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Breast infections

Lactational breast abscess

  • Usually due to Staph. aureus
  • Usually peripherally situated
  • Surgery may be pre-empted by early diagnosis
  • Attempt aspiration
  • If no pus - antibiotics
  • If pus present consider repeated aspiration or incision and drainage
  • Consider biopsy of cavity wall
  • Continue breast feeding from opposite breast
  • No need to suppress lactation

Non-lactational breast abscess

  • Occur in periareolar tissue
  • Culture yield - Bacteroides, anaerobic strep, enterococci
  • Usually manifestation of duct ectasia / periductal mastitis
  • Occur 30- 60 years
  • More common in smokers
  • Often give history of recurrent breast sepsis
  • Repeated aspiration is the treatment of choice
  • Metronidazole and flucloxacillin
  • Drain through small incision if non-resolving
  • Definitive treatment when quiescent with antibiotic prophylaxis
  • Usually a major duct excision = Adair's operation
  • Spontaneous discharge or surgical excision can result in mammary fistula

Non-lactational breast abscess

Bibliography

Dixon J M.  Breast Infection.  BMJ  1994; 309: 946-949.

Marchant D J.  Inflammation of the breast.  Obstet Gynecol Clin North Am 2002;  29:  89-102.

Scott-Connor C E.  Schorr S J.  The diagnosis and management of breast problems during pregnancy and lactation.  Am J Surg 1995;  170:  401-405.

 

 
 

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