Breast abscess: Clinical sciences

A breast abscess occurs when a bacterial infection forms a collection of purulent fluid, or pus, which leads to the development of a painful mass in the breast tissue. It is most often a complication of mastitis, which involves inflammation and infection of the breast.

Most cases of mastitis are lactational or puerperal, resulting from prolonged milk stasis, engorgement, and the entry of bacteria through breaks in the nipple.

Rarely, mastitis can be non-lactational or non-puerperal, which can be idiopathic, related to malignancy, or due to infection from recent surgery, nipple piercings, tattoos, or other trauma.

A breast abscess is more likely to occur in patients who smoke, have diabetes, or can even be a sign of a more serious pathology like inflammatory breast cancer.

Most cases are usually caused by methicillin-sensitive Staphylococcus aureus, while other bacteria like Streptococci sp., Staphylococcus epidermidis, and methicillin-resistant Staphylococcus aureus or MRSA may also be implicated.

Alright, when assessing a patient who presents with a chief concern suggesting a skin abscess, you should first perform an ABCDE assessment to determine if your patient is unstable or stable. If the patient is unstable, stabilize the airway and breathing first. Next, address circulation by obtaining IV access and initiating IV fluids for resuscitation.

Here’s a clinical pearl! Keep in mind that it’s very rare for breast abscess to be the sole cause of hemodynamic instability. Thus, if the patient is unstable, then they’ve likely developed sepsis or even septic shock.

Okay, now that you have taken care of your unstable patients, let’s talk about stable patients. Your first step is to obtain a focused history and physical examination.

Your patient will usually report breast pain, swelling, and purulent discharge from the nipple or from a lesion on the skin.

Make sure to ask about risk factors like a history of smoking, diabetes, recent childbirth, and if they are currently breastfeeding.

When it comes to the physical exam, it might reveal increased warmth over the affected area, as well as erythema, and possible edema. Additionally, you might feel a fluctuant, tender, or palpable mass. Patients also often present with fever. If any of these signs and symptoms are present, you are likely dealing with a breast abscess.

Okay, now that the diagnosis is made, let’s talk about the management. This includes empiric antibiotics and pain medications. Penicillinase-resistant penicillins like dicloxacillin, or a first-generation cephalosporin is the antibiotic of choice,

but for patients with beta-lactam hypersensitivity, or if MRSA is suspected, you can use clindamycin instead.