Mastitis and breast abscess

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It is the inflammation of breast tissues.  Most commonly involved organism is Staph. aureus.  It mostly occurs in lactating mothers.  Infection from infant mouth causes ascending infection of lactiferous ducts or blockage of ducts by epithelial debris causing stasis of milk & multiplication of bacteria.

CLINICAL FEATURES

 

Symptoms

  • Pain usually over one segment.
  • Fever

Signs

Tense, tender, hot, red, swollen breast, usually one segment but sometimes extensive involvement.

INVESTIGATIONS

  • TLC will be raised.
  • Needle aspiration cytology to differentiate from inflammatory carcinoma.

TREATMENT

 

Cellulitis Stage

Antibiotics commonly used are Cap. ampicillin 500 mg T.D.S. for 5 to 7 days.  If sensitive to penicillin, then Cap. Velosef 500 mg T.D.S. for 5 to 7 days.

Analgesia; Tab. Brufen 400 mg T.D.S. for 3 days after meals.

The patient should be encouraged to continue breast-feeding from normal breast & empty affected breast with breast pump.  This milk can be used after boiling.  Apply local heat but avoid a skin burn.

Breast Abscess

If infection does not resolve within 48 hours, incision discharge and curettage should be done. Fluctuation is a late sign & surgery should not be delayed until its appearance.  Usually one sector is involved.  Confirm the presence of pus with needle aspiration.  If more extensive area is involved, USG helps to define the area.  If antibiotics alone are used at this stage, antibioma will result which has to be excised later on.

Preparation Of The Patient For Incision & Drainage:

  • Nil per oral for 6 hours prior to surgery.
  • Set up I/V line.
  • Preoperative antibiotics. e.g. I/V cephalosporin 1G.
  • I&D should always be done under general anaesthesia.

OPERATION

Incision:  Radial incision over the affected segment.  If abscess is central, a circumareolar incision will allow adequate access.  Incision passes through the skin &superficial fascia.  All loculi should be broken.

Send pus for culture and sensitivity in a sterilized tube.

Tissue for biopsy from wall of abscess is obtained to rule out inflammatory carcinoma or tuberculosis.

Pack abscess cavity with gauze or place a drain.

POSTOPERATIVE MANAGEMENT

  • Continue I/V antibiotic for 24 hours, then oral antibiotics for 5-7 days.
  • Inj. diclofenac sodium 75 mg I/M x 12 hourly for first 24 hours, then switch to oral analgesics.
  • Wound toilet and daily dressing.
  • If age of the infant is 6 months to 1-year, milk production can be suppressed by giving dopamine agonist (bromocriptine) as Tab Parlodel 1 x b.i.d. for 10 days.