Breast abscess is collection of pus in the breast tissue. It is usually caused by bacterial infection and most abscesses develop just under the skin of breast tissue. Pus is collection of dead neutrophils. When an infection occurs there is defensive reaction against infection, but it may occur due to presence of foreign body which result in accumulation of neutrophils and pus formation.
Causes of breast abscess
Staphylococcus aureus bacteria is a common cause of breast abscess especially in lactating and pregnant women. Abscess is usually thought as a skin complication and the abscess is usually caused by bacteria commonly found on normal skin. Following are known causes of breast abscess. There might be malignant growth or destruction in tissues such as the breast ducts causing accumulation of fluids (secretions), and these stagnant fluids are prone to infection
When mother breast feed to the baby, there is inflammation of breast called mastitis. There are many precipitating factors
* Crack/fissure in the nipple
*Oral cavity infection in the baby
Infection in hematoma can result in abscess. Staphylococcus produces enzyme that degrades proteins result in abscess. It can enter through nipple produce clotting of milk within which organism multiply.
Clinical features of breast abscess:
Patient presents with severe pain in the breast due to inflammatory exudates. Breast is tense, tender, swollen and warm to touch. These are the initial presentation. When breast abscess develops, there is soft, cystic fluctuant swelling on the breast accompanied by high grade fever with rigors and chills. In untreated patient there is skin necrosis and ulceration over the breast and discharge. If there is throbbing pain and fever with rigors and chills are present immediate treatment is mandatory.
How inflammatory response begins in breast abscess?
When foreign organisms (bacteria) enter a wound, these organisms can kill many of the local cells. These dying cells release cytokines (cytokines are small proteins which certain cells secrete that signal an immune system response in local and in generalized body) which are pro inflammatory cells. The release of cytokines starts an inflammatory response, increasing blood flow and bringing large numbers of white blood cells to that local site. As part of this immune system response, the healthy cells next to the area form a fibrous ‘wall’ or ‘capsule’. Pus accumulates within this capsule, result in formation of palpable swelling, or a ‘cavity’ within the breast.
Types of breast abscesses
It is collection of pus behind pectoralis major muscle. common causes are
- Hematoma with secondary infection
- Tuberculosis of the ribs with cold abscess
- The cold abscess arising from the lymph node.
Subareolar breast abscess:
- Its common in non lactating women
- There is communication with lactiferous duct result in mammary fistula
- It can be due to a sebaceous cyst
Tubercular mastitis (tubercular breast abscess)
Clinical features of this abscess include multiple tender abscesses, sinuses and matted nodes especially in axilla. This is almost secondary to pulmonary lesion.
Investigation for breast abscess:
Laboratory investigations for breast abscess
Full blood count: full blood count will show increase in white blood cells. ESR: There will be increase in erythrocyte sedimentation rate showing infection.
Imaging studies for breast abscess:
Imaging studies for breast abscess are frequently done for to rule out malignancy. Mammogram and ultrasound studies for breast abscess are often inconclusive.
Mammogram for breast abscess
A breast abscess will appear on a mammogram like an ill-defined mass often with some areas of increased density and distortion. These types of features of mammogram are not well differentiated from breast cancer lesions. Mammography is less sensitive for the diagnosis of breast abscess in younger women and those with dense breast tissue.
Ultrasound for breast abscess
Ultrasound is useful in ruling out malignancy. it depends upon location of the breast abscess. A breast abscess on ultrasound will show ill-defined mass with central hypoechogenicity.
MRI scan for breast abscess:
MRI might be useful in diagnosis and differentiating it fro malignancy as it tends to provide a more comprehensive view of the lesion, even below the nipple.
Treatment for breast abscess:
Treatment for breast abscess in its initial cellulitis stage is mainly antibiotics. Drug of choice is cloxacillin. Anti inflammatory drugs such as ibuprofen are given for pain and good support to the breast. When the abscess is formed then abscess should be drained through incision and drainage under antibiotic cover.
Home remedies for breast abscess: Daily wash skin and the nipple with a gentle antibacterial soap. Air-dry that skin area before putting on a bra or shirt. Wear a soft breast pad to help drain pus and reduce any friction that could cause increased discomfort and pain.
Breast abscess surgery:
Before the surgery informed consent is taken. Base line investigations are done. Surgery is carried out through local anesthesia or general anesthesia. Currently the initial treatment policy is ultrasound guided drainage. A small incision is given in breast abscess. The abscess is break up and pocket of pus drained. The area is washed out with saline. If the abscess is situated in any quadrant of breast other than lower quadrant, it is drained by radial incision. Abscess in lower quadrant is drained by inframammary incision which is placed on inferior aaspect of the breast. A sample of tissue and pus may be sent to a lab for tests. The incision may be left open for secondary healing. A bandage is put on incision to keep the area clean and dry.
Prevention of breast abscess
Practicing good hygiene and daily wash with soap is very important. Keep the nipple and areola very clean if there is a piercing. No smoking can help prevent subareolar breast abscesses.
Breast abscess and breast feeding
If there is breast abscess in one side stop breast feeding from that affected side. Start breast feeding from the healthy breast. When both breasts have an abscess, the breast should be emptied and the milk is expressed. That expressed milk can be boiled and given to the child