Breast abscess: Difference between revisions

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{{Breast abscess}}
{{Breast abscess}}
{{CMG}} {{AE}} {{AEL}}  
{{CMG}}; {{AE}} {{AEL}}
<br>
'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''


{{SK}} Mammary abscess, Zuska's disease, lactiferous fistula.
==Overview==
[[Breast]] [[abscess]] is a very rare [[infectious disease]] which is defined as a local collection of [[pus]] beneath the [[skin]] of the [[breast]]. It is the common complicated form of the [[breast]] [[inflammation]] ([[mastitis]]). The first cases of the [[breast]] [[Abscess|abscesses]] return back to 1840. It can be classified according to the [[abscess]] location and the lactational state of the patient. [[Abscess|The abscess]] is caused commonly by [[staphylococcus aureus]] when there is an [[injury]] in the [[breast]] [[skin]] specially during the puerperal phase of the patient. [[Breast]] [[abscess]] should be differentiated from other [[masses]] that can be noticed in the breast like: [[inflammatory breast cancer]], [[mastitis]], [[lipoma]], [[lymphangioma]], [[hemangioma]], [[cellulitis]] and [[fibroadenoma]]. It has [[incidence]] of 3000-11000 per 100000 patients of [[mastitis]] and it can happen in the [[infants]] and the adults. There are many risk factors that may cause [[breast]] [[abscess]], the most important one is a [[trauma]] to the breast tissue. Other risk factors may include smoking, [[obesity]], [[diabetes mellitus]], insect bites and surgical procedures. The abscess may burst out on the skin if it is kept untreated. [[Milk]] [[fistula]] and [[antibioma]] can be considered complications of the [[breast]] [[abscess]].It has a good prognosis but a high rate of recurrence. [[The abscess]] is noticed like a [[lump]] and its clinical manifestations are: [[pain]] in the abscess site, [[fever]], [[nipple discharge]], [[erythema]] and warmth. It can be diagnosed through US besides [[mammography]] and [[CT scan]] to exclude other breast masses. Breast abscess treatment includes [[abscess]] [[aspiration]] and surgical drainage alongside with the antibiotic medical therapy.


==Historic Perspective==
{{SK}} Mammary abscess, Zuska's disease, Lactiferous fistula
In 1841, Dr. Jonathan Toogood reported a case of [[breast]] [[abscess]] out of only 5 cases at that time.<ref name="pmid21379654">{{cite journal| author=Toogood J| title=On Deep-Seated Abscess of the Breast. | journal=Prov Med Surg J (1840) | year= 1841 | volume= 2 | issue= 47 | pages= 418-9 | pmid=21379654 | doi= | pmc=2489248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21379654  }} </ref>


==Classification==
==[[Breast abscess overview|Overview]]==
[[Breast]] [[Abscess]] may be classified according to anatomical location and [[lactation]] state of the patient into subtypes.<ref name="pmid7755694">{{cite journal| author=Dixon JM| title=ABC of breast diseases. Breast infection. | journal=BMJ | year= 1994 | volume= 309 | issue= 6959 | pages= 946-9 | pmid=7755694 | doi= | pmc=2541130 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7755694  }} </ref>


*Anatomical location:
==[[Breast abscess historical perspective|Historical Perspective]]==
**[[Subcutaneous]]
**[[Subareolar abscess|subareolar]]
**Interlobular
**Central
**[[Retromammary]]


*[[Lactation]] state:
==[[Breast abscess classification|Classification]]==
**Lactational
**Non-Lactational.


