Acute & sub-acute

inflammation of the breast

{Presented by

DR. MD. ABDULLAH AL MAMUN

Indoor Medical Officer
Mainamoti Medical College & Hospital
 Bacterial Mastitis
 Commonest variety.
 Usually caused by Staphylococcus aureus.
 Associated with lactation in the majority of cases
& caused by teeth bite of infant.
 May also be associated with ascending infection
from cracked nipple or, sore and may occur in
non-lactating woman.
 Clinical Features
 Presents the classical signs of acute
inflammation.
 Early stage: Cellulitis.

 Late stage:

 Abscess.
 One-quarter breast is involved.
Clinical Features

Figure: Large breast Abscess.

 Investigations

 CBC.
 RBS.

 USG of affected breast if needed guided

aspiration.
 Treatment

 During Cellulitis stage :

 Appropriate antibiotic (Flucloxacillin or,

amoxiclav).
 Feeding from affected side may continue.

 Support of the breast.

 Local heat and analgesia will alleviate pain.

 Treatment
During Abscess Stage:
 Aspiration must be done before make the incision

and pus sent C/S.

 Incision (Radial or, Circum-areolar) & drainage

under GA & breaking down of all loculi with lightly
packed .

 Antibiotic Coverage (Flucloxacillin or, AmoxIclav).

 Regular dressing and follow up.

 Treatment

Figure: Aspiration from breast.

 Treatment

Figure: Radial incision & Circum-areolar incision.

 ANTIBIOMA

 If antibiotic is prescribed in a breast

abscess with out drainage, there is
change of formation of large sterile
edematous brawny swelling known as
ANTIBIOMA which may take many
weeks to resolve.
 It may mimic carcinoma.
CHRONIC
INTERMAMARY

ABSCESS
It is almost similar to antibioma.
 Differentiation from carcinoma can be done by
biopsy and histopathology.

Figure: Intramammary breast abscess.

 TUBERCULOSIS OF
BREAST
 Rare.
 Associated with active pulmonary TB or,

Tubercular cervical adenitis.

 CLINICAL FEATURES

 Commonly occurs in parous women.

 Usually present with multiple abscess and

sinuses.
 Atypical bluish attenuated appearance of the

surrounding skin.
CLINICAL FEATURES

Figure: Tubercular mastitis.

 Investigations


Bacteriological & Histological examinations.
 Treatment
 Anti TB drugs.
 No major surgery without prior histopathology.
 Mastectomy is should be restricted to patients
with persistent residual infection.
 Excision of sinuses and/or, lumps.
 Incision, drainage and curettage of chronic
abscesses.
 ACTINOMYCOSIS

 Rare.
 MONDOR’S DISEASE
 It is thrombophlebitis of superficial veins of breast and
anterior chest wall although it has been encountered in the
arm.

Figure: Mondor’s disease evident in the lateral aspect of the right

breast.
 DUCT ECTASIA
 A dilatation of the breast ducts, which often
associated with peri-ductal inflammation.
 Mean age 33 years.

 Pathogenesis is obscure and more common in

smoker.
 CLINICAL FREATURES

 Nipple discharge (Any color).

 Sub-areolar mass.

 Abscess.

 Mammary Duct Fistula .

 Nipple retraction.
CLINICAL FREATURES

Figure: Subareolar abscess in duct ectasia..

CLINICAL FREATURES

Figure: Mammary fistula originating in a chronic

subareolar abscess.
 Treatment
Exclude malignancy by imaging, FNAC & cervical
biopsy.
Appropriate Sugary:

 Incision & drainage.

 Wide excision.

 Hadfield’s operation.

Appropiate antibiotics (Co-amoxiclav or,

Flucloxacillin & metronidazole).

Similar condition with Granulomatous mastitis.


Thank You For
Your SUPPORT
& Patience
Hearing