QuestionSBA
QuestionChoice
Urgent breast clinic referral would be warranted if there are signs of a breast abscess. A breast abscess would present with a painful swollen lump in the breast, often with a history of recent mastitis
32445
c
Urgent referral to the breast surgery clinic
QuestionChoice
This woman has signs and symptoms consistent with mastitis. First-line management is with reassurance, simple analgesia and encouragement of breastfeeding
32443
a
Encourage breastfeeding and provide simple analgesia
QuestionChoice
It is essential that breastfeeding continues to help prevent stasis of breast milk which can predispose to infection and worsening of symptoms
32446
d
Advise against breastfeeding until symptoms resolve
QuestionChoice
There are no signs that this patient is systemically unwell and in need of hospital admission. Oral antibiotics would be the next step if her symptoms do not respond to conservative management
32447
e
Admit to hospital for IV antibiotics
QuestionChoice
Antibiotics should be prescribed in cases that are likely to be due to infectious mastitis. These include the presence of a nipple fissure, symptoms not improving with continuous milk removal for 12-24 hours and a positive breast milk culture
32444
b
Prescribe oral flucloxacillin
QuestionComment
why wedge shape?
28316
QuestionComment
Possibly trying to confuse us with another question about non lactational mastitis, in which they also have a wedge but needed co amoxiclav instead
60400
User
subscriber
Prolapsed Fissure
User
subscriber
hiney
QuestionComment
What is the significance of the wedge shaped erythema ?
29018
User
subscriber
Guten Morgen Deutschland
QuestionComment
She's got a fever, how is this not infective mastitis?
43723
User
subscriber
Botox Haemophilus
QuestionComment
it doesnt say how long she has had symptoms for which is what guides treatment !!
59515
User
subscriber
Hematoma Gastro
Concept
Chapter
# Summary
 

Mastitis is an inflammation of the breast, often associated with lactation in postpartum women, referred to as puerperal mastitis. Key signs and symptoms include localised pain, tenderness, redness and heat in the breast, along with systemic symptoms such as fever, rigours, myalgia, fatigue, nausea and headache. Diagnosis is primarily clinical. Ultrasound may be used if a breast abscess is suspected. Management strategies focus on reassurance about continued breastfeeding, advice on milk removal, analgesia, antibiotics, and in severe cases, surgical intervention.
 

# Definition
 

Mastitis is the inflammation of the breast tissue, which can be with or without an infection. When associated with lactation in postpartum women, the condition is specified as puerperal mastitis. Alternatively, mastitis can be seen in women who are not breastfeeding.
 

# Epidemiology
 

Non-lactational mastitis is significantly less common than 
 

# Aetiology
 
Mastitis unrelated to pregnancy and breastfeeding is typically due to obstruction of the ducts from cellular debris. This can result in a local inflammatory response in non-infectious mastitis. 

In infectious mastitis, bacteria from the skin can then enter the ducts, causing inflammation and may progress to peri-areolar abscesses. The most common causative pathogen is Staphylococcus aureus. 

Risk factors for non-lactational mastitis include:

- Cigarette smoking
- Nipple rings 
- Diabetes mellitus
- Immunocompromise 
 

# Signs and Symptoms
 

Mastitis diagnosis is primarily clinical, based on characteristic local and systemic symptoms.
 

 -  Localised symptoms: Painful, tender, red, and hot breast.
 -  Systemic symptoms: Fever, rigours, myalgia, fatigue, nausea, and headache.
 -  Additional information: The condition is usually unilateral and tends to present within the first week postpartum.
 

In some cases, mastitis may develop into a breast abscess, manifesting as a fluctuant, tender mass with overlying erythema.
 

# Differential Diagnosis
 

The differential diagnosis for mastitis should include other conditions that also cause breast pain and inflammation:
 

 -  **Breast abscess**: Fluctuant mass, tenderness, overlying erythema, systemic signs of infection.
 -  **Inflammatory breast cancer**: Swelling, skin changes resembling orange peel, nipple inversion, axillary lymphadenopathy.
 -  **Breast engorgement**: Typically bilateral and associated with milk stasis, painful, and tense breasts.
 

# Investigations
 

While the diagnosis of mastitis is primarily clinical, further investigations may be necessary in certain circumstances.
 

 -  Ultrasound: Utilised to identify a potential abscess, appearing as a collection of pus.
 -  Additional information: Early referral to secondary care is vital if an abscess is suspected.
 

# Management
 

Managing mastitis involves multiple strategies:
 

 -  Provide analgesia to manage symptoms (i.e. paracetamol, ibuprofen)
	 -  Warm and cold compresses may also help.
 -  Antibiotics may be considered if acute pain, severe symptoms or symptoms lasting more than 12-24 hours, fever or positive cultures 
	 -  Flucloxacillin or clindamycin for those with penicillin allergy
	 -  Treatment is indicated for 10-14 days.
 -  In cases where the condition does not improve, consider intravenous antibiotics (i.e. vancomycin) or ultrasound to evaluate for the presence of a breast abscess.
 -  Patients may also benefit from antifungal therapy (i.e. nystatin) for concomitant nipple candidiasis 

 
#  Complications
 
Complications of mastitis include:
 
 - Breast abscess
 - Recurrence:
	 - More common if treatment is delayed or too short in duration 
 

# NICE Guidelines
 
[NICE CKS on mastitis and breast abscess](https://cks.nice.org.uk/topics/mastitis-breast-abscess/)

# References

[BMJ Best Practice Mastitis and Breast Abscess](https://bestpractice.bmj.com/topics/en-gb/1084)

[Patient Info Benign Breast Diseas](https://bestpractice.bmj.com/topics/en-gb/1084) 

[NHS Mastitis](https://www.nhs.uk/conditions/mastitis/)
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Mastitis
Topic
55
Breast Disease
6489
Mastitis in breastfeeding women is typically managed with reassurance, analgesia, and continued breastfeeding to promote drainage and healing.
A 25-year-old woman presents to her GP with an 8 hour history of a red and swollen left breast. She is ten weeks post-partum and has been regularly breastfeeding with no complications.

On examination, she has a temperature of 37.6°C and an erythematous and tender left breast. The erythema is noted to extend in a wedge-shaped distribution.

Which of the following is the next best step in management?
a