Practice ABC of Breast Diseases, 4th Edition

Breast Infection

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f3291 (Published 16 December 2013) Cite this as: BMJ 2013;347:bmj.f3291
  1. J Michael Dixon
  1. Western General HospitalEdinburgh Breast Unit Edinburgh, UK

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Overview

  • Breast infection during breastfeeding is less common than it used to be

  • Early prescription of appropriate antibiotics in infection limits abscess formation

  • Delay in referral to breast clinics of patients with lactating infection that does not settle rapidly with antibiotics continues to be a problem

  • Breast abscesses can be aspirated or drained through a very small skin incision

  • Breast cancer should be excluded in patients with inflammatory changes that do not settle rapidly on appropriate therapy

Breast infection is now much less common than it used to be. It is seen occasionally in neonates, but it most commonly affects women aged between 18 and 50; in this age group it can be divided into lactational and non-lactational infection. Infection can affect the skin overlying the breast, when it can be a primary event, or it may develop secondary either to a lesion in the skin, such as a sebaceous cyst, or to an underlying skin condition, such as hidradenitis suppurativa.

Treatment

There are four guiding principles in treating breast infection:

  • Appropriate antibiotics should be given early to reduce the likelihood of abscess development (Tables 1 and 2).

  • Hospital referral is indicated if the infection does not settle rapidly following one course of antibiotic treatment.

  • If an abscess is suspected it should be confirmed by ultrasonography, aspiration or both before surgical drainage is considered.

  • Breast cancer should be excluded in patients with an inflammatory lesion that is solid on ultrasonography or on aspiration that does not settle despite apparently adequate antibiotic …

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