==Pathophysiology==
==[[Breast abscess pathophysiology|Pathophysiology]]==
Following untreated [[mastitis]], breast [[abscess]] could occur.
[[Breast|Breas]]<nowiki/>t [[abscess]] is usually caused by [[staphylococcus aureus]] [[bacterial]] [[infection]] to an injured [[breast]] [[skin]]. [[Staphylococcus aureus]] could form [[abscess]] by secretion of several killing agents like [[enzymes]] and [[toxins]] which causes breast tissue necrosis. In a reaction to these [[bacterial]] substances, assembled [[white blood cells]] in this tissue produces anti-bacterial [[Antibodies|anti-bodies]] that help in killing the [[bacteria]]. However, these cells cause damage to the [[soft tissue]] contributing in the [[abscess]] formation.
As the [[breast]] [[abscess]] is the complicated form of [[mastitis]], the pathophysiology is mostly like the [[mastitis pathophysiology]].<ref name="pmid25749135">{{cite journal| author=Kobayashi SD, Malachowa N, DeLeo FR| title=Pathogenesis of Staphylococcus aureus abscesses. | journal=Am J Pathol | year= 2015 | volume= 185 | issue= 6 | pages= 1518-27 | pmid=25749135 | doi=10.1016/j.ajpath.2014.11.030 | pmc=4450319 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25749135  }} </ref>
===Pathogenesis===
[[Breast abscess]] is the result of underlying [[inflammation]] ([[mastitis]]) in the breast skin. [[Injury]] may happen either during the [[lactation]] process from the infant or in the [[non-lactaion]] state of the patient as a cracking in the [[breast]] [[skin]]. This injury accelerates the entry of the causative [[bacteria]] which by its role form the [[abscess]]. <ref name="pmid24465097">{{cite journal| author=Kataria K, Srivastava A, Dhar A| title=Management of lactational mastitis and breast abscesses: review of current knowledge and practice. | journal=Indian J Surg | year= 2013 | volume= 75 | issue= 6 | pages= 430-5 | pmid=24465097 | doi=10.1007/s12262-012-0776-1 | pmc=3900741 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24465097  }} </ref><br>In neglected cases, there may be [[necrosis]] in the abscess location leads to [[fibrosis]], scarring and [[nipple retraction]].


*'''Lactational''':
==[[Breast abscess causes|Causes]]==
**Injured [[breast]] skin allows the entrance of the [[bacteria]] to the mammillary [[ducts]]. This [[bacteria]] can be from the infant or the mother herself. Overproduction of the breast milk with no flow to the infant forms an opportunistic field for the bacteria to cause [[infection]].<ref name="pmid11892876">{{cite journal| author=Marchant DJ| title=Inflammation of the breast. | journal=Obstet Gynecol Clin North Am | year= 2002 | volume= 29 | issue= 1 | pages= 89-102 | pmid=11892876 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11892876  }} </ref>
**[[Duct ectasia of breast|Breast Duct Ectasia]]: [[Metaplasticity|Metaplastic]] change of the duct cells can cause [[Duct ectasia of breast|duct ectasia]]. This change causes widening of the ducts lining which leads to thickening of the ducts and obstruction. The ducts become filled with fluid which leads to [[nipple discharge]] and [[infection]] by the entrance of the bacteria and can form [[pus]] and [[abscess]] as a final result. <ref name="pmid4041720">{{cite journal| author=Bundred NJ, Dixon JM, Lumsden AB, Radford D, Hood J, Miles RS et al.| title=Are the lesions of duct ectasia sterile? | journal=Br J Surg | year= 1985 | volume= 72 | issue= 10 | pages= 844-5 | pmid=4041720 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4041720  }} </ref>


*'''Non-Lactional''':
==[[Breast abscess differential diagnosis|Differentiating Breast abscess from other Diseases]]==
**Non lactational breast abscess is less common than lactational form. It can be subgrouped into central, peripheral and skin associating.
**Cracking in the skin will overtly help the bacteria to enter and form the abscess.


===Associated Diseases===
==[[Breast abscess epidemiology and demographics|Epidemiology and Demographics]]==
There is no associated diseases with breast abscess.


==Causes==
==[[Breast abscess risk factors|Risk Factors]]==
[[Breast abscess]] is a bacterial infectious disease that is caused by many bacterial pathogens and it may also be caused by fungi mostly common [[candida]] through the infant mouth. It is almost caused by the same pathogens causing [[Mastitis (domestic animals)|mastitis.]] To understand the common species causing breast abscess we can classify them into [[Gram positive bacteria|gram +ve]] and [[Gram-negative bacteria|gram -ve]] bacteria. <ref name="pmid20443790">{{cite journal| author=Dabbas N, Chand M, Pallett A, Royle GT, Sainsbury R| title=Have the organisms that cause breast abscess changed with time?--Implications for appropriate antibiotic usage in primary and secondary care. | journal=Breast J | year= 2010 | volume= 16 | issue= 4 | pages= 412-5 | pmid=20443790 | doi=10.1111/j.1524-4741.2010.00923.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20443790  }} </ref><ref name="pmid23345385">{{cite journal| author=Kaneda HJ, Mack J, Kasales CJ, Schetter S| title=Pediatric and adolescent breast masses: a review of pathophysiology, imaging, diagnosis, and treatment. | journal=AJR Am J Roentgenol | year= 2013 | volume= 200 | issue= 2 | pages= W204-12 | pmid=23345385 | doi=10.2214/AJR.12.9560 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23345385  }} </ref><ref name="pmid8268353">{{cite journal| author=Surani S, Chandna H, Weinstein RA| title=Breast abscess: coagulase-negative staphylococcus as a sole pathogen. | journal=Clin Infect Dis | year= 1993 | volume= 17 | issue= 4 | pages= 701-4 | pmid=8268353 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8268353  }} </ref>


