- Lactational abscess (associated with breastfeeding)
- Non-lactational abscess (unrelated to breastfeeding)
Mastitis - inflammation of breast tissue. Often related to breastfeeding. May or may not be accompanied by infection.
Causes/Factors
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Smoking
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Damage to the nipple - eczema, candidal infection or piercings
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Underlying breast disease
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In lactating women, milk stasis is usually the primary cause
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Staphylococcus aureus (the most common)
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Streptococcal species
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Enterococcal species
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Anaerobic bacteria (such as Bacteroides species and anaerobic streptococci)
Presentation
Usually both acute onset
- Painful breast
- Fever general malaise
- Red, swollen and heard area of the breast often in a wedge-shaped distribution
A breast abscess should be suspected if there is:
- A history of recent mastitis.
- A painful, swollen lump in the breast, with redness, heat, and swelling of the overlying skin.
- Fever and/or general malaise.
Investigations
The diagnosis of mastitis or a breast abscess can usually be made clinically, with a history and examination.
Management
- Lactational mastitis caused by blockage of the ducts is managed conservatively - continued breastfeeding, heat packs, warm showers, simple analgesia.
- Flucloxacillin or equivalent for active infection or unresolved symptoms
Management of non-lactational mastitis
- Analgesia
- Antibiotics - broad spec - co-amox or erythro/clarythro + Metronidazole
- Treatment for underlying cause
Management of breast abscess:
- Referral to on-call surgical team
- Antibiotics
- USS - to exclude other pathology
- Drainage
- MC&S of drained fluid
Women who are breastfeeding are advised to continue breastfeeding when they have mastitis or breast abscesses. They should regularly express breast milk if feeding is too painful, then resume feeding when possible. This is not harmful to the baby and is important in helping resolve the mastitis or abscess.