DIAGNOSIS
DIFFERENTIAL DIAGNOSIS
• Inflammatory carcinoma;
• Advanced carcinoma with erythema, edema, and/or ulceration;
• Rarely, tuberculous abscess;
• Hydradenitis of breast skin;
• Sebaceous cyst with infection.

WORKUP
• Clinical examination sufficient;
• If abscess suspected, referral to surgeon for incision, drainage, and biopsy;
• If possible abscess or advanced carcinoma, referral for workup required.
LABORATORY TESTS
• Perform C&S test of abscess contents.
• If mammogram or ultrasound prevented by discomfort, perform after resolution of abscess if required.
TREATMENT
NONPHARMACOLOGIC THERAPY
• Established abscess: incision and drainage, preferably with general anesthesia;
• Biopsy of abscess cavity wall to exclude carcinoma.

ACUTE GENERAL Rx
• Antibiotics: the pathogen is generally staphylococci in lactational abscess. Recommended initial antibiotic therapy is with nafcillin or oxacillin 2g q4h IV or cefazolin 1g q8h IV.
• If acute mastitis is treated early, resolution without drainage is possible.
• Subareolar abscess: broad-spectrum antibiotic treatment and drainage are needed to control acute phase.
CHRONIC Rx
Further surgical treatment for recurrences or fistula
DISPOSITION
• Lactational abscess: possible to continue breast-feeding without apparent risk of infection to the infant;
• Subareolar abscess:
1. Notorious for recurrence or complication of fistula formation;
2. Patient informed and referred for subsequent care.
REFERRAL
• If abscess drainage required;
• For surgical consultation if subareolar abscess involved.

Abscess of the Breast

BASIC INFORMATION
DEFINITION
Breast abscess is an acute inflammatory process resulting in the formation of a collection of pus. Typically there is painful erythematous mass formation in the breast, occasionally with draining through the overlying skin or nipple duct opening.

SYNONYMS
Subareolar abscess;
Lactational or puerperal abscess;
Abscess of the breast;
Abscess of the nipple related to childbirth;
Abscess of the breast related to childbirth.

EPIDEMIOLOGY & DEMOGRAPHICS
• 10% to 30% of all breast abscesses are lactational.
• Acute mastitis occurs in 2.5% of nursing mothers, with 1 in 15 of these women developing abscess.

PHYSICAL FINDINGS & CLINICAL PRESENTATION
Painful erythematous induration involving the part of the breast leading to fluctuant abscess.

ETIOLOGY
• Lactational abscess: milk stasis and bacterial infection leading to mastitis, then to abscess, with Staphylococcus aureus the most common causative agent.

• Subareolar abscess:
1. Central ducts involved, with obstructive nipple duct changes leading to bacterial infection.
2. Cultured organisms mixed, including anerobes, staphylococci, streptococci, and others.