{{Family tree/start}}
==[[Breast abscess screening|Screening]]==


{{Family tree | | | | | | | | | | | | | | | | | A01 | | | | | | | | | |  A01= '''Bacterial pathogens causing breast abscess''' }}
==[[Breast abscess natural history, complications, and prognosis|Natural History, Complications, and Prognosis]]==
{{Family tree | | | | | | | |,|-|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|-|.| | | | |}}
{{Family tree | | | | | | | B01 | | | | | | | | | | | | | | | | | | B02 | | | B01= Gram positive | B02= Gram negative }}
{{Family tree | | | | | | | |!| | | | | | | | | | | | | | | | | | | |!| | | | | |}}
{{Family tree | |,|-|-|-|v|-|^|-|v|-|-|-|.| | | | | | | |,|-|-|-|v|-|^|-|v|-|-|-|.| |}}
{{Family tree |boxstyle=text-align: left; | |C01 | | C02 | | C03 | | C04 | | | | | | C05 | | C06 | | C07 | | C08 |C01= [[staphylococcus aureus|Staphylococcus Aureus]] (Most common cause of the lactational [[abscess]])<br> •[[MRSA]] (Became a common pathogen causing the abscess) <br> •[[Coagulase]] negative [[staphylococcus aureus|Staphylococcus Aureus]]| C02= [[streptococcus pyogens|Streptococcus pyogens]]| C03= [[Lactobacillus]] | C04= [[Clostridium]] | C05= [[Veillonella]] | C06= [[Bacteroids]] | C07= [[Escherishia Coli]]| C08= [[Enterobacteria]]| }}
{{Family tree/end}}


