Abstract
Most breast abscesses develop as a complication of lactation mastitis. The incidence ranges from 0.4 to 11 per cent of all lactating mothers. Lactational breast abscesses are most often caused by Staphylococcus aureus and streptococcal species, Methicillin-resistant S. aureus is becoming increasingly common.
Introduction and Epidemiology
Most breast abscesses develop as a complication of lactation mastitis. The incidence ranges from 0.4 to 11 per cent of all lactating mothers. Lactational breast abscesses are most often caused by Staphylococcus aureus and streptococcal species, Methicillin-resistant S. aureus is becoming increasingly common.1
Risk Factors
2. Birth after 41 weeks’ gestation
3. Age >30 years
4. Recent mastitis
5. Previous history of mastitis or breast abscess2
Clinical Picture
Patients may provide lactation history. You need to ask about any history of prior breast infections and the previous treatment. It is also important to ask about the patient’s medical history, including diabetes, especially in recurrent or chronic cases.
Signs and Symptoms
1. Severe breast pain
2. Breast erythema, warmth and possibly oedema are the most common
3. Tender on palpation
4. Induration
5. Fever and rigours
6. Nausea, vomiting
7. Palpable mass or area of fluctuance
8. Purulent discharge at the nipple or site of fluctuance
9. Reactive axillary adenopathy may be present
10. In a large breast or if the abscess is deeply located, a mass may not be felt
Diagnosis
Clinical Diagnosis
It is a clinical diagnosis, based on the clinical picture.
Laboratory Diagnosis
1. Full blood count may show leucocytosis but this is not specific
2. Culture and sensitivity of any breast discharge
3. Breast ultrasound
Breast ultrasound scan is used to differentiate abscess from mastitis, also to exclude breast cancer.
Abscess appears as ill-defined mass with very stiff outer rim due to oedema and inflammation. There are internal septations and very soft central area.
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