Mastitis/ Breast abscess

Question 1

Define

Answer 1

Mastitis: infection of mammary duct often associated with lactation – usually S. aureus or epidermidis

Breast abscesses come in two forms: lactational and non-lactational

Question 2

Causes

Answer 2

• Mastitis typically develops when milk is not properly removed
• Risk factors for mastitis:

1. BREAST FEEDING
2. poor latch
3. cracked nipples
4. use of a breast pump
5. weaning
6. tight fitting clothes
7. trauma
8. post nipple piercing

• Mastitis can lead to abscess formation

Note: periductal mastitis and abscess formation is seen in older women which may also be due to anaerobes

• Abscesses are caused by infection. Causative organisms:
  
  • Lactational: staphylococcus aureus
  • Non-lactational: staphylococcus aureus or anaerobes
• Risk factors for breast abscesses

1. lactation
2. smoking
3. mammary duct ectasia
4. periductal mastitis
5. wound infections e.g. from surgery

Question 3

Epidemiology

Answer 3

Mastitis common in breast feeding women – 10%

Lactational breast abscesses common

Non-lactational tend to occur in 30-60 yr smokers

Question 4

Symptoms

Answer 4

Abscess presents as painful hot swelling of breast segment

Local pain, especially whilst breast feeding

Redness + swelling

Fever

Malaise

Question 5

Signs

Answer 5

• Red, swollen, tender breast
• Cracked nipple
• Non-lactational abscess: scars or tissue distortion from previous episodes; signs of duct ectasia
• Systemic: pyrexia, tachycardia

Question 6

Investigations

Answer 6

Diagnosis usually based on presentation

Breast examination

Ultrasound can help detect a potential abscess – helps differentiate if a mass if tumour or abscess

Culture may be needed to determine type of organism – MC+S of pus samples

Question 7

Management

Answer 7

• To relieve pain: paracetamol or ibuprofen
• Advice on warm compressions to relieve pain and help milk flow
• Advise to continue breastfeeding to allow milk removal – if not all milk removed, use hand or breast pump to remove.
• Avoid bras
• Oral antibiotics: first line: flucloxacillin (if allergic to penicillin: erythromycin/clarithromycin) or if non-lactational: antibiotics covering anaerobes too
• Reassure
• If signs of sepsis: hospital admission
• For breast abscess suspicion: refer to surgeon for open incision or percutaneous drainage. Any residual mass remaining after drainage and antibiotic treatment will need triple assessment.

Question 8

Complications

Answer 8

Sepsis

Recurrent mastitis

Abscess is complication of mastitis

Question 9

Prognosis

Answer 9

Good