==Differentiating Breast abscess from other Diseases==
== Diagnosis ==
[[Breast abscess]] should be differentiated from other diseases that cause swelling in the breast skin. These diseases are like [[mastitis]], [[inflammatory breast cancer]], [[galactocele]], [[plugged duct]], [[Mondor's syndrome]] and [[fibroadenoma]].<ref name="pmid16713771">{{cite journal| author=Greydanus DE, Matytsina L, Gains M| title=Breast disorders in children and adolescents. | journal=Prim Care | year= 2006 | volume= 33 | issue= 2 | pages= 455-502 | pmid=16713771 | doi=10.1016/j.pop.2006.02.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16713771  }} </ref><ref name="pmid23450563">{{cite journal| author=Jahanfar S, Ng CJ, Teng CL| title=Antibiotics for mastitis in breastfeeding women. | journal=Cochrane Database Syst Rev | year= 2013 | volume=  | issue= 2 | pages= CD005458 | pmid=23450563 | doi=10.1002/14651858.CD005458.pub3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23450563  }} </ref> <ref name="pmid24791941">{{cite journal| author=Lam E, Chan T, Wiseman SM| title=Breast abscess: evidence based management recommendations. | journal=Expert Rev Anti Infect Ther | year= 2014 | volume= 12 | issue= 7 | pages= 753-62 | pmid=24791941 | doi=10.1586/14787210.2014.913982 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24791941  }} </ref><ref name="pmid11250736">{{cite journal| author=Kleer CG, van Golen KL, Merajver SD| title=Molecular biology of breast cancer metastasis. Inflammatory breast cancer: clinical syndrome and molecular determinants. | journal=Breast Cancer Res | year= 2000 | volume= 2 | issue= 6 | pages= 423-9 | pmid=11250736 | doi=10.1186/bcr89 | pmc=138665 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11250736  }} </ref><ref name="pmid20603440">{{cite journal| author=Dawood S, Merajver SD, Viens P, Vermeulen PB, Swain SM, Buchholz TA et al.| title=International expert panel on inflammatory breast cancer: consensus statement for standardized diagnosis and treatment. | journal=Ann Oncol | year= 2011 | volume= 22 | issue= 3 | pages= 515-23 | pmid=20603440 | doi=10.1093/annonc/mdq345 | pmc=3105293 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20603440  }} </ref><ref name="pmid1588366">{{cite journal| author=Jaiyesimi IA, Buzdar AU, Hortobagyi G| title=Inflammatory breast cancer: a review. | journal=J Clin Oncol | year= 1992 | volume= 10 | issue= 6 | pages= 1014-24 | pmid=1588366 | doi=10.1200/JCO.1992.10.6.1014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1588366  }} </ref><ref name="pmid17126205">{{cite journal| author=Indelicato DJ, Grobmyer SR, Newlin H, Morris CG, Haigh LS, Copeland EM et al.| title=Delayed breast cellulitis: an evolving complication of breast conservation. | journal=Int J Radiat Oncol Biol Phys | year= 2006 | volume= 66 | issue= 5 | pages= 1339-46 | pmid=17126205 | doi=10.1016/j.ijrobp.2006.07.1388 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17126205  }} </ref><ref name="pmid21855258">{{cite journal| author=Belleflamme M, Penaloza A, Thoma M, Hainaut P, Thys F| title=Mondor disease: a case report in ED. | journal=Am J Emerg Med | year= 2012 | volume= 30 | issue= 7 | pages= 1325.e1-3 | pmid=21855258 | doi=10.1016/j.ajem.2011.06.031 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21855258  }} </ref><ref name="pmid11566698">{{cite journal| author=Shetty MK, Watson AB| title=Mondor's disease of the breast: sonographic and mammographic findings. | journal=AJR Am J Roentgenol | year= 2001 | volume= 177 | issue= 4 | pages= 893-6 | pmid=11566698 | doi=10.2214/ajr.177.4.1770893 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11566698  }} </ref><ref name="pmid23959419">{{cite journal| author=Kadioglu H, Yildiz S, Ersoy YE, Yücel S, Müslümanoğlu M| title=An unusual case caused by a common reason: Mondor's disease by oral contraceptives. | journal=Int J Surg Case Rep | year= 2013 | volume= 4 | issue= 10 | pages= 855-7 | pmid=23959419 | doi=10.1016/j.ijscr.2013.07.026 | pmc=3785854 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23959419  }} </ref>


{|
[[Breast abscess history and symptoms|History and Symptoms]] | [[Breast abscess physical examination|Physical Examination]] | [[Breast abscess laboratory tests|Lab Tests]] | [[Breast abscess other diagnostic studies|Other Diagnostic Studies]]
|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Diseases
! colspan="2" |Laboratory Findings
! colspan="3" |Physical Examination
! colspan="8" |History and Symptoms
! rowspan="2" |Other Findings
|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Culture of the discharge
!Biopsy
!Breast tenderness
!Skin induration
!Cordlike vein appearance
!History of trauma
!Nipple retraction
!Nipple discharge
!Erythema
!Fever
!Warmth
!Lymphadenopathy
!Itching
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Breast abscess
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✘
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✘
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✘
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✘
|style="background: #F5F5F5; padding: 5px;" |✘
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Mastitis
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✘
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |✘
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✘
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✘
|style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Inflammatory breast cancer
| style="background: #F5F5F5; padding: 5px;" |✘
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |✘
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✘
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✘
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |*Peau d' orange appearance of the skin
<nowiki>*</nowiki>Metastasis is common.
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Galactocele
|style="background: #F5F5F5; padding: 5px;" |✘
|style="background: #F5F5F5; padding: 5px;" |✘
|style="background: #F5F5F5; padding: 5px;" |✘
|style="background: #F5F5F5; padding: 5px;" |✘
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |✘
|style="background: #F5F5F5; padding: 5px;" |✘
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✘
|style="background: #F5F5F5; padding: 5px;" |✘
|style="background: #F5F5F5; padding: 5px;" |✘
|style="background: #F5F5F5; padding: 5px;" |✘
|style="background: #F5F5F5; padding: 5px;" |✘
|style="background: #F5F5F5; padding: 5px;" |It is differentiated from other masses by US.
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Mondor's syndrome
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✘
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |Retracted breast skin and elevation of the skin may be observed.
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Cellulitis
|style="background: #F5F5F5; padding: 5px;" |✘
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✘
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✘
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Fibroadenoma
|style="background: #F5F5F5; padding: 5px;" |✘
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✘
|style="background: #F5F5F5; padding: 5px;" |✘
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |✘
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |✘
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |*Peau d' orange skin apperance.
<nowiki>*</nowiki>Enlarged veins on the skin
|}


