Seminar on breast abscess

1. BREAST ABSCESS
PRESENTED BY
Dr. SIDDHIKA NAZEEM SHAIKH

2. Anatomy
o The breast is modified sweat gland, the
shape of the female breast is due to the
fat contain within fibrous septa.
o The breast lies between the skin and
pectoral fascia to which it is loosely
attached.
o It extends from the 2nd to the 6th ribs
and from the lateral border of the
sternum to the mid axillary line.

3. Lymphatic Drainage Of Breast
oLymph From the breast drains into:
1) Axillary Lymph Nodes
2)The internal mammary lymph nodes
3) Some lymph also reaches supraclavicular,
cephalic, posterior ,intercostal
subdiaphgrametic and subperitoneal lymph
nodes.

4. o Axillary Lymph nodes : arranged in
five groups :
o 1. Anterior : present deep to pectoralis
major along the lower border of
pectoralis minor,
o 2. Posterior : present along the
subscapular vessels;
o 3. Lateral : present along the axillary
vein
o 4. Central : present in the axillary fat
o 5 .Apical : present at the apex of the
axilla above pectoralis minor and
along the medial side of the axillary
vein(through which all the other
axillary nodes drain) .

5. Classification of Breast Abscess
Breast abscesses can be
classified into:
1. Subareolar abscess
2. Intramammary abscess
o Lactational
o Non -Lactational
3.Retromammary abscess

6. Subareolar abscess
o It is the infection under the areola due to cracks in the
nipple or areola.
o It results from an infected gland of Montgomery or a
furuncle of the areola. There is blockage of the ducts of
these glands.
o Often it is associated with duct ectasia-causing formation
of abscess, sinus and fistula.
o It is common in nonlactating women.
o Risk factors are – diabetes, smoking, nipple cracks

7. Clinical Features:
o Red, inflamed,
edematous areola with a tender
swelling underneath;
Nipple retraction may develop.
Treatment:
o Under cover of antibiotics pus is drained by
making a subareolar incision.

8. Lactating Abscess
Commonly seen in lactating women. Usually up to 6 months
of lactation period
Precipitating Factors:
Cracked nipple; Retracted nipple ,
Improper cleaning of the nipple ,
Inadequate milk sucking by baby or milk
expression causing stasis ,
Infection from the mouth of the baby Haematoma getting
infected

9. o Staphylococcus aureus is the most common organism but
occasionally staph.epidermidis and streptococci also
implicated.
o Drainage of milk from the affected segment is often reduced
causing stagnant milk to become infected.
Clinical Features
Continuous throbbing pain in the breast and high grade fever.
Diffuse redness, tenderness, warmness and brawny induration in
the breast.
Purulent discharge from the nipple.

10. Non-lactating infection
o It commonly occurs in duct ectasia and periareolar
infections.
o Common organisms are bacteroides, anaerobic
streptococci, enterococci and gram-negative
organisms.
o It is recurrent with tender swelling under the areola.
o It is common in diabetes mellitus and
immunosuppression.

11. Retromammary Abscess
o It is commonly due to tuberculosis of the intercostal
lymph nodes or ribs beneath or suppuration of the
intercostal lymph nodes. Empyema necessitans or
infected hematoma in the chest wall can also be the
cause.
o Presentations: Pain and swelling in the chestwall deep
to breast which is nonmobile.
o Treatment :
Drainage through submammary/retromammary incision

12. Investigations
Breast Ultrasound
o For an erythematous area, ultrasonography helps to
identify an underlying abscess.
o Hypoechoic lesion (abscess)
o Maybe well circumscribed
o Macrolobulated, irregular, or ill defined with possible
septae

13. o Diagnostic needle aspiration drainage
A breast abscess can be drained by needle
aspiration for therapeutic and diagnostic purposes.
Purulent fluid indicate a breast abscess
o FNAC
o Mammogram

14. Management
Lactating abscess
o Treated with flucloxacillin , cephalosprins , or amoxicillin
o If allergic to penicillin, then clarithromycin can be given.
o Established abscess is treated by recurrent aspiration or
incision and drainage.
o Encourage women to breastfeed to promote milk drainage.

15. Non-Lactating abscess
o Treatment is with appropriate antibiotics.
o Abscess are aspirated or incised and drained.
o Recurrent infection is common because the treatment
does not remove the damaged sub areolar duct which
requires total duct excision.

16. Prevention
Primary prevention
o Good breastfeeding habits (e.g., emptying breasts fully
and proper Latching)
o Proper nipple hygiene help to minimize the risk of
developing lactational mastitis.
o Sterile equipment and techniques should be used for
nipple piercing.

17. Secondary Prevention
o Breastfeeding should be encouraged if feasible during
lactation.
o Smoking cessation should also be encouraged, to
minimize the risk of recurrence.
o Mastitis may increase the risk of transmission of HIV
through breastfeeding. Therefore if an HIV-positive
women develop mastitis or an abscess, she should avoid
breast feeding from the affected side while the condition
persists.

18. THANK YOU