What is the difference between mastitis and abscess

It is usually associated with lactation 'lactational' or 'puerperal mastitis' , but it can also occur in non-lactating women 'non-lactational mastitis'. A breast abscess is a localized collection of pus within the breast.

It is a severe complication of mastitis, although it may occur without apparent preceding mastitis. Other complications of mastitis can include sepsis, scarring, and recurrent mastitis. In lactating women, milk stasis is usually the primary cause of mastitis. The accumulated milk causes an inflammatory response which may or may not progress to infection. The most common organism associated with infective mastitis in lactating women is Staphylococcus aureus.

Puerperal mastitis leading to breast abscess is often due to infections with Staphylococcus aureus and Streptococcus species. It most commonly occurs within the first 6 weeks of breastfeeding; however, it can occur at any time during breastfeeding.

Predisposing factors include damaged nipple tissue, missing feedings, oversupply of milk, poor attachment by infant, pressure on the breast, maternal stress, or fatigue. Mastitis is a clinical diagnosis. Laboratory tests and diagnostic procedures do not need to be routinely preformed.

Per the WHO report on mastitis, breastmilk culture should be obtained if:. Treatment of mastitis includes counseling, effective milk removal, antibiotics, and symptomatic treatment. Patients need to be reassured that they can continue to breast feed from the affected breast, that it will not affect the baby, and that in fact it will help the breast to recover.

They also need to be counseled on effective milk removal, which is a critical part of treatment. This includes improving latching of the infant, frequent breastfeeding in both frequency and length of feed as required by the infant , and in some cases using hand expression or pumping. Symptomatic treatment includes non-steroidal anti-inflammatory medications and cold compresses. Antibiotics should cover Staphylococcus aureus. First line antibiotics are dicloxacillin mg by mouth four times per day for days or cephalexin mg by mouth three times a day for days.

If patients do not respond to initial treatment, MRSA should be considered, and antibiotics should include trimethoprim-sulfamethoxazole by mouth twice daily for days or clindamycin mg by mouth three times per day for days. Breast abscess can be concurrent with mastitis or an abscess can develop five days to four weeks after a patient has developed mastitis.

It is important to differentiate mastitis in the non-lactating female from inflammatory breast cancer, which is a rare form of breast cancer but can present similarly to mastitis with diffuse erythema and edema of the breast tissue. Mastitis, however, generally causes a fever and responds to antibiotics differentiating it from inflammatory breast cancer.

In a series of 60 patients with recurrent sub-areolar breast abscesses it was found there is a For the emergency physician, if mastitis is detected prior to development of an abscess, outpatient antibiotics with follow up with their ob-gyn or primary care is appropriate. If a patient is non-lactating and does not have systemic symptoms, referring to a breast radiologist or breast surgeon would be appropriate for ensuring this is mastitis and not inflammatory breast cancer.

In the lactating patient with mastitis, if the patient has had symptoms for less than 24 hours, it is reasonable to encourage them to focus on effective removal of milk for a day or two prior to starting antibiotics. However, if there is concern for abscess in either lactating or non-lactating patients, drainage and antibiotics are imperative. Physical exam should include thorough examination of the breast tissue, lymph node exam, assessment of nipple discharge, and skin exam. Bedside ultrasound or formal ultrasound can assist with assessing if there is a breast abscess.

Historically, breast abscesses were treated with incision and drainage, oftentimes at bedside. However, this is invasive and often results in scarring, possible structural damage, and poor cosmetic outcomes. Fine needle aspiration under direct visualization, usually by a breast radiologist, is the preferred method of drainage. Abscesses that are larger than 5 cm, have a large volume of aspirated pus on needle aspiration, or have a significant delay in treatment are risk factors for failure of needle aspiration and may require surgical incision and drainage.

Emergency physicians often do not drain breast abscesses due to the sensitivity of breast tissue and cosmetic concerns. Ideally patients with abscess should be referred to breast radiology or breast surgery for abscess drainage while the emergency room physician starts them on antibiotics, which should include coverage for MRSA.

Case 1: This patient meets sepsis criteria with a heart rate of and temperature of We do not endorse non-Cleveland Clinic products or services. And while mastitis is treatable with antibiotics, some women will develop a full-blown infection known as an abscess. Any nursing mom can get mastitis. It often develops when moms wean their babies too quickly. Other risk factors include being overweight and smoking in case you needed another reason to avoid smoking. You know mastitis has developed into an abscess when you feel a hard, red, fluid-filled mass on your breast that is very painful.

It usually occurs in one breast only. You also develop a high temperature fever and feel like you are coming down with flu. Other symptoms might include muscle pains, headaches and feeling tired and low. A blocked milk duct sometimes occurs in breast-feeding women. A blocked milk duct also causes a painful, swollen area in a breast. The overlying skin is sometimes red and inflamed, but it tends not to be as bad as mastitis and doesn't make you feel unwell.

When you feed your baby, the pain may increase due to the pressure of milk building up behind the blocked duct. A blocked milk duct will usually clear within days and symptoms will then go. However, in some cases a blocked milk duct becomes infected and develops into mastitis. So, some cases of mastitis develop as a complication of a blocked milk duct, but some cases occur without a blockage happening first.

A blocked milk duct may clear more quickly if you feed your baby more often from the affected breast and gently massage your breast towards your nipple while you are breast-feeding. The quickest way to get rid of mastitis is to continue breast-feeding.

Mastitis may need to be treated with a course of an antibiotic. However, a mild case may get better without any medical treatment. If you notice a tender swollen area in your breast when you're breast-feeding, it may be a blocked milk duct or mastitis developing. It may be reasonable to 'see how it goes' over a day or so. However, if your symptoms become worse you should see a doctor.

After talking to you and examining you, they may prescribe an antibiotic. They may suggest that you wait 24 hours before starting the antibiotics, if your symptoms are mild or have only just begun. The mastitis will usually clear within a few days of starting the antibiotic. Occasionally, an abscess may form inside an infected section of breast. An abscess is a collection of pus that causes a firm, red, tender lump.

This is thought to happen to between about 3 and 7 women with mastitis, out of every If this happens to you, you will need to go to hospital for treatment.