An inflamed breast abscess is a disease primarily affecting breastfeeding women and very rarely occurs outside the puerperium period. The occurrence of an abscess after the first pregnancy is a predisposing factor for the development of a similar lesion in each subsequent pregnancy.
Breast abscessusually occurs during lactation and is preceded bybreast inflammation . The mechanism of the abscess formation is relatively simple and is related to the disturbed outflow of milk from the dilated milk ducts, in which there is a gradual retention of food. This condition favors the multiplication of pathogens, mainly staphylococci -Staphylococcus aureus . An additional factor contributing to the colonization of bacteria are the open gates of infection - mechanical injuries of the nipple resulting from improper grasping of the breast by the newborn. If an abscess is formed outside the puerperium and is not associated with lactation, it is likely to form on a pre-existing cyst. Inflammations not related to lactation include peripapillary inflammation, nipple fistula or dilatation of the milk ducts. An abscess is nothing more than a fluid reservoir surrounded by a bag, with local inflammation, to which they predispose:
- too long observation of the abscess, without proper therapeutic treatment - delay of antibiotic therapy or too low therapeutic dose or too short duration of drug administration.
- giving up breastfeeding with developed inflammation
- history of inflammatory breast abscess
- the development of inflammation is favored by the persistent blocked outflow from the affected breast
Breast abscess: symptoms
Breast inflammation on the basis of the abscess is usually observed 2-3 weeks after the start of breastfeeding. The characteristic ailments include:
- breast soreness, and on palpation, apart from increased tenderness of the mammary gland, a point hardening with regular contours is palpable
- symptoms of inflammation: excessive heat, redness of the skin in the affected area of the skin
- enlarged and painful adjacent lymph nodes, mainly in the armpit
- general symptoms: general malaise, weakness, fever, tachycardia and elevated markers in laboratory testsinflammation: CRP or ESR, also moderate leukocytosis.
A cystic breast abscess, not related to lactation, gives a clinical picture similar to that observed in the course of breast cancer:
- breast pain not related to menstruation
- leakage of pathological discharge from the nipple
- nipple pulled in
- palpable bump.
These are alarm symptoms, therefore they always require thorough diagnostics.
Breast abscess: diagnosis
The first-line examination when a breast abscess is suspected is ultrasonography. The presence of liquid content in the tank allows it to be punctured and emptied, of course under ultrasound control. The collected material is sent for microbiological examination. Identification of the pathogenic pathogen allows for targeted antibiotic therapy, which undoubtedly speeds up the diagnostic and therapeutic process, and from the patient's point of view, the time to improve is clearly shortened.
Treatment of a breast abscess
Spontaneous recovery of symptoms has been observed very rarely. The mainstay of therapeutic management is antibiotic therapy, usually started before obtaining the result of a microbiological test. The period of breastfeeding is a contraindication to the administration of many antibiotics, therefore the treatment options are very limited. In addition to antibiotic therapy, symptomatic treatment is practiced - non-steroidal anti-inflammatory drugs. In this case, special care should be taken in people with a history of gastric and duodenal ulcer disease, because NSAIDs have a strong ulcerogenic effect.
Occasionally the abscess reservoir is small and the amount of content is negligible. This allows fluid aspiration under ultrasound guidance. The treatment is effective, but requires repetition. Larger abscesses require surgical drainage, performed in an operating room, after local anesthesia. Usually, patients are referred to the hospital for a short hospitalization, during which the abscess is incised and the purulent contents are evacuated. After the procedure, the abscess bed is filled with a filter. It is nothing more than a sterile rubber that successively drains the remnants of pathological secretions. After some time, the filter is removed and the wound is surgically treated (usually requires a single suture). Too sparing an abscess incision increases the likelihood of recurrences.
Worse situation is in the case of abscess and inflammation of the breast beyond the puerperium. Treatment is difficult, it is usually temporary, and relapses are very frequent. Standard in many casesthe abscess incision performed is complicated by the formation of a fistula. The radical procedure is to excise the inflamed tissue, which is then sent for histopathological examination in order to exclude neoplastic changes. Each diagnosed case of a breast abscess should be differentiated from a milk cyst, but above all from an inflammatory or non-inflammatory breast tumor, including breast cancer.