Breast abscess

Question 1

What is the definition of a breast abscess?

Answer 1

Localised collection of pus within the breast

Question 2

What is the epidemiology of breast abscesses?

Answer 2

Breast abscesses develop in 3–11% of women with mastitis

Question 3

What is the pathology of breast abscesses?

Answer 3

• Most commonly staphylococcus aureus
• Lactiferous duct lining undergoes epidermalisation and keratin production = plugging
(see image on notes)

Question 4

What are the risk factors/aetiology of breast abscesses?

Answer 4

• Mastitis – inflammation of the breast
• Breastfeeding
• Sore/cracked nipples
• Nipple piercing
• Milk statis
• Periductal mastitis – subareolar ducts are damaged/infected
• Duct ectasia – harmless, age related breast change
• Diabetes (immunosuppression)
• HIV (immunosuppression)
• Rheumatoid arthritis
• Trauma
• Corticosteriod treatment
• Granulomatous lobular mastitis (GLM) – autoimmune reaction to substances secreted from mammary ducts
• Poor socio-economical status
• Poor hygiene

Question 5

What are the signs/symptoms of breast abscesses?

Answer 5

• Painful, swollen lump in the breast – redness, hot, swelling of overlying skin
• Fever
• Flu like symptoms
• Malaise

Question 6

What diseases present similarly to breast abscesses?

Answer 6

• Breast cancer

* Fibrocytic disease

Question 7

What investigations would be carried out for suspected breast abscesses?

Answer 7

• Breast examination
• US
• Culture of fluid from abscess
• Breast milk culture

Question 8

What are the surgical treatments for breast abscesses?

Answer 8

• Drainage via ultrasound guided needle aspiration/surgical drainage

Question 9

What are the pharmacological treatments for breast abscesses?

Answer 9

• Antibiotics

* Analgesia

Question 10

What are the non pharmacological treatments for breast abscesses?

Answer 10

• Continue breast feeding if possible
• Improve milk removal via breast feeding technique
• Do not wear a bra at night