Primary Breast Abscess

Primary Breast Abscess is a localized collection of pus in the breast tissue. Most commonly secondary to unresolved mastitis or cellulitis.

Risk factors for lactational mastitis;

1. Age >30 years
2. First pregnancy
3. Gestation >41 weeks
4. Tobacco use
5. Most common organism- s.aureus
6. Others- s.pyogenes, e.coli, bacteroides spp
7. A recurrent abscess has mixed flora and anaerobes

Clinical features

• Localized painful inflammation
• Fever, malaise
• Fluctuant, tender palpable mass
• May develop 5-28 days following treatment for mastitis

Diagnosis.

1. Clinical
2. Ultrasound- fluid collection
3. Culture for breast milk- for those breastfeeding
4. Blood culture- severe infection

Differential diagnosis

1. For those lactating; – galactocele, plugged duct
2. Other women- inflammatory breast cancer

Management

1. Drainage

1. Ultrasound-guided- recommended if overlying skin is not ischemic
2. Surgical drainage- compromised skin, non-responsive to drainage or antibiotics

2. Antibiotics- cover for S.aureus

Severe infection- vancomycin

No severe infection;

1. Methicillin-susceptible- dicloxacillin or cephalexin. Clindamycin is the alternative
2. Methicillin-resistant- cotrimoxazole or Clindamycin
3. Recurrent abscess- Clindamycin or duct excision
4. In lactation, do milk drainage
5. An abscess is not a contraindication to breastfeeding

Complications

• Milk fistula
• Mammary duct fistula
• Antiboma