Mastitis/ breast abscess Flashcards
What is mastitis?
Mastitis is defined as inflammation of the breast with or without infection
Mastitis with infection can be lactational (puerperal) or non-lactational (e.g. duct ectasia)
mastitis can lead to abscess formation
What is a breast abscess?
a localised area of infection with a walled-off collection of pus → main complication of mastitis, but it may or may not be associated with mastitis
What are some risk factors for mastitis?
(Mastitis typically develops when milk is not properly removed)
RFs:
- BREAST FEEDING
- poor latch
- cracked nipples
- use of a breast pump
- weaning
- tight fitting clothes
- trauma
- post nipple piercing
- smoking; can cause damage to the breast tissue
What are the causative agents of breast abscesses?
⇒ Lactational: staphylococcus aureus
⇒ Non-lactational: staphylococcus aureus or anaerobes
most common:
- staph aureus
- coagulase-negative staphylococci.
- Methicillin-resistant S aureusis (MRSA)
Breast infections may sometimes be polymicrobial (up to 40% of abscesses), with isolation of aerobes as well as anaerobes
What are some risk factors for breast abscess?
- lactation
- smoking
- diabetes (immunosupression)
- inflammatory breast cancer
- mammary duct ectasia
- periductal mastitis
- wound infections e.g. from surgery
Summarise the epidemiology of mastitis
● Mastitis common in breast feeding women – 10%
● Lactational breast abscesses common
● Non-lactational tend to occur in 30-60 yr smokers
What are some causes of non-infectious mastitis?
- idiopathic granulomatous (lobular) inflammation- benign disease of unknown aetiology
- underlying duct ectasia (peri-ductal mastitis or plasma cell mastitis)
- other inflammatory conditions (e.g., foreign body reaction: nipple piercing, breast implant, or silicone)
What are some causes of lactational mastitis?
- Bacteria entering through breaks in the nipple
- Prolonged milk stasis, leading to engorgement of the ducts
What are some causes of non- lactational/ non-puerperal mastitis?
- idiopathic
- related to malignancy
- infection (surgery, piercings)
What signs of breast abscess/ mastitis can be found on history?
- fever
- decreased milk outflow
- breast warmth
- purluent discharge from nipple or lesion
- breast tenderness
- breast firmness
- breast swelling
- breast erythema
- flu-like symptoms, malaise, and myalgia
- breast pain
- RFs: smoking, diabetes, breast feeding
What signs of mastitis can be found on examination?
- Red, swollen, tender breast
- increased warmth of affected area
- erythema, possible edema
- fluctuant, palpable mass
- distant skin infections
- Cracked nipple
- Non-lactational abscess: scars or tissue distortion from previous episodes; signs of duct ectasia
- Systemic:
1. pyrexia of >38°C (100.4°F)
2. tachycardia
What investigations are used to monitor possible mastitis?
- Diagnosis usually based on presentation
- Breast examination
- breast ultrasound (helps differentiate b/t tumor vs abscess)
- diagnostic needle aspiration drainage
- cytology of nipple discharge or sample from fine-needle aspiration
- milk, aspirate, discharge, or biopsy tissue for culture and sensitivity
- histopathological examination of biopsy tissue
What is the first line approach to managing a patient with breast abscess?
- ABCDE assessment
What is the next step if a pt with a breast abscess is found to be unstable after the ABCDE assessment?
- stabilize airway, make sure they are breathing
- Address circulation by obtaining IV access (initiating IV fluids for resuscitation)
note: rare for breast abscess to be sole reason for haemodynamic instability- check for sepsis
What is the next step if a pt with a breast abscess is found to be stable after the ABCDE assessment?
- Take a focused history and perform a breast examination
- on history look for signs and risk factors
