Breast Infection

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Breast Infection
Wirsma Arif Harahap Surgical Oncologist Oncology
Division Surgery Department
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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.

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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.

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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

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Treatment

• Antibiotics given at an early stage usually
  control the infection and stop abscess formation.
  
• gt 80 of staphylococci are resistant to
  penicillin, flucloxacillin or amoxicillin-clavulan
  ate 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
  breast-feeding women because they enter breast
  milk and may harm the child

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• Abcess ? aspiration by usg guide.
• a small incision (mini-inci- sion) is made over
  the point 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

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• The infant is not harmed by bacteria in the milk,
  nor by flu- cloxacillin, amoxicillin-clavulanate,
  or ervthromvcin.
• Only rarely is it necessary to suppress lactation
  with cabergoline in patients with breast
  infection.

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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

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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

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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
  undering 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.

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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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Thank You