Transcript Breast Infection

Breast Infection
Wirsma Arif Harahap
Surgical Oncologist
Oncology Division – Surgery Department
Epidemiology
Affects women between the ages of 18 and 50 years.
In the adult : lactational or nonlactational.
Infection can also affect the skin overlying the breast,
and occurs either as a primary event or secondary to a
lesion in the skin, such as a sebaceous cyst, or a more
generalized condition, such as hidradenitis
suppurativa.
LACTATIONAL INFECTION
 Caused by S. aureus, but it can also be caused by
Staphylococcus epidermidis and Streptococcus
species.
 the patient has a history of a cracked nipple or a skin
abrasion, which results in a break in the body's
defense mechanisms and an increase in the number
of bacteria over the skin ofthe breast.
 bacteria enter the breast through the nipple and
infect poorly draining segments.
Clinical Symptoms
 commonly occurs following a flrst pregnancy in the
first 6 weeks of breast-feeding or during weaning.
 pain, erythema, swelling, tenderness, or systemic
signs of infection. The breast is swollen, tender, and
erythematous; if an abscess is present, a fluctuant
mass with overly- ing shiny, red skin.
 Axillary lym- phadenopathy is not usually a feature.
 Patients can be toxic with pyrexia, tachycardia, and
leukocytosis
Treatment
 Antibiotics given at an early stage usually control the
infection and stop abscess formation.
 > 80% of staphylococci are resistant to penicillin,
flucloxacillin or amoxicillin-clavulanate are given.
 except in patients with a penicillin sensitivity :
erythromycin or clarithromycin is usually effective.
 Tetracycline, ciprofloxacin, and chloramphenicol
should not be used to treat infection in breastfeeding women because they enter breast milk and
may harm the child
 Abcess  aspiration by usg guide.
 a small incision (mini-inci- sion) is made over the point
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of maximal fluctuation, and the pus is drained .
The cavity can be irrigated with local anes- thetic
solution, which produces instant pain relief.
Irrigation is continued daily until the incision site closes.
If the skin overly- ing the abscess is necrotic, the necrotic
skin is excised, which allows the pus to drain.
Breast- feeding should be continued if possible because
this promotes drainage ofthe engorged segment and
helps resolve infection.
Beware : inflamatory cancer
 The infant is not harmed by bacteria in the milk, nor
by flu- cloxacillin, amoxicillin-clavulanate,
ervthromvcin.
or
 Only rarely is it necessary to suppress lactation with
cabergoline in patients with breast infection.
Non Lactational Infection
Nonlactational infections can be
divided into those occurring
centrally in the breast in the
periareolar region and those
affecting peripheral breast tissue
Periareolar lnfection
 Periareolar infection is most commonly seen in
young women; the mean age of occurrence is 32
years, and most are ciga- rette smokers.
 Location : near or beneath nipple areolar complex.
 Assc : nipple retraction.
 Complication : abcess, mammary duct fistula
Peripheral Nonlactational Breast Abscess
 Peripheral nonlactational breast abscesses are less
common than periareolar abscesses and have been
reported to be associated with a variety of under$ing
disease states, such as dia- betes, rheumatoid
arthritis, steroid treatment, and trauma.
 S. aureus is the organism usually responsible, but
some abscesses contain anaerobic organisms.
Tuberculous Mastitis
 tuberculosis more commonly reaches the breast ihrough
lymphatic spread from axillary, mediasti- nal, or cervical
nodes or directly from underlying structures such as the
ribs.
 Tuberculosis predominantly affects women in the latter
part of their childbearing years' An axillary or breast
sinus 1s present in up to 50% of patients.
 The most common presenlation is that of an acute
abscess resulting from infection of an area of tuberculosis
by pyogenic organisms .
 Treatment is with local surgery and antitubercular drug
therapy.
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