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