Treatment of breast infection
BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d396 (Published 11 February 2011) Cite this as: BMJ 2011;342:d396
This article has a correction. Please see:
- J Michael Dixon, professor of surgery and consultant surgeon12,
- Lucy R Khan, specialty registrar breast surgery2
- 1Breakthrough Research Unit, Edinburgh Breast Unit, Western General Hospital, Edinburgh EH4 2XU, UK
- 2Edinburgh Breast Unit
- Correspondence to: J M Dixon jmd{at}ed.ac.uk
Summary points
Early prescription of appropriate antibiotics reduces the rate of breast abscess development
Refer to hospital all patients whose infection does not settle rapidly after one course of appropriate antibiotics
Use ultrasound routinely in patients referred with a suspected abscess to see whether pus is present
Breast abscesses can usually be treated in the outpatients department by repeated aspiration or mini-incision and drainage under local anaesthesia
Patients whose inflammatory changes do not settle after a course of antibiotics may have inflammatory breast cancer; in such cases perform imaging and image guided core biopsy if a localised suspicious abnormality is present
Recurrent central infection is usually associated with periductal mastitis—a smoking related disease—and total duct excision is often needed
A cohort study of American women reported that 10% of women who breast feed have mastitis,1 and a recent Cochrane review reported the incidence to be as high as 33%.2 Breast abscesses are seen less often, but when they do develop delays in referral to a specialist surgeon may occur. A recent survey in the United Kingdom found that many surgical units have no clear protocols for managing patients with breast infection who are referred to hospital.3 Some surgeons aspirate breast abscesses under local anaesthesia, whereas others use general anaesthesia. The management of breast infection has evolved over the past two decades, with advances in both diagnosis and treatment. A new concept is bedside ultrasound, and this plays an important part in current management.
We review management of breast infection in the primary care setting and after hospital referral. The review is based on our current practice and the best quality evidence available. Few randomised controlled trials deal with this topic, and most breast specialists have adopted their own protocols for clinical management, loosely based on published algorithms, and largely …
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