Mastitis/ breast abscess

Question 1

What is mastitis?

Answer 1

Inflammation of the breast +/- infection of mammary duct often associated with lactation (usually S. aureus or epidermidis)

Question 2

What is a breast abscess?

Answer 2

localised breast infection with a walled-off collection of pus

Question 3

What are the 2 forms of breast abscess

Answer 3

Lactational

Non-lactational

Question 4

Describe the aetiology of mastitis

Answer 4

Typically develops when milk is not properly removed

Non-infectious mastitis may result from underlying duct ectasia or foreign material e.g. piercing

Question 5

What may mastitis lead to?

Answer 5

Abscess formation

Question 6

Give a causative organism for each type of breast abscess

Answer 6

Lactational: staphylococcus aureus

Non-lactational: staphylococcus aureus or anaerobes

Question 7

List 11 risk factors for mastitis

Answer 7

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

Question 8

List 6 risk factors for breast abscess

Answer 8

Previous mastitis/ breast abscess
Lactation
Smoking
Mammary duct ectasia
Periductal mastitis
Wound infections e.g. from surgery

Question 9

Describe the epidemiology of mastitis and breast abscesses

Answer 9

Mastitis common in breastfeeding women
Lactational breast abscesses common
Non-lactational tend to occur in 30-60 yr smokers

Question 10

List 5 symptoms of mastitis

Answer 10

Abscess presents as painful hot swelling of breast segment 
Local pain, esp. whilst breast feeding 
Redness + swelling 
Fever 
Malaise   
Decreased milk outflow

Question 11

List signs of mastititis

Answer 11

Red, swollen, warm, tender breast
Cracked nipple
Systemic: pyrexia, tachycardia

Question 12

List signs of non lactational abscesses

Answer 12

Scars or tissue distortion from previous episodes

Signs of duct ectasia

Question 13

What is diagnosis usually based on?

Answer 13

Hx

Breast examination

Question 14

What investigations may be performed for breast abscesses?

Answer 14

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

Question 15

What tests may be considered for patients with breast abscess/ mastitis?

Answer 15

Preg test
Milk for leukocyte count + bacterial quantification (can differentiate non-infectious vs. Infectious mastitis)
Tuberculin skin test (needs to be ruled out)

Question 16

Describe the management of mastitis

Answer 16

To relieve pain: paracetamol or ibuprofen

Question 17

What advice is given to women with mastitis?

Answer 17

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

Question 18

List 3 complications of mastitis

Answer 18

Sepsis
Recurrent mastitis
Abscess

Question 19

What is the prognosis of mastitis ?

Answer 19

Good

Question 20

What alternate cause may periductal mastitis and abscess formation in older woman be due to?

Answer 20

Anaerobes

Question 21

Describe management of lactational mastitis

Answer 21

Oral flucloxacillin

if allergic to penicillin: cefalexin/ clindamycin

Question 22

Describe management of breast abscess

Answer 22

Needle aspiration with LA

+ abx e.g. flucloxacillin

Question 23

What antibiotics are required for non-lactational breast abscesses? Give an example

Answer 23

abx covering anaerobes too

Flucloxacillin

Question 24

How is nipple candiasis treated?

Answer 24

If nipple candidiasis => antifungal therapy (nystatin or miconazole or ketoconazole for mum + nystatin for infant)

Question 25

How should a patient with breast abscess raising suspicion of breast cancer be managed?

Answer 25

refer to surgeon for open incision or percutaneous drainage.
Any residual mass remaining after drainage + abx tx (e.g. flucloxacillin) will need triple assessment.