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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.

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