Breast abscess / mastitis

Overview

• Mastitis: Inflammation of breast tissue, which may or may not be accompanied by infection.
• Breast abscess: Collection of pus within the breast tissue, usually as a complication of untreated mastitis.

Causes

• Lactational mastitis: Common in breastfeeding mothers, typically within the first 6 weeks postpartum.
• Infectious agents: Staphylococcus aureus (most common), Streptococci.
• Blocked milk duct: Milk stasis can lead to bacterial growth.
• Non-lactational mastitis: Can be due to duct ectasia, trauma, or foreign bodies.

Symptoms & Signs

• Localised pain: Typically unilateral.
• Redness and swelling: Over affected area.
• Palpable mass: In case of abscess.
• Fever and malaise: Indicative of systemic involvement.
• Nipple discharge: Possible in non-lactational mastitis.

Investigations

• Ultrasound: Differentiate between mastitis and abscess; guide aspiration or drainage.
• Mammogram: Useful in non-lactational mastitis to exclude malignancy.
• Aspiration: If abscess is suspected; send aspirate for culture.

Management

• Antibiotics: Flucloxacillin is commonly used.
• Analgesics: Paracetamol or ibuprofen for pain relief.
• Continue breastfeeding: Encouraged even in the presence of mastitis.
• Warm compresses: Can aid relief.
• Incision and drainage: For breast abscesses.

Key Points

• Early treatment of mastitis can prevent progression to abscess formation.
• Breastfeeding should continue during treatment unless contraindicated.
• Abscesses require drainage, and antibiotic choice should be guided by culture results.