Breast Infection: A Review of Diagnosis and Management Practices

Abstract

Mastitis is a common condition that predominates during the puerperium. Breast abscesses are less common, however when they do develop, delays in specialist referral may occur due to lack of clear protocols. In secondary care abscesses can be diagnosed by ultrasound scan and in the past the management has been dependent on the receiving surgeon. Management options include aspiration under local anesthetic or more invasive incision and drainage (I&D). Over recent years the availability of bedside/clinic based ultrasound scan has made diagnosis easier and minimally invasive procedures have become the cornerstone of breast abscess management. We review the diagnosis and management of breast infection in the primary and secondary care setting, highlighting the importance of early referral for severe infection/breast abscesses. As a clear guideline on the management of breast infection is lacking, this review provides useful guidance for those who rarely see breast infection to help avoid long-term morbidity.

Keywords: Mastitis; abscess; infection; lactation.

Figure 1. a, b

(a) Erythema associated with mastitis and (b) lactational breast abscess with visible swelling and erythema

Figure 2. a, b

US scan (a) shows a well circumscribed hypoechoic lesion and US scan (b) shows a chronic abscess with a hypoechoic rim

Figure 3

US-guided aspiration of a breast abscess

Figure 4. a, b

Surgical management of lactational breast abscesses (a) shows a lactational breast abscess with erythema, thin overlying skin and necrotic tissue (b) small I&D of a breast abscess

Figure 5. a, b

(a) Shows severe necrosis due to delayed management, with (b) post management, with significant asymmetry/scarring