MASTITIS

Breast Abscess

Infection of the breast usually in a breastfeeding mother.

Causes

  • 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 (shinny 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 reccurrence

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

MANAGEMENT

  • Stop breastfeeding on the affected breast but express milk and discard to avoid breast
    engorgement
  • Give analagesics 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 utrasound 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 (Refer to section on care of the mother and baby
    immediately after delivery