Breast Abcess

Pedia

Symptoms

• A painful swelling in the breast, which feels full of fluid.
• There may be discoloration of the skin at the point of the swelling.

Cause

• Usually secondary to mastitis that has not been effectively managed.

Management

• An abscess needs to be drained and treated with penicillinase-resistant antibiotics.

• When possible, drainage should be either by catheter through a small incision or by needle aspiration (which may need to be repeated)

• Placement of a catheter or needle should be guided by ultrasound.

• A large surgical incision should be avoided.

• The mother may continue to feed from the affected breast. However, if suckling is too painful or if the mother is unwilling, she can be shown how to express her milk and advised to let her baby start to feed from the breast again as soon as the pain is less, usually in 2–3 days.

• She can continue to feed from the other breast. Feeding from an infected breast does not affect the infant.

• Sometimes milk drains from the incision if lactation continues. This dries up after a time and is not a reason to stop breastfeeding.

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Surgery

Lactational & non-lactational.

Lactational:

• Lactating women.
• Staphylococcus aureus.
• Pain, swelling & tenderness.
• Milk drainage from the affected segment is reduced promoting infection.
• Fluocloxacillin 500mg 6 hourly for the early stage.
• Abscess- repeated aspiration or incision- drainage.

Non-lactational Breast Infection

Periareolar infection:

Young female, smokers(90%) with underlying periductal mastitis. Presentation: Pain, peri-areolar swelling, tenderness and nipple retraction(slit)

Treatment:

• Antibiotics- Augmentin( 375 mg 8 hr.), clarithromycin+ metronidazole.
• Abscess- aspiration (small) or drainage (large)
• Recurrence common. May develop duct fistula.
• Surgical excision of the affected duct- in recurrent disease

Peripheral abscess:

Uncommon. Treated by antibiotics and aspiration/ drainage