lactational mastitis mimic?
Inflammatory breast cancer
Give 4 features suggestive of infective mastitis
Nipple fissure that looks infected.
Purulent discharge.
Influenza-like Sx + pyrexia lasting for longer than 24h.
Considerable breast discomfort.
Give 2 features suggestive of infective mastitis in lactating women
Sx not improving (/ worsening) after 12–24h despite effective milk removal.
+ve breast milk culture
Give 4 features of when breast abscess should be suspected?
Hx of recent mastitis/ prior breast abscess.
Fever +/or malaise- may have subsided if taken abx for suspected infectious mastitis.
Painful, swollen lump in the breast, with redness, heat, + swelling of overlying skin.
OE: lump may be fluctuant with skin discolouration.
Describe diagnosis of mastitis
Clinical dx
+/- milk culture
+/- imaging
When is breast milk culture indicated?
Inadequate response to initial empirical abx
Severe burning breast pain, indicative of ductal infection
Give 3 indications for imaging in mastitis
Poor response to empiric abx (within 48-72h)
Exclude ddx
Evaluation for complications e.g. abscess
Describe initial management for puerperal mastitis
Reassure
Continue breastfeeding
Analgesia
Warm compresses
When are antibiotics indicated in puerperal mastitis?
If has nipple fissure that is infected
Sx have not improved (/ worsening) after 12–24h despite effective milk removal
+/or breast milk culture is +ve.
Which antibiotics are used in lactational mastitis if milk cultures are unavailable?
Flucloxacillin 500mg QDS for 10–14 days.
If pen allergic: Erythromycin 250–500mg QDS or Clarithromycin 500mg BD for 10–14 days.
How should you advise women on commencement of antibiotics for lactational and non-lactational mastitis?
Advise to seek immediate medical advice if Sx fail to settle after 48h of Abx Tx