Other differential diagnosis of breast abscess can include:
== Treatment ==
*[[Cystosarcoma phyllodes]]
[[Breast abscess medical therapy|Medical Therapy]] | [[Breast abscess primary prevention|Primary Prevention]] | [[Breast abscess secondary prevention|Secondary Prevention]] |  [[Breast abscess future or investigational therapies|Future of Investigational Therapies]]
*[[Breast cyst]]
*[[Breast carcinoma]]
*[[Lymphangioma]]
*[[Hemangioma]]
*[[Lipoma]]


==Epidemiology and Demographics==
==Case Studies==
Breast abscess is a rare disease that may occur due to improper treatment of the mastitis. There is no significant prevalence concerning the abscess.
[[Breast abscess case study one|Case #1]]


===Incidence===


*The [[incidence]] of [[breast]] [[abscess]] is 3,000-11,000 per 100,000 of patients with [[mastitis]].
{{WH}}
*The incidence of breast abscess is only 100-3,000 per 100,000 of the puerperal patients. <ref name="pmid15663122">{{cite journal| author=Amir LH, Forster D, McLachlan H, Lumley J| title=Incidence of breast abscess in lactating women: report from an Australian cohort. | journal=BJOG | year= 2004 | volume= 111 | issue= 12 | pages= 1378-81 | pmid=15663122 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15663122  }} </ref><ref name="pmid11050577">{{cite journal| author=Whitaker-Worth DL, Carlone V, Susser WS, Phelan N, Grant-Kels JM| title=Dermatologic diseases of the breast and nipple. | journal=J Am Acad Dermatol | year= 2000 | volume= 43 | issue= 5 Pt 1 | pages= 733-51; quiz 752-4 | pmid=11050577 | doi=10.1067/mjd.2000.109303 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11050577  }} </ref>
{{WS}}
 
===Age===
*Patients of all age groups may develop breast abscess.
*Breast abscess is more common observed in the infants and the young more than the elder.
*It is common in neonates with mastitis as approximately 50 percent of the [[neonatal]] patients with mastitis can develop breast abscess.<ref name="pmid23345385">{{cite journal| author=Kaneda HJ, Mack J, Kasales CJ, Schetter S| title=Pediatric and adolescent breast masses: a review of pathophysiology, imaging, diagnosis, and treatment. | journal=AJR Am J Roentgenol | year= 2013 | volume= 200 | issue= 2 | pages= W204-12 | pmid=23345385 | doi=10.2214/AJR.12.9560 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23345385  }} </ref>
 
===Gender===
Breast abscess occurs commonly in women. It is very rare to be developed in men.
 
===Race===
Breast abscess is more prevalent in the african american race.<ref name="pmid19669231">{{cite journal| author=Bharat A, Gao F, Aft RL, Gillanders WE, Eberlein TJ, Margenthaler JA| title=Predictors of primary breast abscesses and recurrence. | journal=World J Surg | year= 2009 | volume= 33 | issue= 12 | pages= 2582-6 | pmid=19669231 | doi=10.1007/s00268-009-0170-8 | pmc=3892669 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19669231  }} </ref>
 
==Risk Factors==
 
===More common risk factors===
*The most important risk factor of breast abscess is trauma.Trauma increases the possibility of the abscess formation as it facilitates the entrance of the causative bacteria into the soft tissue. Trauma can take place by different ways like shaving subareolar hair, piercing of nipple, infant's mouth during breastfeeding and picking [[acne]] [[lesions]].
*Smoking: increases the chances of abscess recurrence.<ref name="pmid20610247">{{cite journal| author=Gollapalli V, Liao J, Dudakovic A, Sugg SL, Scott-Conner CE, Weigel RJ| title=Risk factors for development and recurrence of primary breast abscesses. | journal=J Am Coll Surg | year= 2010 | volume= 211 | issue= 1 | pages= 41-8 | pmid=20610247 | doi=10.1016/j.jamcollsurg.2010.04.007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20610247  }} </ref>
*[[Obesity]]
*[[Diabetes mellitus]]
*[[Duct ectasia of the breast|Duct ectasia of the breast.]]
*[[Local skin infection]]
 
