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
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. |