Mastitis/Breast Abscesses

Question 1

Definition

Answer 1

· Abscess formation in breast tissues.

o TWO main forms:
· Lactational
· Non-Lactational

Question 2

Aetiology

Answer 2

· Caused by INFECTION

· Causative organisms differ based on whether the abscess is:

o Lactational
· Staphylococcus aureus

o Non-Lactational
· Staphylococcus aureus
· Anaerobes

Question 3

Risk factors

Answer 3

o Lactation
o SMOKING
o Mammary duct ectasia
o Periductal mastitis
o Wound infections (e.g. from breast surgery)

Question 4

Epidemiology

Answer 4

· Lactational breast abscess are COMMON and tend to occur soon after starting breast feeding or weaning

· Non-lactational breast abscesses are more common in 30-60 yo smokers

Question 5

Presenting symptoms

Answer 5

· Breast discomfort

· Painful swelling

· Generally unwell and feverish

· Non-lactational - tend to present with a history of previous infections with less pronounced systemic upset

Question 6

Signs on physical examination

Answer 6

· Local
o Swollen, warm and tender area of the breast
o Overlying skin may be inflamed
o The nipple may be cracked
o Non-Lactational:
· Scars or tissue distortion from previous episodes
· Signs of duct ectasia (e.g. nipple retraction)

· Systemic
o Pyrexia
o Tachycardia

Question 7

Investigations

Answer 7

· Ultrasound

· MC&S of pus samples (microscopy, culture and sensitivity)

Question 8

Management plan

Answer 8

· Medical
o Antibiotics:
· Lactational: flucloxacillin
· Non-Lactational: flucloxacillin + metronidazole

· Surgical
o Lactational: Incision and drainage
o Non-Lactational: open drainage should be avoided. The involved duct system should be excised once the infection has settled

Question 9

Possible complications

Answer 9

· Mammary fistula

· Overlying skin may (rarely) undergo necrosis

Question 10

Prognosis

Answer 10

· If untreated, a breast abscess may discharge onto the skin surface

· Non-lactational breast abscesses tend to recur