Mastitis/ breast abscess Flashcards
What is mastitis?
Inflammation of the breast +/- infection of mammary duct often associated with lactation (usually S. aureus or epidermidis)
What is a breast abscess?
localised breast infection with a walled-off collection of pus
What are the 2 forms of breast abscess
Lactational
Non-lactational
Describe the aetiology of mastitis
Typically develops when milk is not properly removed
Non-infectious mastitis may result from underlying duct ectasia or foreign material e.g. piercing
What may mastitis lead to?
Abscess formation
Give a causative organism for each type of breast abscess
Lactational: staphylococcus aureus
Non-lactational: staphylococcus aureus or anaerobes
List 11 risk factors for mastitis
BREAST FEEDING (poor technique) Milk stasis Cracked nipples Use of a breast pump Weaning Tight fitting clothes Trauma Post nipple piercing Previous mastitis Shaving/plucking aerola hair Skin infections
List 6 risk factors for breast abscess
Previous mastitis/ breast abscess Lactation Smoking Mammary duct ectasia Periductal mastitis Wound infections e.g. from surgery
Describe the epidemiology of mastitis and breast abscesses
Mastitis common in breastfeeding women
Lactational breast abscesses common
Non-lactational tend to occur in 30-60 yr smokers
List 5 symptoms of mastitis
Abscess presents as painful hot swelling of breast segment Local pain, esp. whilst breast feeding Redness + swelling Fever Malaise Decreased milk outflow
List signs of mastititis
Red, swollen, warm, tender breast
Cracked nipple
Systemic: pyrexia, tachycardia
List signs of non lactational abscesses
Scars or tissue distortion from previous episodes
Signs of duct ectasia
What is diagnosis usually based on?
Hx
Breast examination
What investigations may be performed for breast abscesses?
Ultrasound: detect a potential abscess: helps differentiate if a mass is tumour or abscess
Needle aspiration + biopsy: Culture may be needed to determine type of organism: MC+S of pus samples
What tests may be considered for patients with breast abscess/ mastitis?
Preg test
Milk for leukocyte count + bacterial quantification (can differentiate non-infectious vs. Infectious mastitis)
Tuberculin skin test (needs to be ruled out)
Describe the management of mastitis
To relieve pain: paracetamol or ibuprofen
What advice is given to women with mastitis?
Warm compressions to relieve pain + help milk flow
Continue breastfeeding to allow milk removal: if not all milk removed, use hand or breast pump to remove.
Avoid bras
List 3 complications of mastitis
Sepsis
Recurrent mastitis
Abscess
What is the prognosis of mastitis ?
Good
What alternate cause may periductal mastitis and abscess formation in older woman be due to?
Anaerobes
Describe management of lactational mastitis
Oral flucloxacillin
if allergic to penicillin: cefalexin/ clindamycin
Describe management of breast abscess
Needle aspiration with LA
+ abx e.g. flucloxacillin
What antibiotics are required for non-lactational breast abscesses? Give an example
abx covering anaerobes too
Flucloxacillin
How is nipple candiasis treated?
If nipple candidiasis => antifungal therapy (nystatin or miconazole or ketoconazole for mum + nystatin for infant)
How should a patient with breast abscess raising suspicion of breast cancer be managed?
refer to surgeon for open incision or percutaneous drainage.
Any residual mass remaining after drainage + abx tx (e.g. flucloxacillin) will need triple assessment.
