A breast abscess is a localized, encapsulated collection of pus within the breast tissue, often following an infection such as mastitis. It occurs primarily in lactating women (puerperal abscess) but can also develop in non-lactating women due to other risk factors.
Etiology
- Puerperal (lactating) Mastitis: This is the most common cause of breast abscesses, typically occurring during breastfeeding. The infection usually begins when bacteria, often Staphylococcus aureus, enter through a nipple fissure.
- Nonpuerperal Abscesses: These are uncommon but may occur due to trauma, obesity, smoking, or immunosuppression. They are often polymicrobial, involving both aerobic and anaerobic bacteria.
Clinical Features
- Breast Pain: The affected breast is tender to the touch.
- Swelling and Erythema: The area is swollen, red, and warm.
- Fluctuant Mass: A soft, fluctuant mass may be palpable, indicating pus accumulation.
- Purulent Nipple Discharge: The affected breast may have purulent discharge from the nipple.
- Systemic Signs: Fever and nausea may accompany the infection, signaling systemic involvement.
Diagnosis
- Clinical Evaluation: Diagnosis is primarily clinical, based on the presence of swelling, redness, tenderness, and a palpable mass.
- Breast Ultrasound: Imaging is used to confirm the diagnosis and distinguish the abscess from other breast conditions. Ultrasound typically reveals an irregular, fluid-filled cavity.
- Aspiration: Fine needle aspiration may be performed to drain the abscess and obtain samples for bacterial culture.
Treatment
- Drainage: Essential for the management of a breast abscess.
- Percutaneous Aspiration: First-line treatment, often guided by ultrasound.
- Incision and Drainage: Indicated for larger or multiloculated abscesses, or if percutaneous aspiration is ineffective.
- Antibiotics: Empiric antibiotic therapy is started and adjusted based on culture results.
- First-line: Oral penicillinase-resistant penicillin (e.g., dicloxacillin) or cephalexin.
- MRSA Risk: Clindamycin or trimethoprim-sulfamethoxazole (TMP-SMX).
- Severe Illness: IV vancomycin.
- Caution: Avoid TMP-SMX in lactating mothers with newborns under 30 days old due to the risk of kernicterus.
- Pain Management: NSAIDs or other analgesics are used to manage pain and inflammation.
- Breastfeeding: Lactating women are encouraged to continue breastfeeding or pumping to prevent milk stasis.
Complications
- Chronic Abscess: Without proper treatment, the abscess may persist or recur.
- Fistula Formation: An untreated abscess can lead to fistula formation, where there is an abnormal connection between the breast ducts and the skin.
- Sepsis: In severe cases, the infection can spread systemically, causing sepsis.
Prevention
- Proper Breastfeeding Techniques: Ensuring proper latch-on during breastfeeding can prevent nipple cracks and mastitis, reducing the risk of abscess formation.
- Early Treatment of Mastitis: Quick intervention for mastitis can help prevent abscess formation.
Conclusion
Breast abscesses, although common in lactating women, can also occur in non-lactating individuals with certain risk factors. Prompt diagnosis and appropriate treatment, including drainage and antibiotic therapy, are crucial to prevent complications.