===Less common risk factors===
These risk factors are related more to the non-lactational breast abscess.<ref name="pmid2696229">{{cite journal| author=Benson EA| title=Management of breast abscesses. | journal=World J Surg | year= 1989 | volume= 13 | issue= 6 | pages= 753-6 | pmid=2696229 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2696229  }} </ref>
 
*Insect bites
*Increasing age
*Surgical treatment: increases recurrence rate of the abscess.<ref name="pmid20610247">{{cite journal| author=Gollapalli V, Liao J, Dudakovic A, Sugg SL, Scott-Conner CE, Weigel RJ| title=Risk factors for development and recurrence of primary breast abscesses. | journal=J Am Coll Surg | year= 2010 | volume= 211 | issue= 1 | pages= 41-8 | pmid=20610247 | doi=10.1016/j.jamcollsurg.2010.04.007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20610247  }} </ref>
 
==Natural history, complications and prognosis==
 
===Natural History===
There is no significant natural history regarding the breast abscess. However, the abscess generally if not treated it will burst around its site or necrosis will take place.
 
===Complications===
Complications that can develop in cases of breast abscess are:
 
*[[Milk]] [[fistula]]: A very rare complication that may occur in the lactating patient. It is defined as an opening between the lactiferous duct to the skin causing leakage of the milk on the skin.
*[[Antibioma]]: Chronicity of the breast abscess, a condition that may take place in case of using antibiotics for a long time without surgical drainage of the abscess.
 
===Prognosis===
Breast abscess prognosis is good with treatment but it has a high recurrence rate. In non lactational abscess has a high chance of recurrence (more than 50% of the cases).<ref name="pmid24450694">{{cite journal| author=Kasales CJ, Han B, Smith JS, Chetlen AL, Kaneda HJ, Shereef S| title=Nonpuerperal mastitis and subareolar abscess of the breast. | journal=AJR Am J Roentgenol | year= 2014 | volume= 202 | issue= 2 | pages= W133-9 | pmid=24450694 | doi=10.2214/AJR.13.10551 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24450694  }} </ref>. In the lactational abscess the chance of recurrence is around 35-50% of the cases.<ref name="pmid24519768">{{cite journal| author=Miller AB, Wall C, Baines CJ, Sun P, To T, Narod SA| title=Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomised screening trial. | journal=BMJ | year= 2014 | volume= 348 | issue=  | pages= g366 | pmid=24519768 | doi=10.1136/bmj.g366 | pmc=3921437 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24519768  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24785471 Review in: Evid Based Med. 2014 Oct;19(5):183]  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24842441 Review in: Ann Intern Med. 2014 May 20;160(10):JC7] </ref>
<ref name="pmid22553470">{{cite journal| author=Fahrni M, Schwarz EI, Stadlmann S, Singer G, Hauser N, Kubik-Huch RA| title=Breast Abscesses: Diagnosis, Treatment and Outcome. | journal=Breast Care (Basel) | year= 2012 | volume= 7 | issue= 1 | pages= 32-38 | pmid=22553470 | doi=10.1159/000336547 | pmc=3335354 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22553470  }} </ref>
 
==Diagnosis==
===History and Symptoms===
Breast abscess can be noticed first by the patient like a [[Breast mass causes|breast mass]] or [[lump]]. The patient usually has current breast infection(mastitis) or history of the infection.
In order to get precise diagnosis of breast abscess, these items should be put in consideration:<ref name="pmid23450563">{{cite journal| author=Jahanfar S, Ng CJ, Teng CL| title=Antibiotics for mastitis in breastfeeding women. | journal=Cochrane Database Syst Rev | year= 2013 | volume=  | issue= 2 | pages= CD005458 | pmid=23450563 | doi=10.1002/14651858.CD005458.pub3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23450563  }} </ref> <ref name="pmid24791941">{{cite journal| author=Lam E, Chan T, Wiseman SM| title=Breast abscess: evidence based management recommendations. | journal=Expert Rev Anti Infect Ther | year= 2014 | volume= 12 | issue= 7 | pages= 753-62 | pmid=24791941 | doi=10.1586/14787210.2014.913982 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24791941  }} </ref>
*Local painful breast lump
*History of mastitis
*[[Nipple discharge]]
*Risk factors of the breast abscess like [[trauma]], duct ectasia or insect bites. 
*If lactating patient: breast-feeding history
*If non-lactating history: diabetic history
 
