Write a Review
x
Feedback General Surgery

Acute and Chronic mastitis

 Types
  • Subareolar
  • Intramammary
  • Retromammary (submammary)

Anatomy of the Breast

Blood supply
  • Anterior intercostal artery – branch of internal thoracic a
  • Lateral thoracic and thoracoacromial a – branch of axillary a
  • Posterior intercostal a – branch form thoracic aorta
Structure

Subareolar mastitis

  • Infection under the areola – due to cracks in nipple
    • Results from infected gland of Montgomery
  • Associated with duct ectasia – causes formation of abscess, sinus, fistula
  • Common in nonlactating women

Clinical features

    • Red, inflamed, oedematous areola with tender swelling underneath
    • Nipple retraction

Differential diagnosis – Paget’s disease of the nipple

Treatment – pus drained under antibiotics through subareolar incision

Intramammary mastitis

Lactational abscess of the breast – seen in lactating women

  • Precipitating factors
    • Cracked/retracted nipple
    • Improper cleaning of the nipple
    • Inadequate milk suckling by baby
    • Infection from the mouth of the baby
  • Mode of infection – initially infection is localised but eventually involves the whole breast
    • Bacteria (S.aureus) enters breast during sucking through cracked nipple
    • S.aureus causes clotting of milk in the blocked duct and multiply
    • Duct gets blocked by epithelial debris or retracted nipple
  • Clinical features
    • Continuous throbbing pain and high fever
    • Diffuse redness, tenderness, warmness, brawny induration
    • Purulent discharged from nipple
  • Differential diagnosis – inflammatory ca of breast
  • Treatment
    • Antibiotics – cephalosporins, flucloxacillin
    • Bromocriptine (dopamine agonist) – stops lactation by suppressing prolactin
    • Repeated US guided aspiration
    • Drainage under general anaesthesia – if mastitis doesn’t resolve with antibiotics in 48 hours
  • Complications
    • Antibioma formation – nontender, hard breast lump with sterile pus inside
    • Sinus formation, skin necrosis, fistula
    • Recurrent infection, bacteraemia, septicaemia

Nonlactational abscess of the breast

  • Occurs in duct ectasia and periareolar infections
  • Organisms – bacteroides, anaerobic streptococci, enterococci
  • Recurrent with tender swelling under the areola
  • Treatment – antibiotics, aspiration, drainage, excision

Retromammary mastitis

  • Due to tuberculosis of intercostals lymph nodes/ribs or suppuration of the intercostals lymph nodes
  • Breast is normal
  • Investigations
    • CXR, FNAC, ESR
    • US of breast and chest wall
    • CT chest
  • Treatment – treat cause; drainage through submammary/retromammary incision

Antibioma

  • If intramammary mastitis is not drained but only treated by ABs, pus localises and becomes sterile with a thick fibrous tissue cover
  • Clinical features
    • Previous history of mastitis treated with ABs
    • Painless swelling, smooth, nontender, hard, fixed to breast tissue
  • Investigations – FNAC, mammography, US breast
  • Treatment – excision and later ABs

Duct ectasia

  • Dilation of lactiferous ducts due to muscular relaxation of duct wall with periductal mastitis
  • ‘plasma cell mastitis’
  • Commonly many ducts involved
Feedback