Mastitis/Breast Abscesses

Question 1

Define mastitis:

Answer 1

Infection of mammary duct often associated with lactations - caused by S.aureus and epidermis

Question 2

Define breast abscesses:

Answer 2

A pus filled cavity. Come in two forms. Lactational and non-lactational

Question 3

Aetiology of mastitis:

Answer 3

When milk is not removed properly

Can lead to an abscess

Question 4

Risk factors of mastitis:

Answer 4

Breast feeding
Post Nipple piercing 
Cracked nipples 
Using a breast pump 
Tight fitting clothes
Trauma 
Poor latch

Question 5

Aetiology of breast abscesses:

Answer 5

Lactational due to S.aureus

Non-lactational due to S.aureus or anaerobes

Question 6

Risk factors of Abscess:

Answer 6

Periductal mastitis
SMOKING
lactation 
Duct ectasia 
Wound infections

Question 7

Symptoms:

Answer 7

Abscess - painful hot swelling of the breast segment

Local pain especially when breast feeding

Redness and swelling

Fever

malaise

Question 8

Signs:

Answer 8

Red, swollen tender breasts

Cracked nipple

Pyrexia and tachycardia

Non-lactational - scars of previous episodes or tissue distortion or duct ectasia.

Signs of duct ectasia (small lump near the nipple, nipple discharge or retraction)

Question 9

Investigations:

Answer 9

Diagnosis is based on presentation

Breast examination

USS may be used to distinguish a tumour from an abscess

MC&S of a pus sample

Question 10

Management:

Answer 10

Painkillers such as paracetamol or ibuprofen

Avoid bras

Warm compression for pain and to help milk flow

Continue breast feeding - if not all the milk is removed then use a breast pump

Oral antibiotics - flucloxacilin (if allergic to penicillin then use erythromycin). Non-lactational must treat anaerobes too

Reassure

If there is an abscess then surgical incision and drainage

If sepsis signs then hospital admission

Question 11

Complications:

Answer 11

Sepsis
Recurrent Mastitis
Abscesses - complication of mastitis

Question 12

Prognosis:

Answer 12

Good