====Most common symptoms====
Breast abscess has a typical abscess symptoms which are:
*[[Fever]] and [[fatigue]]
*[[Erythema|Redness]]
*Warmth
*localized [[swelling]]
*Breast [[Induration|skin induration]]
 
====Less common symptoms====
*Nipple discharge<ref name="pmid16371879">{{cite journal| author=Faden H| title=Mastitis in children from birth to 17 years. | journal=Pediatr Infect Dis J | year= 2005 | volume= 24 | issue= 12 | pages= 1113 | pmid=16371879 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16371879  }} </ref>
*[[Fistula]]
 
===Physical examination===
Patients with breast abscess are remarkable for the [[Tenderness|breast tenderness]], swelling, redness and warmth of the skin.
 
===Laboratory findings===
Breast abscess diagnosis depends only on the clinical manifestations of the abscess not the laboratory findings. However, a culture could be taken from the milk and the [[pus]] just to decide the [[antibiotics]] needed for the treatment.<ref name="pmid18819238">{{cite journal| author=Spencer JP| title=Management of mastitis in breastfeeding women. | journal=Am Fam Physician | year= 2008 | volume= 78 | issue= 6 | pages= 727-31 | pmid=18819238 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18819238  }} </ref>
 
===Electrocardiogram===
There is no significant changes in the [[EKG]] of breast abscess patients.
 
===Chest X ray===
There is no x-ray changes in the chest of breast abscess patients.
 
===CT Scan===
CT scan is not used to diagnose the breast abscess. However, it can be performed to exclude other diseases like breast cancer.
 
===Ultrasound===
*Ultrasonography is an important imaging approach for diagnosis of the breast abscess. It is mainly used to differentiate between the different diseases causing breast lumps. It is also used in abscess needle aspiration guiding.<ref name="pmid15029418">{{cite journal| author=Muttarak M, Chaiwun B| title=Imaging of giant breast masses with pathological correlation. | journal=Singapore Med J | year= 2004 | volume= 45 | issue= 3 | pages= 132-9 | pmid=15029418 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15029418  }} </ref>
*Breast abscess on chest ultrasonography appears like medium sized collections with not well defined margins and may have some areas with increased density.<ref name="pmid22553470">{{cite journal| author=Fahrni M, Schwarz EI, Stadlmann S, Singer G, Hauser N, Kubik-Huch RA| title=Breast Abscesses: Diagnosis, Treatment and Outcome. | journal=Breast Care (Basel) | year= 2012 | volume= 7 | issue= 1 | pages= 32-38 | pmid=22553470 | doi=10.1159/000336547 | pmc=3335354 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22553470  }} </ref>
*There is no vascularity in the US image.
 
[[Image:Breast abscess US.gif|500px|The imaging description]]
 
===Other Imaging Findings===
[[Mammography]] is not indicated to be used in diagnosis of the breast abscess. However, it is strongly recommended in these cases to be used to differentiate between the breast abscess and other breast diseases and [[cancer]].<ref name="pmid12965983">{{cite journal| author=Kerlikowske K, Smith-Bindman R, Ljung BM, Grady D| title=Evaluation of abnormal mammography results and palpable breast abnormalities. | journal=Ann Intern Med | year= 2003 | volume= 139 | issue= 4 | pages= 274-84 | pmid=12965983 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12965983  }} </ref>
 
==Treatment==
Breast abscess treatment regimen includes both abscess drainage (surgically and by aspiration) and antibiotic medical therapy.It is treated mainly surgically through abscess drainage and suction.The patient should be referred immediately to the breast surgeon to start the [[abscess drainage]].<ref name="pmid24465097">{{cite journal| author=Kataria K, Srivastava A, Dhar A| title=Management of lactational mastitis and breast abscesses: review of current knowledge and practice. | journal=Indian J Surg | year= 2013 | volume= 75 | issue= 6 | pages= 430-5 | pmid=24465097 | doi=10.1007/s12262-012-0776-1 | pmc=3900741 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24465097  }} </ref>
 
===Medical therapy===
Medical treatment is important alongside the surgical treatment.Breast abscess is treated with antibiotic medical therapy as a supportive line to the surgical measures and to prevent the abscess recurrance. The choice of the antibiotic medications depends on the pathogen type however, the high possibility of the pathogen to be staphylococcus aureus leads to start the antibiotic medications before the result of the discharge culture.<ref name="pmid17639835">{{cite journal| author=Dixon JM| title=Breast abscess. | journal=Br J Hosp Med (Lond) | year= 2007 | volume= 68 | issue= 6 | pages= 315-20 | pmid=17639835 | doi=10.12968/hmed.2007.68.6.23574 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17639835  }} </ref>.
 
