Nonlactating Breast Infection

Periareolar infection occurring in patients with periductal mastitis has already been described. This infection is usually central and subareolar.

Peripheral breast abscesses can occur in patients with other systemic conditions such as diabetes, steroid therapy and rheumatoid arthritis. The clinical presentation, diagnosis and management are similar to those for a lactational breast abscess.

It should be noted that the organisms cultured from nonlactational peripheral abscesses include alpha-hemolytic streptococci and a variety of gram-positive and gram-negative anaerobic bacteria. It is therefore useful to obtain cultures of aspirated pus and commence the patient on appropriate antibiotic therapy with incision and drainage if necessary.

Peripheral non-lactating breast infection
Infections affecting peripheral portions of the breast are uncommon, but when they occur they are often associated with a pre-existing condition such as diabetes, rheumatoid arthritis, steroid treatment and trauma. Infections may also occur as part of a condition known as granulomatous lobular mastitis.

Pilonidal abscesses may also affect the breasts, particularly in sheep shearers and hairdressers.

Infective organisms may be aerobic or anaerobic and include Staphylococcus aureus, Enterococci, Anaerobic streptococci and Bacteroides species.

As with other breast infections antibiotics should be prescribed, and if there are abscesses these should be recurrently aspirated or incised and drained.

Granulomatous lobular mastitis
This is a condition affecting young parous women, and is characterized by the formation of multiple peripheral abscesses in the breast. There may be large areas of infection.

It is a chronic inflammatory condition which may be due to TB, sarcoidosis, Wegener’s granulomatosis, or mammary duct ectasia.

It is difficult to treat as the condition tends to recur, and therefore extensive surgery should be avoided.

Periareolar non-lactating breast infection
This is a condition where non-dilated subareolar breasts ducts become infected. It most commonly affects young women, with a mean age of 32 years.

The condition may present with periareolar inflammation, and the breast may be tender. There may be a history of nipple discharge and on examination the nipple may be retracted and there may be an associated inflammatory mass or abscess.

References

1. Roberts MM, Elton RA, Robinson SE et al. Consultations for breast disease in general practice and hospital referral patterns. Br J Surg 1987; 74:1020-1022.
2. Cochrane RA, Singhal H, Monypenny IJ et al. Evaluation of general practitioner referrals to a specialist breast clinic according to the UK national guidelines. Eur J Surg Oncol 1997; 23:198-201.
3. Hughes LE, Mansel RE, Webster DJT. Aberrations of normal development and involution (ANDI): A new perspective on pathogenesis and nomenclature of benign breast disorders. Lancet 1987; 2:1316-1319.
4. Minton JP, Foecking MK, Webster DJ et al. Response of fibrocystic disease to caffeine withdrawal and correlation of cyclic nucleotides with breast disease. Am J Obstet Gynecol 1979; 135:157-158.
5. Boyd NF, McGuire V, Shannon P et al. Effect of a low-fat high-carbohydrate diet on symptoms of cyclical mastopathy. Lancet 1988; 2:128-32.
6. Horrobin DF. The effects of gamma-linolenic acid on breast pain and diabetic neuropathy: possible noneicosanoid mechanisms. Prostaglandins Leuko Essent Fatty Acids 1993; 48:101-104.
7. ...

Complete References

A.D. Purushotham, P. Britton and L. Bobrow
A prospective study of benign breast disease and the risk of breast cancer. JAMA 2002

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Hereditary Breast Cancer   Tumor-related factors   Curative Treatment   Breast Cancer & Risks of Pregnancy   Periductal Mastitis   Quality Assurance   Benign Breast Diseases: Classification, Diagnosis, and Management   Angiogenesis of Early Breast Lesions   Conclusion - Biology of High Risk Benign Breast Lesions   Radial Scar   Clinical Clues to Early Detection of Breast Cancer   Mastodynia   Surgery for Pure DCIS   Nipple Discharge   Complications of Axillary Dissection   Evaluation of Breast Cancer Screening   Abnormal Vaginal Bleeding and breast cancer   Hereditary Breast Cancer and the Identification of BRCA1 and BRCA2   Probability of Detecting Mutations in BRCA1 or BRCA2   Sclerosing Adenosis   HRT After Diagnosis and Treatment of Breast Cancer   Breast Cancer Differential Diagnosis

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To minimize your chances of future breast infections, follow the general guidelines listed above and be sure to wash your hands thoroughly before you touch your breasts. It is very easy to go from a diaper change into nursing, but you must be very careful to wash your hands completely in-between.

posted by Breast on 03/18/2010 at 11:51 pm -08:00