Matitis/Breast Abscesses Flashcards
Define mastitis
Inflammation of the breast
• Infectious
- Lactational (puerperal) – milk stasis/overproduction and bacterial infection
- Non-lactational (duct ectasia) – dilated ducts associated with inflammation
• Non-infectious
- Idiopathic granulomatous inflammation
- Foreign material e.g. nipple piercing, breast implant
Define breast abscess
Localised area of infection with a walled off collection of pus
What are the causes/risk factors of mastitis/breast abscesses?
Bacterial skin commensal infection
• Staphylococcus aureus
• Streptococcus pyogenes
• Staphylococcus epidermis
Risk factors • Broken skin e.g. piercing, breastfeeding, eczema • Lactation • Milk stasis • Previous mastitis
What are the symptoms of mastitis/breast abscesses?
- Malaise
- Myalgia
- Fever
- Breast pain
- Decreased milk flow
What are the signs of mastitis/breast abscesses?
- Warmth/erythema
- Firmness
- Swelling
- Mass
- Nipple discharge
- smooth surface
- distinct borders
- firm/lax consistency
- fluctuant mobility
- no fixity
- lymphadenopathy
What investigations are carried out for mastitis/breast abscesses?
Triplle assessment
• Clinical Examination
• Radiological Examination:
- USS if the patient < 35 - well circumcised black masses.
- View Mammography if the patient > 35 - Hypoechoic lesion (abscess); may be well circumscribed, irregular, or ill defined with septae.
• FNA or Core Biopsy
- Before you do this you need to do inflmamtory markers, clotting and platelets. And you should do a blood culture aswell.
- Purulent fluid on fine needle biopsy indicates a breast abscess.
- Microbiology: Microscopy, culture and sensitivity of pus samples.
• Bloods – CRP, FBC etc to identify inflammation, WCC
What is the management for mastitis/breast abscesses?
Medical:
• Lactational: Early, cellulitic phase may be treated with flucloxacillin.
• Nonpuerperal: Flucloxaclillin with the addition of metronidazole for anaerobes.
• Give them analgesia as they will still be breast feeding and check if it is safe in brastfeeding.
Surgical:
• Lactational: Daily needle aspiration with antibiotic cover may be successful, but in most cases, formal incision and drainage is carried out.
• Incision should allow full drainage and be cosmetically acceptable
• Loculi are explored and broken down with a finger.
• Breastfeeding should continue from the non-affected breast and the affected side emptied either manually or with a breast pump.
• Advice on avoiding cracked nipples.
Non-puerperal: Open drainage should be avoided, or carried out through a small incision.
• Definitive treatment should be carried out once the infection has settled by the excision of the involved duct system.
What are the complications of mastitis/breast abscesses?
- Mammary fistula formation.
- Rarely, the overlying skin undergoes necrosis.
- You want to carry on breastfeeding as milk may block the ducts more so.
- Can lead to sepsis, pain, fistula, scarring –especially if you need biopsy done of the area. You can also get extra-mammary skin infections as a result.