Mastitis/Breast Abscess
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Infection of the breast usually in a breastfeeding mother.
Cause
- Usually Staphylococcus aureus enters from the baby’s mouth through a cracked nipple into an engorged breast. Less frequently Streptococci
Clinical features
- Pain in the breast, which is swollen, often shiny, and tender with enlarged veins
- Often in 2nd postpartum week
- Fever
- May proceed to become an abscess; a collection of pus within the breast tissue
- There may be localised erythema (shiny red skin)
- Firm lump, felt initially but may later become fluctuant
- May drain pus spontaneously
Complications
- Recurrent infection, scarring
- Loss of breast size, noticeable breast asymmetry
- Mammary duct fistula formation due to recurrence
Differential diagnosis
- Breast engorgement (for mastitis)
- Breast lump/cancer (for abscess)
Investigations
- Breast milk: For C&S
- US scan to rule out breast abscess in patients with recurrent mastitis
ManagementTreatment
- Stop breastfeeding on the affected breast but express milk and discard to avoid breast engorgement
- Give analgesics such as paracetamol 1 g every 8 hours for 3 days
- Apply warm compresses to relieve pain in affected breast
- Continue breastfeeding on the normal breast
- Give cloxacillin 500 mg 6 hourly for 10 days or
- (If not available use amoxicillin 500 mg every 8 hours for 10 days)
- If penicillin allergies: erythromycin 500 mg every 6 hours for 10 days
- Or cephalexin 500 mg PO every 6 hours for 10 days
If not improving
- Refer to hospital for ultrasound scan and further management
- If clinical or US scan features of breast abscess: incise and drain
Prevention
- Proper attachment of baby on the breast
- Frequent emptying of the breast
- Ensure the baby is sucking on the areolar and not the nipple
- Manage breast engorgement if not breastfeeding, or lost baby