====General measures====
[[Breast abscess]] is painful so providing [[analgesics]] like [[profen]] is indicated to the patients. In order to relieve the [[pain]] and decrease the [[edema]], breast support is indicated also.<ref name="pmid24465097">{{cite journal| author=Kataria K, Srivastava A, Dhar A| title=Management of lactational mastitis and breast abscesses: review of current knowledge and practice. | journal=Indian J Surg | year= 2013 | volume= 75 | issue= 6 | pages= 430-5 | pmid=24465097 | doi=10.1007/s12262-012-0776-1 | pmc=3900741 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24465097  }} </ref>
 
====Lactaitonal breast abscess====
*Preferred regimen: [[Flucloxacillin]] 500 mg BID if there is no allergy to penicillin.
*Preferred regimen: [[Dicloxacillin]] 500 mg PID if there is no allergy to penicillin. 
*Alternative regimen: [[Erythromycin]] 500 mg BID in case of penicillin allergy.
 
====Non lactational breast abscess====
*Preferred regimen: [[Co-amocyclave]] 375 TID if there is no allegy to penicillin.
*Alternative regimen: Combination of [[Erythromycin]] 500 mg BID and [[Metronidazole]] 200 mg TID in case of penicillin allergy.
 
===Surgery===
The first line of breast abscess treatment is US guided needle aspiration and surgical drainage of the abscess.<ref name="pmid24947530">{{cite journal| author=Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL et al.| title=Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. | journal=Clin Infect Dis | year= 2014 | volume= 59 | issue= 2 | pages= 147-59 | pmid=24947530 | doi=10.1093/cid/ciu296 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24947530  }} </ref>
 
====Aspiration====
 
Needle [[aspiration]] is used particularly in the small and medium sized abscesses. It can be US-guided aspiration or without the US. Local anesthesia is required in order to reduce the pain of the abscess location. It is preferred in case the breast skin is not affected with the abscess. This process is preferably done two or three times to ensure that the abscess location is completely clean from all the pus.
 
====Surgical drainage====
 
If there is no response after several times of needle aspiration to the abscess then surgical drainage is the best line of treatment in this case. If there is no response to the surgical drainage then the last line of treatment is to do excision to the lactiferous duct of the affected breast.<ref name="pmid21997989">{{cite journal| author=Trop I, Dugas A, David J, El Khoury M, Boileau JF, Larouche N et al.| title=Breast abscesses: evidence-based algorithms for diagnosis, management, and follow-up. | journal=Radiographics | year= 2011 | volume= 31 | issue= 6 | pages= 1683-99 | pmid=21997989 | doi=10.1148/rg.316115521 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21997989  }} </ref>
 
Abscess surgical drainage is the best line of treatment in these cases:
*The skin is included in the abscess.
*Unresponsive abscess to medical therapy or the aspiration.
*Large abscesses.
 
Video explaining how the breast abscess is drained:
{{#ev:youtube|baG-qBPdeRA}}
 
===Prevention===
Breast abscess prevention depends on the prevention of the risk factors and the patients hygiene specially in the lactating patients:
 
*Patients should be taught to keep the nipple area clean especially if there is injury
*Complete emptying of the breast after feeding the infant in order to prevent milk stasis
*Keep the infant in a good contact during breastfeeding
*Avoid dehydration in the nipple and the surrounding to prevent cracking
*Keep the infant clean
*Infection control through washing hands frequently
*It is advised to continue breastfeeding after the drainage to prevent recurrence and help healing.<ref name="pmid18819238">{{cite journal| author=Spencer JP| title=Management of mastitis in breastfeeding women. | journal=Am Fam Physician | year= 2008 | volume= 78 | issue= 6 | pages= 727-31 | pmid=18819238 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18819238  }} </ref>
 
==References==
{{Reflist|2}}
 
 
{{WS}}{{WH}}


[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Gynecology]]
[[Category:Obstetrics]]
[[Category:Surgery]]
[[Category:Emergency medicine]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]
[[Category:Gynecology]]

Latest revision as of 20:41, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2]
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Synonyms and keywords: Mammary abscess, Zuska's disease, Lactiferous fistula

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