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.

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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.