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Breast Abscess

 

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A breast infection is an infection in the tissue of the breast. An abscess is a pus-filled hollow space that can appear on the skin or inside the body. Common causes of benign breast masses include fibrocystic disease, fibroadenoma, and abscess. Symptoms may include painful local swelling of the breast, a breast lump, and redness and tenderness of the breast. Your healthcare provider will suspect an abscess if the lump remains tender and does not go away with the treatment listed under plugged ducts and mastitis. Breast abscesses can affect women between the age of 18 and 50, but they are very uncommon in women who are not producing milk. Breast masses can involve any of the tissues that make up the breast, including overlying skin, ducts, lobules, and connective tissues. Fibrocystic disease, the most common breast mass in women, is found in 60-90% of breasts during routine autopsy. you are temporarily unable to breastfeed on the breast with an abscess, use an electric breast pump to empty the breast and nurse baby more frequently on the other breast. When the lactiferous duct lining undergoes epidermalization, keratin production can cause plugging of the duct and result in abscess formation. This helps explain the high recurrence rate (an estimated 39-50%) of breast abscesses in patients treated with standard incision and drainage (I&D). It is normal for the breasts to feel tender during breastfeeding, but you should consult your GP straightaway if you have heat or pain in either breast.

Patients typically do not present in the ED with a breast mass as their chief complaint; however, knowledge of the pertinent anatomy, pathophysiology, and clinical clues is essential. Engorgement, mastitis, or a plugged duct can sometimes lead to a breast abscess. The infection causes the immune system to activate white blood cells and chemicals to fight the bacteria. Most abscesses form just under the skin and are the result of a bacterial infection. The first is related to nursing (breastfeeding). In this case, redness, tenderness, and skin changes take place on the breast from the baby's feeding and sucking on the nipple. If untreated an abscess will form. If the abscess forms in spite of antibiotics, it may need to be incised and drained, a minor surgical procedure, in order to heal. The second type is unrelated to nursing. If you are temporarily unable to breastfeed on the breast with an abscess, use an electric breast pump to empty the breast and nurse baby more frequently on the other breast. It is normal for the breasts to feel tender during breastfeeding, but you should consult your GP straightaway if you have heat or pain in either breast.

Causes of Breast Abscess

The common Causes of Breast Abscess :

  • Staphylococcus aureus and streptococcal species are the most common organisms isolated in puerperal breast abscesses. Nonpuerperal abscesses typically contain mixed flora ( S aureus , streptococcal species) and anaerobes.
  • Trauma can cause discharge from both breasts.
  • The infection takes place in the parenchymal (fatty) tissue of the breast and causes swelling.
  • A study by Schafer et al found a significant correlation between cigarette smoking and subareolar breast abscess.
  • Drugs such as cimetidine, methyldopa, metoclopramide, oral contraceptives, phenothiazines, reserpine, tricyclic antidepressants , or verapamil .
  • Intraductal papilloma (a small noncancerous growth in the duct of the breast)
  • prolactinoma (prolactin-secreting tumor in the brain)

Symptoms of Breast Abscess

Some common Symptoms of Breast Abscess :

  • Pain.
  • Swelling , tenderness, redness, and warmth in breast tissue
  • Itching.
  • Tenderness.
  • Nipple discharge (may contain pus).
  • Pus draining.
  • Collection ("mass") of pus.
  • Fever.
  • Skin redness.
  • Breast lump .

Treatment of Breast Abscess

  • Early infection (before the Abscess forms or early in the process) - dicloxacillin by mouth or oxacillin intravenously.
  • Larger Abscess - incision and drainage with appropriate antibiotics as above.
  • Self-care may include applying moist heat to the infected breast tissue for 15 to 20 minutes four times a day.
  • Identify the problem and provide pain control, antibiotic therapy, and prompt surgical consultation.
  • Treat with antistaphylococcal antibiotics, warm compresses, and continued emptying of the breast by breastfeeding or breast pumping .
  • You are encouraged to continue to breast-feed or to pump to relieve breast engorgement (from milk production) while receiving treatment.
  • Definitive diagnosis of the etiology can only be made by pathologic examination and is not an emergency. Timely follow-up care, including mammography and involvement of primary physician and surgeon, is essential.