Mastitis/ breast abscess Flashcards
Define mastitis.
Mastitis is defined as inflammation of the breast with or without infection.
Mastitis with infection may be lactational (puerperal) or non-lactational (e.g., duct ectasia).
Non-infectious mastitis includes idiopathic granulomatous inflammation and other inflammatory conditions (e.g., foreign body reaction).
Define breast abscess.
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.
How common is mastitis?
- 1-10% prevalence in lactating women
- duct ectasia (peri-ductal mastitis/dilated ducts from inflammation) occurs in 5% to 9% of non-lactating women
- Idiopathic granulomatous mastitis is a very rare breast condition
What is the aetiology of mastitis?
Infectious causes: bacteria colonising the skin. May be polymicrobial (in up to 40%)
- Staph aureus
- Coagulase negative staphylococci
- MRSA - increasing incidence
- Smokers more likely to have anaerobic infectoion - e.g. Peptostreptococcus, Lactobacillus, Bacteroides
- Unusual: Bartonealla henselae (cat scratch disease agent), Actinomyces, Brucella, fungi (Candida and Cryptococcus), parasites, and maggot infestation
Non infectious - may result from duct-ectasia and infrequently foreign material
What are the risk factors for mastitis?
- Problems with technique of breast-feeding
- Reduced number of feeds –> milk accumulation due to
- partial bottle feeding
- changes in regime
- rapid weaning
- painful breasts
- Pressure on breast from tight clothing, seat belt, sleeping in prone position
- Nipple fissures, cracks and sores
- Trauma to breast
- Blcoked milk ducts
What are the signs and symptoms of mastitis?
- Only one breast affected
- Painful, tender, red, hot
- Fever, rigors, muscle pain, lethargy, depression, nausea, headache
- Usually >1week post-party (congestive mastitis presents within 2-3 days of breast feeding)
Signs:
- Unilateral oedema, erythema in a wedge-shaped area
- Firm and hot
- Abscess - fluctuant tender lump with overlying erythema
- Axillary lymphadenopathy may be present
What investigations would you do for mastitis?
Clinical diagnosis
Detection of pathogens in breast milk - not always possible. Sometimes S aureus and coagulase -ve Staphylococcus species . Culture milk if infectio nis reccurent or does not resolve after 2 days abx.
Refer if abscess suspected
Ultrasound breast - may show collection of pus
What is the conservative management of mastitis?
- Reassure that it will not interfere with breast feeding
- Encourage to breast feed/express milk
- Improve milk removal - positionaing/sucking behaviour/feeding pattern assessment by skilled person.
- Increase feeding frequency
- Feeding on effected side first to empty breast effectively
What is the medical and surgical management of mastitis?
- Analgesia - ibuprofen/paracetamol
- Antibiotics - flucloxacillin or erythromycin
- Surgical for abscess - incision and drainage
- Needle aspiration every other day - alternative to surgery
What are the complications of mastitis? What is the prognosis?
Abscess formation (occur in 3-7%) and sepsis if treatment is delayed
Cessation of breast feeding –> emotional distress in those who planned to continue breast feeding
Prognosis - should not interfere with ability to breast-feed, or affect the long-term appearance of the breast.
What are the teo types of mastalgia?
Cyclical and non-cyclical
What mightnon-itchy nipple eczema be?
Paget’s disease of the breast (usually isn’t itchy) - but this needs to be punch-biopsied
What might dilated veins around the breast be?
Mondor’s disease which is a condition characterized by thrombophlebitis of the superficial veins of breast and anterior chest wall.
What are the types of mastitis?
- Lactational mastitis/abscess
- Peri-ductal mastitis (smokers)
- Granulomatous mastitis (must exclude inflammatory conditions like TB)
- Cancerous mastitis
NB: mastitis is not a
Should you be worried about multi-ductal discharge?
No this can be very normal in about 50% of the population if you press hard enough
Uniductal discharge is more worrying
