Breast abscess f .pptx

Seminar on breast abscess

1. BREAST ABSCESS PRESENTED BY Dr. SIDD HIK A NAZEEM SHAIKH

2. Anatomy The breast is modified sweat gland, the shape of the female breast is due to the fat contain within fibrous septa . The breast lies between the skin and pectoral fascia to which it is loosely attached. It extends from the 2 nd to the 6 th ribs and from the lateral border of the sternum to the mid axillary line.

3. Lymphatic Drainage Of Breast Lymph From the breast drains into: 1 ) Axillary Lymph Nodes 2)The internal mammary lymph nodes 3) Some lymph also reaches supraclavicular , cephalic , posterior ,intercostal subdiaphgrametic and subperitoneal lymph nodes .

4. Axillary Lymph nodes : arranged in five groups : 1. Anterior : present deep to pectoralis major along the lower border of pectoralis minor, 2. Posterior : present along the subscapular vessels; 3. Lateral : present along the axillary vein 4. Central : present in the axillary fat 5 .Apical : present at the apex of the axilla above pectoralis minor and along the medial side of the axillary vein(through which all the other axillary nodes drain) .

5. Classification of Breast Abscess B r e a st abscesses can be classified into: 1 . Subareolar abscess 2. Intramammary abscess Lactational Non -Lactational 3.Retromammary abscess

6. Subareolar abscess It is the infection under the areola due to cracks in the nipple or areola. It results from an infected gland of Montgomery or a furuncle of the areola. There is blockage of the ducts of these glands. Often it is associated with duct ectasia-causing formation of abscess, sinus and fistula. It is common in nonlactating women. Risk factors are – diabetes, smoking, nipple cracks

7. Clinical Features : Red , inflamed, edematous areola with a tender swelling underneath; Nipple retraction may develop . Treatment : Under cover of antibiotics pus is drained by making a subareolar incision.

8. Lactating Abscess Commonly seen in lactating women. Usually up to 6 months of lactation period Precipitating Factors: Cracked nipple; Retracted nipple , Improper cleaning of the nipple , Inadequate milk sucking by baby or milk expression causing stasis , Infection from the mouth of the baby Haematoma getting infected

9. Staphylococcus aureus is the most common organism but occasionally staph.epidermidis and streptococci also implicated. Drainage of milk from the affected segment is often reduced causing stagnant milk to become infected. Clinical Features Continuous throbbing pain in the breast and high grade fever. Diffuse redness, tenderness, warmness and brawny induration in the breast. Purulent discharge from the nipple.

10. Non-lactating infection It commonly occurs in duct ectasia and periareolar infections. Common organisms are bacteroides, anaerobic streptococci, enterococci and gram-negative organisms. It is recurrent with tender swelling under the areola. It is common in diabetes mellitus and immunosuppression.

11. Retromammary Abscess It is commonly due to tuberculosis of the intercostal lymph nodes or ribs beneath or suppuration of the intercostal lymph nodes. Empyema necessitans or infected hematoma in the chest wall can also be the cause. Presentations : Pain and swelling in the chestwall deep to breast which is nonmobile . Treatment : Drainage through submammary / retromammary incision

12. Investigations Breast Ultrasound For an erythematous area, ultrasonography helps to identify an underlying abscess . Hypoechoic lesion (abscess) M aybe well circumscribed Macrolobulated, irregular, or ill defined with possible septae

13. Diagnostic needle aspiration drainage A breast abscess can be drained by needle aspiration for therapeutic and diagnostic purposes. Purulent fluid indicate a breast abscess FNAC Mammogram

14. Management Lactating abscess Treated with flucloxacillin , cephalosprins , or amoxicillin If allergic to penicillin, then clarithromycin can be given. Established abscess is treated by recurrent aspiration or incision and drainage. Enc ourage women to breastfeed to promote milk drainage.

15. Non-Lactating abscess Treatment is with appropriate antibiotics . Abscess are aspirated or incised and drained. Recurrent infection is common because the treatment does not remove the damaged sub areolar duct which requires total duct excision.

16. Prevention Primary prevention Good breastfeeding habits (e.g ., emptying breasts fully and proper Latching) P roper nipple hygiene help to minimize the risk of developing lactational mastitis. Sterile equipment and techniques should be used for nipple piercing.

17. Secondary Prevention Breastfeeding should be encouraged if feasible during lactation. Smoking cessation should also be encouraged, to minimize the risk of recurrence. Mastitis may increase the risk of transmission of HIV through breastfeeding. Therefore if an HIV-positive women develop mastitis or an abscess, she should avoid breast feeding from the affected side while the condition persists.

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