Practice 10-Minute Consultation

Acute painful breast in a non-lactating woman

BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i2646 (Published 15 June 2016) Cite this as: BMJ 2016;353:i2646
  1. Jessamy Bagenal, editorial registrar and specialty registrar in general surgery1,
  2. Janani Bodhinayake, general practitioner2,
  3. Kathryn E Williams, specialty registrar in general surgery and national TIG oncoplastic fellow3
  1. 1BMJ Editorial, BMA House, London WC1H9JR, UK
  2. 2University College London, London, UK
  3. 3University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
  1. Correspondence to: J Bagenal jbagenal{at}bmj.com

What you need to know

  • Uncomplicated mastitis can be managed in the community

  • Offer admission and urgent referral to a general surgeon to patients with abscess, sepsis, haemodynamic instability, or mastitis with immunocompromise

  • Offer outpatient referral for a cancer appointment to those with suspected inflammatory breast cancer or those whose symptoms fail to resolve

A 50 year old woman describes a three day history of a painful right breast.

Non-lactating women may present with a painful red breast because of periductal inflammation, which can evolve into a breast abscess. This condition must be differentiated from inflammatory breast cancer, a rare type of breast cancer that mimics the signs and symptoms of mastitis (table 1).

View this table:
Table 1

Differentiation of inflammatory breast cancer from mastitis or breast abscess

Smoking is the main predisposing factor for periductal mastitis due to ductal damage (relative risk from 6.2 to 26.4 for heavy smokers).1 2 3 There is usually an infective element; commonly Staphylococcus aureus, enterococci, or Bacteroides. Poor hygiene and lower socioeconomic status are associated with breast abscess.4

What you should cover

History

Pain of mastitis typically starts over hours to days—typical symptoms are …

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