Breast abscess & cyst

• What is a breast abscess?

  Collection of pus within an area of the breast, usually caused by a bacterial infection
• What are the 2 types of breast abscess?

  Lactational abscess (associated with breastfeeding)

  Non-lactational abscess (unrelated to breastfeeding)
• What is pus?

  Thick fluid produced by inflammation

  Contains dead WBCs & waste from fighting infection
• What happens when pus becomes trapped in a specific area?

  Abscess forms and gradually increases in size
• What is mastitis?

  Inflammation of breast tissue

  Often related to breastfeeding, sometimes caused by infection
• How can bacteria cause mastitis? What can this lead to?

  Bacteria enter through nipple & back tracks into ducts -> infection & inflammation

  Can lead to breast abscess
• What are the RFs of breast abscesses?

  Smoking

  Damage to nipple

  Underlying breast disease (e.g. cancer) -> affects breast drainage
• What are the most common causative bacteria of breast abscesses?

  Staphylococcus aureus

  Streptococcal species

  Enterococcal species

  Anaerobic bacteria
• What are the signs & symptoms of breast abscess?

  Fluctuant, tender lump within breast

  Nipple changes

  Purulent nipple discharge

  Localised pain

  Tenderness

  Warmth

  Erythema

  Hardening of the skin/breast tissue

  Swelling

  Fatigue

  Fever

  Signs of sepsis
• What are the Inx for breast abscesses?

  Full Hx & examination

  Pregnancy test

  Milk culture

  Bloods (FBC, U&Es, CRP, cultures)

  USS

  Aspiration
• What are the DDx of breast abscesses?

  Galactocele

  Fibrocystic breasts

  Fibroadenoma

  Invasive breast cancer

  Fat necrosis (usually secondary to trauma)
• What is the management of breast abscesses?

  Referral to on-call surgical team

  Abx

  USS (confirm diagnosis)

  Drainage (needle aspiration or surgical incision & drainage)

  Microscopy, culture & sensitivities of drained fluid

  Advise to keep breastfeeding/expressing
• What is the management of lactational mastitis?

  Conservative

  • continued breastfeeding/expressing
  • breast massage
  • heat packs, warm showers
  • analgesia

  If symptoms do not improve -> Abx (flucloxacillin or erythromycin/clarithromycin)
• What is the management of non-lactational mastitis?

  Analgesia

  Abx (co-amoxiclav OR erythromycin/clarithromycin + metronidazole)

  Treatment for underlying cause
• What are breast cysts?

  Fluid-filled sacs within the breast tissue

  Can be palpated as lumps
• In which group are breast cysts most commonly seen?

  Premenopausal women

  Typically 35-50 yrs
• What is believed to play a role in the development of breast cysts?

  Hormonal fluctuations
• How can breast cysts present?

  May be asymptomatic

  Pain

  Tenderness

  Round/oval & smooth lump with distinct edges
• What are the Inx of breast cysts?

  Full Hx & examination

  USS

  Fine needle aspiration (clear fluid aspiration without a residual mass = simple cyst)
• What is the management of breast cysts?

  Symptomatic

  • watchful waiting
  • oral contraceptives (regulate hormonal imbalances)
  • surgical excision (if persistent or recurrent)
  • advise that cysts do NOT increase risk of breast cancer